Story medicine: a mixed methods study of brief group dramatherapy with UK and US veterans

Background: UK and US military veterans can face challenges navigating civilian society, along with specific mental health conditions such as Posttraumatic Stress Disorder (PTSD). In this study brief group dramatherapy with veterans with clinical and subclinical PTSD symptom levels were brought together to operationalise the teamwork of the Forces in creative exercises. The goal was to facilitate story sharing as a therapeutic practice and as chosen by participants. This intervention was then assessed for its impact on participant wellbeing, sense of belonging and transition. Methods: Using a mixed methods approach, this study triangulated qualitative narrative inquiry with quantitative outcome measures (for PTSD [PCL5], Changes in Outlook [a posttraumatic growth measure], Sense of Belonging and Community Reintegration of Service Members) with data collected over 14 months including before and after the group dramatherapy series (8 weekly 90-minute sessions), and at 3- and 12-months after. The findings were based on 4 separate groups (2 UK; 2 US). This study included 19 participants and was grounded in their words to guard against appropriation of the embodied experience of military service that the researcher did not have. Co-creation (co-production) was a part of the dramatherapy approach. Findings: Main themes of homecoming and sense of belonging arose in all group contexts suggesting common transition challenges across decades. Reframing veteran-life challenges occurred in the group contexts to foster the creation of a narrative of capacity but also inhibited the sharing of some types of stories that were shared only in post-group interviews. Story sharing over the life course revealed that early-life and veteran-life traumas impacted wellbeing. An intervention focused solely on military service stories would miss this breadth of wellbeing stories. Participation reduced PTSD symptoms for more than half of participants over the year of the study, with sense of belonging enhanced for some participants during the group but not sustained for most once the group concluded suggesting a lower sense of belonging particularly for veterans living in civilian communities. Benefits from participation were greater for veterans who lived in civilian communities as compared to veterans in veteran-only communities who exhibited lower PTSD symptoms and a higher sense of belonging before, during and after the study. Conclusion: Findings suggest recurring challenges for veterans across decades with some UK and US similarities and differences. Findings also suggest reconsidering group therapy to address stress and transition challenges faced by veterans over the life course. Also, the value of an ongoing group, with veterans deciding when and how long to attend, was suggested by participants.