CompletedInterventional

R&R: A trial for moral injury related mental health difficulties

Moral injury can happen when someone experiences or witnesses events that go against their core moral beliefs. Many UK veterans struggle with painful feelings like guilt, shame, or anger after such events, and regular trauma therapies do not always help. This clinical trial is looking at a new, structured talking therapy called Restore & Rebuild (R&R). Designed specifically for moral injury, R&R aims to help veterans process these complex emotions and move forward. In this study, UK veterans will receive either the new R&R therapy or the standard psychological care currently offered by Combat Stress. Sessions are delivered by trained therapists, and researchers will compare how well both treatments work using simple questionnaires before and after therapy. The goal is to see if R&R can offer better, longer-lasting recovery for veterans.

At a glance

Status

Completed

Sponsor

Forces in Mind Trust

Enrolment target

Start

06 Jul 2023

Estimated completion

01 Jul 2026

What is this study about?

During military service, personnel may face situations that deeply clash with their personal values or sense of right and wrong. When these events cause lasting emotional pain, guilt, shame, or broken trust, it is known as 'moral injury'. While moral injury is not a mental illness on its own, it can lead to severe mental health difficulties like depression, anxiety, and post-traumatic stress disorder (PTSD).

Standard trauma treatments, like routine cognitive behavioural therapy (CBT), often focus on threat and fear. However, many UK veterans and clinicians find that these standard therapies do not fully address the intense guilt and moral distress of moral injury. In some cases, traditional therapies may even feel unhelpful. Because of this, there is an urgent need for specialised care designed specifically around moral injury.

To fill this gap, researchers at King's College London and the charity Combat Stress created a new psychological programme called Restore & Rebuild (R&R). An early pilot study showed that R&R is safe, well-received, and helpful for veterans. This phase 2 trial will test R&R on a larger scale to see whether it provides better relief and everyday functioning than usual standard psychological care.

By taking part, veterans can help doctors and therapists understand how best to treat moral injury. If the trial is successful, R&R could become a regular treatment option across the UK, improving mental healthcare for the entire veteran community.

Key takeaways

A UK clinical trial testing a new talking therapy (R&R) specifically for moral injury in veterans.
Delivered through Combat Stress by experienced, qualified psychotherapists via remote video sessions.
Participants are randomly assigned to either the new R&R therapy or standard care.
No medication is involved; the study uses questionnaires to measure your recovery.
Taking part is voluntary, confidential, and safe, with your GP kept informed.

Who may be eligible?

This study is open to UK military veterans aged 18 and older who are experiencing mental health challenges linked to a moral injury from their time in service. A clinician at Combat Stress will assess whether your difficulties are related to moral injury. Participants must have reliable internet access to join therapy sessions remotely and be willing to let the team share updates with their NHS GP.

The trial is not suitable for everyone. It does not include veterans who are currently experiencing severe crises, such as active self-harm, significant thoughts of suicide, severe psychosis, or unmanaged drug and alcohol dependencies. Veterans who have completed individual trauma therapy within the past three months, or who are currently dealing with severe life crises like homelessness, will also not be able to take part.

In addition, anyone who already took part in the earlier pilot version of R&R is not eligible. Service branch, rank, age, and where you served do not affect your eligibility.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

I am a UK military veteran aged 18 or older.
I am experiencing mental health struggles connected to difficult events from my service.
I have reliable internet access and am willing to attend video therapy sessions.
I am not currently receiving other individual trauma therapy and have not had trauma therapy in the last 3 months.
I am not currently dealing with severe alcohol or substance addiction, severe psychosis, or active self-harm.
I am comfortable with the study team sharing treatment updates with my GP.

Answer every question to see your result.

What does participation involve?

If you take part, you will be placed into one of two groups by chance (like flipping a coin). One group will receive the new Restore & Rebuild (R&R) therapy, while the other group will receive Combat Stress's usual psychological therapy. Both treatments involve one-to-one talking sessions with a qualified, experienced therapist, delivered online.

No medication is involved in this study. Before starting treatment, you will fill out questionnaires about your thoughts, feelings, and day-to-day well-being. You will complete these same questionnaires again after your therapy finishes so researchers can track your progress. Some veterans will also be invited to complete a short interview to share their personal feedback on the therapy.

Overall, your participation will last across the course of your therapy programme and follow-up checks. If you still need psychological support when the study ends, your care team will help arrange further help.

Potential risks and benefits

You may not get any direct personal benefit from taking part, but receiving therapy could help you better manage distressing emotions, and your involvement will help improve mental health services for other veterans. Talking about painful memories can feel emotionally difficult or upsetting at times, but this is a normal part of therapy. Both study therapies are run by experienced professionals trained to support you through tough feelings. Taking part is completely voluntary, and you are free to stop or withdraw at any time without your regular NHS or charity healthcare being affected.

Locations (1)

Some site locations are approximate. We're improving this — please verify with the trial team before travelling.

Combat Stress
City only
Leatherhead, England

Common questions

What is moral injury?

Moral injury refers to the deep psychological distress, guilt, shame, or anger that can occur after witnessing, failing to prevent, or doing things that contradict your personal morals and ethics.

Can I choose which therapy I receive?

No. A computer puts participants into a treatment group at random. This ensures the trial is fair and gives reliable scientific results.

Do I have to pay anything to take part?

No. The therapy and all study assessments are provided completely free of charge.

Will my GP be told about my participation?

Yes. To keep you safe and ensure good medical care, you must agree to let the team share treatment information with your NHS GP.

What happens if therapy becomes too difficult for me?

Your therapist is experienced in supporting veterans with distress. You can pause, take a break, or stop the therapy at any point without losing access to future care.

How to find out more

Victoria Williamson

victoria.williamson@kcl.ac.uk +44 207 8485347 Official trial record

Always speak to your GP or specialist before deciding to take part in a study.