The High Res approach to mental wellbeing

This brief introduces DVA’s High Res SMART (Self-Management and Resilience Training) tools. These veteran-specific online tools are informed by best practice and designed to help serving and ex-serving Australia Defence Force (ADF) personnel and their families increase their resilience, learn to manage stress and distress, and build social connections.¹

Veterans commonly experience anxiety disorders, depression, post-traumatic stress disorder and alcohol misuse.^2-6 These conditions can arise or be exacerbated at stressful times, such as when transitioning from military to civilian life.⁶ Coming to terms with a sudden change in identity and meaning, coping with feelings of disorientation and disconnect from families and a change in status can make adjusting to civilian life difficult for many.^2, 7 Some older veterans may still struggle many years after transitioning, finding it difficult to settle into civilian life.

Recovery from mental health issues can be substantially hindered by increased stress, relationship problems and a perceived lack of social support.⁵ Offering veteran-specific self-help strategies and social support services, and encouraging family involvement can facilitate continued use of treatments and promote recovery for many veterans.⁵

Current guidelines for mood disorders, anxiety disorders and trauma or stressor disorders recommend a range of strategies to not only achieve symptom relief and a return to normal functioning but also to build resilience against future illness. Guidelines from Royal Australian and New Zealand College of Psychiatrists, for example, recommend lifestyle changes and psychological interventions as essential baseline strategies in the treatment of mood disorders (Figure 1).⁸

Using the High Res SMART tools

1. Talk to your patients about building resilience

Resilience is the ability to adapt to change, cope with and bounce back from stressful or distressing situations, and maintain an optimal level of performance under such adverse circumstances. It is influenced by emotional, cognitive, behavioural, social and psychological factors.⁹ Fostering and building resilience plays an important role across all stages in the recovery and prevention of mood disorders.^8, 9

Psychological strategies, such as social skills training and mindfulness-based and cognitive behavioural therapies (CBT), build resilience and strengthen stress-response systems and related cognitive, emotional and social functioning.⁹

The High Res SMART tools use CBT in conjunction with mindfulness and relaxation techniques, to help veterans manage stress and distress and build resilience.¹

The tools focus on helping veterans identify and adapt unhelpful reactions to difficulty and distress, including physical responses, thoughts, emotions and behaviours (see Figure 2).¹

As with other skills and techniques learned in CBT or closely aligned therapeutic approaches, patients practising the techniques to the point where they become habits or automatic constitutes a key step forward in recovery.

2. Ask your DVA patient about stress

Unless specifically asked, some veterans may not be fully aware of their reactions to stress or difficulty or may be reluctant to openly discuss how these reactions are affecting their life.⁵

Reactions to stress can be physical (e.g. rapid breathing) or can affect thoughts, emotions and behaviours.¹ Ask specific questions about how your patient reacts to stressful situations, including reactions to immediate or acute stressors as well as to longer-term stress. Their responses help decide which High Res SMART tools are the most appropriate for them (see Figure 3).

Help your patient recognise their reactions to stress so they can practise the relevant techniques before they feel overwhelmed.¹⁰

3. Help your patient choose their High Res SMART tools

If your patient’s reaction to stress significantly reduces the quality and day-to-day enjoyment of their life, recommend suitable self-help High Res SMART tools, available at the Open Arms website: www.openarms.gov.au/get-support/self-help-tools/find-self-help-tool

Using the tools takes between 1 and 20 minutes and they can be used daily or as needed. They can be used either as standalone strategies or to complement other treatments.

Choose High Res SMART tools appropriate to your patient’s responses to stress and distress

Responses	High Res SMART tools*
Physical
Rapid breathing Fast or pounding heart Dizziness or light-headedness Trembling or shaking Muscle tension or pains Nausea or 'butterflies' in the stomach Tiredness Pain	Progressive muscle relaxation Controlled breathing Isometrics Guided grounding Quick grounding
Thoughts
Negative thoughts and negative self-talk Difficulty thinking through problems Frequently worrying Concentration and memory problems	Stop and swap thoughts Challenge your thoughts Reassess your thoughts Problem solving
Emotions
Fearful or apprehensive Stressed or 'on edge' Angry or frustrated Feeling down or depressed, guilty or ashamed Lacking motivation Feeling confused or overwhelmed with problems	Defusing anger Managing emotions Distraction Being calm
Behaviours
Changes in sleep patterns Changes in appetite Drinking or smoking too much Misuse of other substances (including prescription medicines) Being verbally or physically aggressive Not spending enough time with others or doing satisfying activities	Social connections Healthy sleeping Physical activities Enjoyable and rewarding activities

*In the online Therapeutic Brief, click directly through to the tools using the links in the table; otherwise go to www.openarms.gov.au/get-support/self-help-tools/show-all-tools

Figure 3. High Res SMART tools¹

Encourage the patient’s family to take part, where possible; their involvement and support can aid recovery, provide a sense of connection and belonging for the patient, and lessen the risk of suicidal behaviour.⁵

Helping patients who need additional support

Psychological therapies have proven effectiveness for people with a range of mental health conditions; they can be used alone or in combination with pharmacotherapy.^8, 11, 12

Mental health professionals will be familiar with the strategies included in the High Res tools and can support their use.

Veterans can access mental healthcare, either face-to-face or by telehealth through Non-liability Health Care. DVA funds evidence-based mental health treatments provided by mental health care professionals for mental health conditions for veterans without the need for the condition to be accepted as related to service. For further information, go to: www.dva.gov.au/health-and-treatment/injury-or-health-treatments/mental-health-care/free-mental-health-care-veterans

• To find a psychologist who is a member of the Australian Psychological Society call 1800 333 497 or go to: www.psychology.org.au/Find-a-Psychologist
• To find an Accredited Mental Health Social Worker go to: www.aasw.asn.au/find-a-social-worker/search/
• To find an occupational therapist (mental health) go to: www.otaus.com.au/find-an-ot
• Patients can also access Open Arms – Veterans & Families Counselling; they provide confidential counselling, group programs and workshops, crisis accommodation support and peer support for anyone who has served at least one day in the armed forces and their families. CBT and IPT are both available through Open Arms.
• Counsellors are available 24 hours a day, 7 days a week: call 1800 011 046 or go to: www.openarms.gov.au
• Open Arms – Veterans & Families Counselling Safe Zone Support is a free and anonymous counselling line for all ADF personnel, veterans and their families.
• Counsellors are available 24 hours a day, 7 days a week: call 1800 142 072 or go to: www.openarms.gov.au/safe-zone

Having sufficient social support can help buffer against stressors and promote recovery. Encourage patients and their families to join veteran-specific support and charity services, including:

• Defence Member and Family Support is available by calling 1800 624 608 or at: www.defence.gov.au/members-families
• Mates4Mates at: www.mates4mates.org
• Legacy at: www.legacy.com.au
• Australian War Widows at: https://warwidows.org.au
• The Partners of Veterans Association of Australia at: www.pva.org.au
• Vietnam Veterans Association of Australia at: www.vvaa.org.au
• The Returned and Services League of Australia (RSL Australia), at: www.rslaustralia.org

Financial support resources are available at: www.dva.gov.au/financial-support

References

1. Open Arms-Veterans & Families Counselling. Self-help tools. Available at: www.openarms.gov.au/get-support/self-help-tools [Accessed July 2021].
2. Van Hooff M, Lawrence-Wood E, Hodson S, Sadler N, Benassi H, Hansen C, et al. Mental Health Prevalence, Mental Health and Wellbeing Transition Study. Australian Government Department of Defence and Department of Veterans’ Affairs. Canberra. 2018.
3. McFarlane A, Hodson S, Van Hooff M, Davies C. Mental health in the Australian Defence Force: 2010 ADF Mental Health and Wellbeing Study: Full report, Department of Defence. Canberra. 2011.
4. Read J, Sharpe L, Modini M, Dear B. Multimorbidity and depression: a systematic review and meta-analysis. J Affect Disord. 2017; 221: 36-46.
5. The Australian Centre for Post-traumatic Mental Health. Mental Health Advice Book for treating veterans with common mental health problems. Australian Government Department of Veterans’ Affairs. Canberra. 2012.
6. Oster C, Morello A, Venning A, Redpath P, Lawn S. The health and wellbeing needs of veterans: a rapid review. BMC Psychiatry. 2017; 17: 414-428.
7. Pease J, Billera M, Gerard G. Military culture and the transition to civilian life: suicide risk and other considerations. Soc Work. 2016; 61: 83-86.
8. Malhi G, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2021; 55: 7-117.
9. Malhi G, Das P, Bell E, Mattingly G, Mannie Z. Modelling resilience in adolescence and adversity: a novel framework to inform research and practice. Transl Psychiatry. 2019; 9: 316.
10. Phoenix Australia. Centre for Post-traumatic Mental Health. Coronavirus (COVID-19) Practitioner tips. Available at: www.phoenixaustralia.org/wp-content/uploads/2020/03/Coronavirus-Practitioner-tip-sheet.pdf [Accessed July 2021].
11. Ijaz S, Davies P, Williams CJ, Kessler D, Lewis G, Wiles N. Psychological therapies for treatment-resistant depression in adults. Cochrane Database Syst Rev. 2018; 5: CD010558.
12. Apolinario-Hagen J, Harrer M, Kahlke F, Fritsche L, Salewski C, Ebert DD. Public attitudes toward guided internet-based therapies: web-based survey study. JMIR Ment Health. 2018; 5: e10735.

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