Nicolò Zarotti

Purpose: The transition from active military service to employment within mental healthcare remains an underexplored area of research. This article aims to describe the lived experience of a former British Army serviceman who transitioned into a career in mental health and to identify both the challenges and opportunities associated with this career change. Design/methodology/approach: A reflective approach was adopted, drawing on the first author’s experiences of leaving military service, engaging in higher education and progressing into mental healthcare. Key stages of educational and professional development were examined to identify themes relating to adjustment, identity, support and the transferability of skills. Personal reflections were used to explore the subjective experience of adapting to a new professional culture and role. Findings: The transition involved a range of challenges, including adapting to unfamiliar social and professional dynamics, managing changes in identity and navigating educational and occupational systems that differed substantially from military environments. However, military experience provided several advantages that facilitated adjustment. These included confidence in high-pressure situations, resilience, professionalism, strong communication and presentation skills and high standards of organisation and timekeeping. These attributes were perceived as beneficial not only to the individual’s progression but also to the multidisciplinary teams in which they worked. Originality/value: This reflective piece contributes to the limited literature on military-to-clinical career transitions. By providing a first-person perspective, it offers novel insights into the experiences of service leavers entering mental healthcare and highlights considerations for future research and support initiatives.

Acquired brain injury (ABI) is among the leading causes of death and disability in people under 40 years old [1,2]. Each injury is unique, with wide-ranging difficulties including cognitive, psycho...

People with Huntington's disease (HD) commonly experience anxiety, yet access to psychological interventions remains limited. Guided self-help is a low-cost, scalable, evidence-based approach with the potential to improve access to psychological support. This qualitative study aimed to explore participants' experience of GUIDE-HD, a remote guided self-help intervention designed to address anxiety in people with HD based on cognitive behavioural therapy and acceptance and commitment therapy, by examining: (i) the acceptability of the intervention, (ii) any perceived benefits or challenges, and (iii) ways to enhance its relevance and accessibility for people with HD (pwHD). Qualitative individual semi-structured interviews were conducted with nine pwHD and three carers and analysed using framework analysis. Three overarching themes emerged: (1) A therapeutic journey for people with and affected by HD; (2) Mechanisms of benefit; (3) Experiencing various gains. Participants valued the intervention's relevance, structure, accessibility, personalization and facilitation. Reported gains extended beyond reduced anxiety to increased acceptance of the realities of living with and managing the condition and better relationships. While a number of limitations should be considered, such as the sample size and its predominant female representation, the GUIDE-HD intervention was acceptable and showed promise as a tailored psychological approach for pwHD.

Background: Deficits of emotion recognition have received increasing attention in people with Huntington's disease (HD) in the three decades since the discovery of the HD gene. However, the characterisation of such deficits across different disease stages, types of stimuli, and sensory modalities is currently unclear. Objective: This study aimed to provide a comprehensive review of the evidence on emotion recognition deficits in HD gene carriers (both manifest and premanifest) over the three decades since definitive gene testing. Method: A systematic review was carried out from January 1993 to January 2025 across MEDLINE, PsycINFO, Academic Search Complete, and CINAHL (PROSPERO registration: CRD42023398649). Results: From 9735 initial citations, 59 studies were eventually included. In manifest HD, facial recognition of negative emotions such as anger, fear, disgust, and sadness was consistently impaired, whereas happiness and neutral expressions were generally spared. A few auditory studies showed consistent deficits for disgust, fear, and anger, while happiness and sadness appeared less affected. Only preliminary evidence is currently available for deficits involving body language, visual and written vignettes, videos, and olfactory and gustatory tasks. Although sparser, the evidence for premanifest HD suggests that some individuals may develop significant recognition difficulties prior to motor onset, particularly due to early frontostriatal deterioration and white matter disruption. Conclusions: Impairments of facial recognition of negative emotions are reported consistently in manifest HD, while only preliminary results are available for other modalities. The evidence involving premanifest HD is much sparser. Key implications for clinical practice and future research are outlined and discussed.

Background: Children of people with Huntington's disease (HD) often face a wide range of early psychological challenges which may lead to further psychological difficulties later in life. Objective: This exploratory retrospective study aimed to investigate the relationship between childhood traumatic experiences and psychological difficulties during adulthood in individuals raised in HD families compared to matched controls. Methods: Thirty-eight adult children of people with HD and 20 matched controls completed a demographic questionnaire, the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and the Symptom Checklist-90-Revised (SCL-90-R). Mann–Whitney U Tests were used to compare groups on all measures. A multiple regression model was developed within the HD Family group to investigate which aspects of childhood trauma best predicted psychological distress in adulthood. Results: Compared to controls, people raised in an HD family reported significantly more total childhood trauma as well emotional abuse, physical abuse, and emotional and physical neglect. Global psychological distress in adulthood, depression, and psychoticism were also observed to be significantly higher in the HD Family Group. The regression model identified childhood emotional abuse as the only significant predictor of global psychological distress in adulthood. Conclusions: Growing up in an HD family may be significantly associated with higher levels of self-reported childhood trauma as well as psychological distress in adulthood, with emotional abuse playing a more significant role in shaping long-term mental health outcomes.

Individuals living with neurological conditions often face chronic issues including motor and sensory impairments and cognitive deficits. These challenges can lead to significant psychological difficulties, including anxiety, depression, and post-traumatic stress. Acceptance and Commitment Therapy (ACT) is a psychotherapeutic approach which aims to enhance psychological flexibility and acceptance while promoting behavioural change. Although ACT groups have shown promise in supporting individuals with neurological conditions, the evidence on patients' experiences of attending them is sparse. This project explored the experiences of individuals with a range of neurological conditions who had attended ACT group sessions as part of routine clinical practice, with the aim to refine future iterations of the intervention and enhancing patient care. Ten individual qualitative semi-structured interviews were carried out and the data were analysed thematically. Three overarching themes emerged from the analysis: (1) Initial Barriers to Group Attendance and Engagement; (2) Building an Environment of Acceptance; (3) Developing an ACT toolkit. Overall, the results showed that the ACT group intervention led participants to develop stronger emotional connectedness, better knowledge of their difficulties, more effective psychological skills, and different mindsets regarding their condition. Implications for the refinement of future ACT groups, neuropsychological service development, and clinical practice are discussed.

Objective: Caregivers of individuals with motor neurone disease (MND) face a wide range of psychosocial difficulties. To address these, non-pharmacological interventions have been trialled, showing promising results. However, no clear characterisation of the breadth of psychosocial constructs examined by the interventions is currently available, resulting in the lack of a core outcome set (COS). The present review explored the types of psychosocial outcomes investigated in studies that adopted non-pharmacological interventions with caregivers of people with MND. Methods: A scoping review was conducted across four major databases (Academic Search Ultimate, CINAHL, PsycINFO, and MEDLINE) from inception to the 1 March 2024. Results: From an initial return of 4802 citations, 10 were considered eligible for inclusion. A total of 10 main psychosocial outcomes were identified: anxiety and depression, psychological distress, resilience, caregiver burden, caregiver preparedness, self-efficacy, quality of life, spiritual wellbeing, and mindfulness. Conclusions: Caregiver burden and symptoms of anxiety and depression represent pivotal outcomes, but caution is advised with regard to caregiver burden’s potential multidimensional structure. Psychological distress and quality of life are also commonly investigated, but clearer consensus is needed on their conceptualisation. There is a paucity of studies characterising important psychosocial outcomes such as resilience, problem-solving, self-efficacy, and mindfulness, while no investigations are available for relevant outcomes such as coping, isolation, and loneliness. Further research is warranted to address these gaps to improve our insight into non-pharmacological support for MND caregivers and ultimately lead to the development of a core psychosocial outcome set in this population.

Over the past 50 years, mental health services have evolved significantly, influenced by shifts in theoretical and practical approaches to mental disorders. Key among these changes are the biopsychosocial and recovery models, which highlight resilience and quality of life in treatment. However, traditional psychiatry has often struggled to embrace these changes because of reductionist perspectives that overlook psychosocial factors, resulting in fragmented care and reduced accessibility. Proposed solutions have faced implementation barriers in absence of a coherent theoretical framework. Here, we outline how attachment theory may offer a promising framework to drive systemic change in mental health by emphasising secure emotional bonds at both the organisational and individual level. Within an attachment-informed culture, services may act as ‘organisational caregivers’ that promote continuity of care, independence and stronger clinical relationships. In turn, this may foster more inclusive, responsive and resilient mental healthcare systems that prioritise patients’ needs and empowerment.

People who survive a subarachnoid haemorrhage (SAH) often face enduring health challenges including physical disability, fatigue, cognitive impairments, psychological difficulties, and reduced quality of life. While group interventions have shown positive results in addressing similar issues in chronic conditions, the evidence involving SAH specifically is still sparse. This service evaluation aimed to explore SAH survivors' experiences of attending a multidisciplinary group-based support programme tailored to address unmet needs identified in previous literature, with the ultimate aim to refine future iterations of the programme and improve quality of care post-SAH. Semi-structured interviews were carried out with 12 individuals who attended the programme. The resulting data were analysed thematically. Four overarching themes emerged from the analysis: (1) Barriers to accessing support after a SAH, (2) Factors acting as enablers of recovery, (3) Sharing lived experience to support one another, (4) Feeling connected while navigating a group format. Lack of communication, fear, loneliness, and cognitive impairments can act as barriers to engagement with support, while acceptance and adjustment, holistic multidisciplinary input, and psychological support may represent successful enablers of recovery. Implications for future iterations of the programme as well as clinical rehabilitation and service development are discussed.