Veteran Mental Health Research Articles

Rationale and Methodology of the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS): A 16-year Follow-up Survey: Raison D'être Et Méthodologie De L'enquête De Suivi Sur La Santé Mentale Des Membres Des Forces Armées Canadiennes Et Des Anciens Combattants, 2018 (ESSMFACM).

Objective:Knowledge is limited regarding the longitudinal course and predictors of mental health problems, suicide, and physical health outcomes among military and veterans. Statistics Canada, in collaboration with researchers at the University of Manitoba and an international team, conducted the Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Herein, we describe the rationale and methods of this important survey.Method:The CAFVMHS is a longitudinal survey design with 2 time points (2002 and 2018). Regular Force military personnel who participated in the first Canadian Community Health Survey Cycle 1.2—Mental Health and Well-Being, Canadian Forces Supplement (CCHS-CFS) in 2002 (N = 5,155) were reinterviewed in 2018 (n = 2,941). The World Mental Health Survey–Composite International Diagnostic Interview was used with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria.Results:The CAFVMHS includes 2,941 respondents (66% veterans; 34% active duty) and includes data on mental disorder diagnoses, physical health conditions, substance use, medication use, general health, mental health services, perceived need for care, social support, moral injury, deployment experiences, stress, physical activity, military-related sexual assault, childhood experiences, and military and sociodemographic information.Conclusions:The CAFVMHS provides a unique opportunity to further understand the health and well-being of military personnel in Canada over time to inform intervention and prevention strategies and improve outcomes. The data are available through the Statistics Canada Research Data Centres across Canada and can be used cross-sectionally or be longitudinally linked to the 2002 CCHS-CFS data.

Barriers and facilitators of videoconferencing psychotherapy implementation in veteran mental health care environments: a systematic review

BackgroundWhilst treatment for mental health issues has traditionally been conducted in-person, advances in technology has seen a recent growth in the use of online video therapy services to help overcome access-to-care barriers faced by those living in rural locations and those unable to travel. These barriers are particularly apparent in the case of veteran populations, which is the focus of this review. Whilst the research investigating the efficacy of online video therapy to treat mental health issues among veterans is promising, widespread adoption and utilisation of this modality remains low with efforts often failing to progress past the pilot phase to implementation. This review focuses on the implementation of online video therapy in veteran mental health care settings and aims to identify the potential barriers and facilitators relevant to implementing the modality in military organisations.MethodsA systematic search of three databases (PsycInfo, PubMed, and Web of Science) was conducted. To be eligible for inclusion, studies had to investigate the challenges, lessons learnt, or factors operating as barriers and/or facilitators to the implementation of online video therapy in veteran health care systems.ResultsThe initial search revealed a total of 202 articles. This was reduced to 133 when duplicates were removed. After screening the titles and abstracts a further 70 articles were excluded leaving 63 to be retrieved for full review. A total of 10 studies were included in this review. The most commonly reported barriers were related to clinician concerns, logistical problems, and technology. Other barriers included access to resources as well as challenges posed by collaborations, policy and recruitment. Facilitators included experience using the modality and having dedicated staff responsible for promoting and managing the new service (e.g., on-site champions and telehealth technicians).ConclusionsThis review suggests that numerous barriers must be identified and addressed before attempting to implement an online video therapy service in veteran organisations. Further research is needed to establish best practice for implementation, particularly across geographically dispersed sites. It is hoped that the findings of this review will be used to help inform future implementation efforts and research initiatives in this space.

Military moral injury: A concept analysis.

Moral injury is the current term describing the breaching or violation of one's moral code and has gained international research attention due to suicide linkages in military populations (Jamieson et al., Invisible wounds and suicide: Moral injury and veteran mental health. International Journal of Mental Health Nursing, 29, 105-109, 2020). Moral injury's core features are spiritual/existential conflict, shame, guilt and self-condemnation. To date, research focuses on the core features of moral injury and or the nature of events that exposed individuals to moral injury. Walker and Avant (Strategies for Theory Construction in Nursing, Prentice Hall New York, 2011) concept analysis model was used to examine the literature. The aim of this study is to enhance understanding of the defining attributes, antecedents, consequences and empirical referents of moral injury and systematically analyse the concept of moral injury in the context of military members. A literature search was undertaken using specific websites and journals, electronic databases, library catalogues and hand-searches. Concept analysis was used to explicate moral injury, focusing exclusively on use of the concept in the included literature, comparing the terms used over time and across disciplines, and measurement tools for the concept. This concept analysis provides a renewed definition of moral injury in relation to the experience of veterans - 'moral trauma' and defined as: 'the existential, psychological, emotional and or spiritual trauma arising from a conflict, violation or betrayal, either by omission or commission, of or within one's moral beliefs or code(s)'. The analysis will facilitate understanding and operationalization of the concept applied to teaching, learning, practice and research.

Congress adopts bipartisan legislation to boost mental health care in VA

Not long ago, passage of comprehensive federal legislation to strengthen mental health services at the U.S. Department of Veterans Affairs (VA) would have been seen as having little impact on community mental health providers outside of the VA. Now that closer collaboration among the various entities that serve veterans has become more common, the newly adopted Commander John Scott Hannon Veterans Mental Health Care Improvement Act is being welcomed as an important initiative for local communities.

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans\u2019 health study

BackgroundThe majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.MethodsVeterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.ResultsA total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education).ConclusionsRural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

Associations of warzone veteran mental health with partner mental health and family functioning: Family Foundations Study

Warzone participation is associated with increased risk of stress-related psychopathology, including posttraumatic stress disorder (PTSD) and depression. Prior research suggests that the mental health of spouses of warzone veterans (WZVs) is linked to that of their partners. Additionally, PTSD among WZVs has been associated with marital dysfunction. Less is known about the effects of depression among WZVs on partner mental health and family relationships. We sought in this study to examine associations between WZV PTSD and depression and partner mental health and relationship outcomes. Using a nationally dispersed sample of Iraq and Afghanistan veterans and their married and unmarried intimate partners, 245 dyads completed structured psychiatric interviews and psychometric surveys assessing family functioning and relationship aggression. Adjusted regression analyses indicated that depression among WZVs was associated with partner depression and anxiety disorders. WZV PTSD and depression were also associated with partner-reported relationship dysfunction, dissatisfaction, and communication issues, and higher rates of intimate partner aggression victimization and perpetration. Mental health consequences of war extend beyond WZVs to the mental health of their intimate partners and their relationships with intimate partners.

Religiosity and veteran mental health compared with non-veterans.

While the potential buffering effects of spirituality are well established in the general population, how spirituality affects those in extremely high-stress occupations like the military and law enforcement is less clear. This paper explores the possibility that spiritual influences may operate differently among military veterans than other people. It specifically proposes that attendance at religious services is an especially important buffer for combat veterans. This study engaged in a secondary analysis of 74 480 respondents from the National Survey on Drug Use and Health for the years 2013-17. The respondents were split into four groups; veterans with combat experience before September 2001, veterans with combat experience since September 2001, veterans with no combat experience and non-veterans. The likelihood of mental illness decreased in the general population along three different measures of religion; the importance of religion, friendships that shared religious beliefs and attendance at religious services. The relationship was weak and disappeared when controls for non-religion variables were included. A major exception was combat veterans, for whom the religious effects were limited to attendance at services, and the effect survived with the addition of non-religion control variables. Mental health professionals, chaplains, pastoral counsellors and clergy need to recognize that among the therapeutic benefits of religious attendance and recognize the value of the religious rituals as ends in themselves.

Affirmative Dialectical Behavior Therapy Skills Training With Sexual Minority Veterans

Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans’ experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group.

Using VR-based interventions, wearable technology, and text mining to improve military and Veteran mental health

Introduction: Virtual reality (VR)-based interventions, wearable technology and text mining hold promising potential for advancing the way in which military and Veteran mental health conditions are diagnosed and treated. They have the ability to improve treatment protocol adherence, assist in the detection of mental health conditions, enhance resilience and increase a patient’s motivation to continue therapy. Methods: This article explores five cutting-edge research projects designed to leverage VR-based interventions, wearable technology, and text mining to improve military and Veteran mental health. A computer-animated virtual agent provides online coaching for posttraumatic stress disorder (PTSD) patients in their own homes to enhance treatment compliance. A head-mounted display safely immerses PTSD patients in a virtual world to relive past experiences and associate them with new meanings. Gaming and simulation technology are tested as a way to improve resilience and performance in military members in deployment-related scenarios. Guidelines are developed for the creation of wearable assistive technology for military members and Veterans. Text mining is explored as a way to assist in the detection of PTSD. Results: VR-based therapy, gaming and simulation, wearable assistive and sensory technology, and text mining hold promise for diagnosing, monitoring, and treating military mental health conditions. Discussion: The five research projects presented have made promising contributions to the field of military and Veteran mental health, either by advancing diagnostic trajectories, contributing to therapy or enhancing the process by developing new approaches to delivering preventive or curative care.

Reducing Veterans’ Symptoms of Depression, Anxiety, Stress, and Posttraumatic Stress, and Enhancing Engagement in Occupations with SCUBA Diving and Occupational Therapy

Veterans face significant occupational and mental health challenges. This article explores whether an occupational therapy program in combination with SCUBA diving can enhance occupational performance and mental health outcomes for veterans more than SCUBA diving alone. A two-group random assignment pretest–posttest design was implemented to compare outcomes across two groups. Veterans in Group 1 (n = 7) completed SCUBA diving while those in Group 2 (n = 8) completed SCUBA diving in combination with occupational therapy. Outcomes were measured using the Canadian Occupational Performance Measure, PTSD Checklist for DSM-5, and the Depression, Anxiety and Stress Scale. Both groups participated in a semi-structured focus group post-participation. Additionally, those in Group 2 engaged in follow-up phone interviews. Trial registration number: NCT03928392. All participants significantly improved their occupational performance and satisfaction with performance, and reduced symptoms of PTSD, depression and stress. Those in Group 2 also experienced significant reductions in anxiety levels and reported applying learned interventions to daily life. Participating in SCUBA diving may contribute to reduced symptoms of PTSD, depression and stress among veterans. Engaging in occupational therapy may additionally contribute to reduced symptoms of anxiety and aid in therapeutic application of interventions to daily life.

Australian military and veteran's mental health care part 1: an introduction to cultural essentials for clinicians.

This article aims to define the cultural specificity of Australian military and veterans, and introduce some of the essential clinician knowledge, skills and attitudes required for effective cultural competence in the management of mental health (MH) conditions in this population. Military culture has the defining characteristics of the military as an organisation with a formal structure, as a cultural group governed by norms and shared values, and as a social group that provides people with identities. Key requirements for cultural competence introduced here are basic knowledge of the military structure, norms and identity; clinical skills including basic assessment and awareness of the commonly occurring MH disorders; and an exploration of attitudes of both the clinician and the military or veteran patient. Further research is needed, particularly in terms of assessing clinician's cultural competence.

Factors contributing to the effective functioning of veterans mental health councils.

Veterans Mental Health Councils (VMHCs) have been established at many Veterans Affairs (VA) medical centers to promote recovery and improve mental health services. Though research shows that consumer-led advisory councils may produce a number of positive outcomes, the aspects of implementation critical for VMHC effectiveness have not been identified. The purpose of this study was to identify factors influencing effective functioning of VMHC, including contextual factors affecting council success. A key goal was to understand how participants defined effective council functioning. In-depth semistructured phone interviews were conducted with 15 council members and VA-employed staff liaisons sampled purposively from a broader group of volunteer participants. Inductive and iterative grounded theory analytic techniques were used to identify influential structural and process elements. Findings suggested that characteristics of council members, staff liaisons, and VA medical centers interact over time to shape council implementation and the effective functioning of councils along two dimensions-setting and accomplishing council goals and supporting recovery among members. VMHCs can develop members and improve the quality of VA mental health services when they are well implemented and supported. Mental health clinicians and supervisors can support councils in several ways. Additional research is needed to explore contextual differences in councils and to quantify the value added to VA mental health services by effective VMHCs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Enhancing the Capacity of the Australian Health Care Workforce to Support Veterans’ Mental Health: A Collaborative Interdisciplinary Approach

Abstract Introduction Military personnel and veterans can have higher rates of mental health problems than the general population, but are no more likely to receive appropriate mental health care. A lack of experience among Australia’s mental health workforce in treating veteran-specific issues has been identified, pointing to a need for strategies to strengthen the workforce capacity. To this end, the Department of Veteran’s Affairs joined with the Mental Health Professionals Network (MHPN) to produce and deliver a series of veteran-specific webinars for health professionals working with military personnel, veterans and their families. Materials and Method Five webinars were produced and delivered between August 2016 and July 2017. Each involved a panel of health professionals with content expertise and was facilitated by a nationally recognized expert in veteran mental health. Each webinar was evaluated using an online survey to address whether learning needs were achieved, likely improvements to work practice, and improvements in knowledge of and confidence in treating veteran mental health issues. Results Of the 5,127 attendees across the five webinars, registration data was collected for 4,809 (94%) and post-webinar data for 3,334 (70%) of registrants. Of these, over 90% indicated that their learning objectives were achieved, that the content was relevant to their practice, and that their work practices would be improved as a result of their participation. Further, almost three quarters reported increased knowledge and skills, and two-thirds increased confidence in treating veterans’ mental health needs. Conclusions The Veterans’ webinar series was effective in engaging a large number and a wide range of professionals working in mental health care in Australia, underscoring the strength of MHPN’s initiatives in terms of scale and reach. With its emphasis on interdisciplinary practice and collaborative care, MHPN is well-placed to continue to support Australia’s mental health workforce.

A Pilot Trial of Online Training for Family Well-Being and Veteran Treatment Initiation for PTSD.

Family members are important supports for veterans with Posttrauamtic Stress Disroder (PTSD), but they often struggle with their own distress and challenges. The Veterans Affairs-Community Reinforcement and Family Training (VA-CRAFT) website was designed to teach family members of veterans with PTSD effective ways to interact with their veterans to encourage initiation of mental health services as well as to care for themselves and improve their relationships. This article presents a pilot investigation of VA-CRAFT. Spouse/partners of veterans who had screened positive for PTSD but were not in mental health treatment were randomized to either use the VA-CRAFT website (n=22) or to a waitlist control condition (n=19) for 3months. Veteran mental health service initiation was assessed posttreatment. Spouse/partner distress, caregiver burden, quality of life, and relationship quality were assessed pre and posttreatment. The study was approved by the Minneapolis VA Health Care System Institutional Review Board (IRB). Differences between groups on veteran treatment initiation were small (Phi=0.17) and not statistically significant. VA-CRAFT participants reported large and statistically significantly greater decreases in overall caregiver burden (η2=0.10) and objective caregiver burden (η2=0.14) than control participants. Effects were larger for those with greater initial distress. Effects sizes for other partner outcomes were negligible (η2=0.01) to medium (η2=0.09) and not statistically significant. Postintervention interviews suggested that only 33% of the VA-CRAFT participants talked with their veterans about starting treatment for PTSD during the trial. Results from this pilot trial suggest that VA-CRAFT holds initial promise in reducing caregiver burden and as such it could be a useful resource for family members of veterans with PTSD. However, VA-CRAFT does not enhance veteran treatment initiation. It may benefit from enhancements to increase effectiveness and caregiver engagement.

Does the physical and mental health of veterans differ by military branch?

The purpose of this study was to examine the relationship between health behaviors and their levels of positive and negative affect and determine the overall level of physical health and mental health among members of the armed forces. Overall, the results showed that veterans in the Army, Navy and Marines are more often than members who are in the Air Force to be deployed. Members in the Army, Navy and Marines also experience higher levels of reported cases of PTSD, higher levels of negative affect (i.e. anxiety), a lower health composite score and report poorer perception of their own health. This study also showed that veterans of the Air Force had a stronger emphasis on their physical health which resulted in higher levels of positive affect (excited about life). Limitations and future directions of this research are discussed.

Video-Enabled Tablets Improve MH Access for Veterans

Back to table of contents Previous article Next article Clinical & ResearchFull AccessVideo-Enabled Tablets Improve MH Access for VeteransTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:19 Sep 2019https://doi.org/10.1176/appi.pn.2019.9b4AbstractPsychotherapy appointments increased among veterans who received tablets as part of a Veterans Health Administration program.A Veterans Health Administration program that provides video-enabled tablets to veterans who live in rural areas, lack transportation, or face other barriers to care improves both access to mental health care and continuity of care, a study in Psychiatric Services in Advance has found.iStock/WavebreakmediaJosephine C. Jacobs, Ph.D., a health economist at the VA Health Economics Resource Center in Menlo Park, Calif., and colleagues compared the health records of 728 patients who received a tablet between May 2016 and September 2017 with those of 1,020 patients in a control group who did not receive a tablet. All patients had at least one mental health condition.On average, tablet recipients participated in two additional psychotherapy appointments in the six months after receiving the devices, whereas psychotherapy visits declined for those in the control group. Tablet recipients had more encounters with mental health professionals regarding medications, were more likely to have participated in at least three psychotherapy visits in a six-week period (a measure of continuity of care), and missed or canceled a smaller proportion of their scheduled appointments than participants in the control group. There were no significant differences between the two groups in number of emergency department or urgent care visits.“Virtual care may be appealing when veterans feel anxious in the VA setting or when they have other health issues that make it difficult to attend appointments in person.” —Donna Zulman, M.D., M.S.“Mental health care may be particularly well suited to virtual modalities because in most cases therapy does not require a physical exam,” said study researcher Donna Zulman, M.D., M.S., a physician investigator at the Center for Innovation to Implementation in the VA Palo Alto Health Care System.Zulman, an assistant professor in the Division of Primary Care and Population Health at Stanford University, noted the complex medical, mental health, and social challenges that many of the patients included in the analysis face: Approximately 75% of the patients had three or more chronic conditions, more than 31% had at least two mental health diagnoses, and roughly 42% had posttraumatic stress disorder. Furthermore, more than 42% lived in rural areas.Want to Learn More About Military and Veteran Mental Health?APA, in collaboration with the Society of Uniformed Services Psychiatrists, offers continuing medical education about military and veteran mental health. The courses are posted here and include the following:Disaster Mental Health: Practical Applications of Disaster Mental Health—Lessons Learned From the U.S. MilitaryAssessment of Access to WeaponsPTSD: Pathophysiology, Treatment, and Military AspectsResilience of Military Children and FamiliesSuicide in the MilitaryAPA offers additional resources here.“It is easy to see how burdensome it might be to navigate such a high volume of health care, especially when the closest health care facility is an hour or two away,” Zulman told Psychiatric News. “For some of these patients, virtual care will be a challenge, but our findings suggest that for the patients who use tablets, the technology may facilitate critical access and continuity. In addition, the virtual care option can be appealing when veterans feel anxious in the VA setting or when they have other health issues that make it difficult to attend appointments in person.”This study was supported by the U.S. Department of Veterans Affairs Rural Health Enterprise Wide Initiative and the eHealth Partnered Evaluation Initiative. ■“Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets” is posted here. ISSUES NewArchived

Impact of Canadian Armed Forces Veterans’ Mental Health Problems on the Family During the Military to Civilian Transition

Military to civilian transition can significantly affect veterans’ lives. This study aimed to increase understanding of how veteran mental health problems impact the family during the transition to civilian life. We used a sequential multiple qualitative design. Twenty-six family members of veterans with mental health problems completed individual interviews and 9 participated in 3 focus groups. Veteran’s mental health problem(s) created multifaceted and pervasive changes in family structure, roles, and routines, and these changes created negative mental health and well-being impacts for family members. Transition may compound stressors related to mental health, with significant consequences for family systems.

Changing Rates of Mental Health Disorders Among Veterans Treated in the VHA During Troop Drawdown, 2007-2013.

Nationally representative data on mental health disorder prevalence are critical to set informed mental health priorities and policies. Data indicating mental health diagnoses within our nation's veteran population treated at the Veterans Health Administration (VHA) are available, but have yet to be examined for changing trends to inform both VHA and community care. We use VHA national program evaluation data from a time of increasing military enrollment (2007) to troop draw down (2013) to examine changes over time in the number of diagnoses in veterans receiving VHA services. The number of veterans in all diagnostic categories increased during our study period with the smallest increase in psychotic disorders (8%) and the largest in posttraumatic stress disorder (71%). Trends in behavioral health diagnoses among veterans have important implications for policy and clinician competencies within VHA and community providers as veteran mental health care needs change.

With Small Power, Comes Great Responsibility: Lessons Learned from an Evaluation of Veteran and Military Mental Health Public Awareness Campaigns.

This study was conducted to determine the feasibility of conducting a cost-benefit evaluation of federally-funded media campaigns encouraging mental health help-seeking among United States military personnel and veterans. To calculate the necessary sample size for the evaluation, we obtained campaign costs, and determined the number of treatment seekers needed for the campaign to break even with its cost and the associated population change that an evaluation would need to detect. The sample size needed for an evaluation with 80% power was greater than the total population of U.S. military personnel and veterans. Given that the necessary sample size exceeds the population to be sampled, an appropriately powered outcome evaluation is not feasible. Other programs that would be cost effective with extremely small effect sizes should not be subject to underpowered and thus inaccurate empirical outcome evaluation.

Evaluating an Internet-based video cognitive processing therapy intervention for veterans with PTSD: A pilot study

Introduction There remain a number of UK military veterans who are not able to access psychological therapies for post-traumatic stress disorder (PTSD). Some of these barriers are practical, including the need to balance work and other life commitments with attendance at residential or outpatient appointments. There is a need to investigate more accessible and flexible methods of delivering psychological therapies to veterans. One such alternative is to use remote-access video technology, often referred to as tele-therapy. The aims of the present study were to explore the feasibility of using tele-therapy in this population, whilst also reporting mental health outcomes for those who accessed the intervention. Methods Participants were recruited from a UK veterans mental health charity. The intervention consisted of 12 sessions of cognitive processing therapy delivered via Skype. Participants completed various measures of mental health, including PTSD at three time points: pre-treatment, post-treatment and at three months follow-up. A measure of therapeutic alliance was also completed by participants and the clinician. Results A total of 27 participants engaged in tele-therapy, with a treatment completion rate of 79% and a ‘did not attend’ rate of 12%, which compared well against similar outpatient services. All mental health outcomes showed maintained improvement at three months follow-up, with the highest effect size recorded for PTSD. Therapeutic alliance was also rated highly by both participants and the clinician. Discussion The findings suggest that tele-therapy could provide a viable alternative format for delivering trauma-focused psychological therapies to veterans. Limitations and recommendations for future research are also presented.