Evaluation of peer Vs clinician delivered culturally informed, skills based and manualised Group Emotional And Relationship Skills (GEARS) training for military, veteran, police and first responders who are at risk of, or have, chronic stress and trauma-related mental health injuries.

Evaluation of peer-delivered versus clinician-delivered Group Emotional and Relationship Skills (GEARS) program for military, veteran, police and first responder personnel. GEARS is a skills based training program targeting emotional regulation and interpersonal relationships, and consists of 12x120min facilitated sessions, delivered weekly. The first six sessions are about emotional regulation, and the second six sessions cover interpersonal relationships. The program is fully manualised and all facilitators have had training in delivery. Non-Drug trial: Materials – The GEARS program is a skills-based intervention and has a manualised workbook for both participants and facilitators, containing explanatory script, exercises and homework. Each session has components of psychoeducation about chronic stress and trauma, and the maladaptive coping mechanisms or behaviours that follow; a focus on Self and Identity from a uniformed service context; appropriate activities to demonstrate what these effects are, how they arise, and how they impact participants; and finish with an appropriate psychological tool (cognitive behavioural therapy, acceptance and commitment therapy, dialectical behavioural therapy, mindfulness activity) to address the issues raised during that session. The program outline is as follows: 1. GEARS introduction, with focus on effects of chronic stress and trauma on self, others, and relationships. Concepts of self and self-identity within a Service culture. 2. Emotions – purpose, meaning, and an introduction to breathing and mindful acceptance of emotional distress. 3. Emotional regulation – Cognitive interventions: restructuring and challenging less-helpful thinking patterns. 4. Emotional regulation – focus on behaviours and behavioural interventions. 5. Emotional regulation – focus on routine and structural interventions with behavioural activation task for stress vulnerability. 6. Emotional regulation – summary of service culture on values and identity; life stage approach to help manage transition from Service. 7. Introduction to relationships, healthy characteristics of relationships and relationship patterns. 8. Relationships – Roles, patterns, and maintaining healthy boundaries 9. Relationships – Developing and maintaining individuality within relationships, including effects of power and dependence. 10. Relationships – Managing conflict using effective communication. NB- session includes partners. 11. Relationships – Developing and maintaining intimacy for healthy relationships. NB – session includes partners. 12. Summary – review of progress during the program; effects on self and others; future plans for continued functioning. Procedures – participants can be referred in by their clinicians (psychologists, psychiatrists, general practitioners); rehabilitation coordinators; other personnel from within their sponsoring organisations. An explanation of the program and clinician referral form can be found here: https://mesha.org.au/resources-and-support/our-programs/gears-program/ Note the referral form has the participation inclusion requirements of military or emergency service history, some concern about mental health, and the exclusion criteria of no active suicide plan or psychotic symptoms. Potential participants will be allocated to the wait-list for program sessions prior to being enrolled in a particular group. Allocation to GEARS program groups will be limited to the facilitator resources in the location because there are limited peer-facilitators available for delivery of the GEARS programs. Who – Facilitators will be clinicians with a minimum of 3 years post-graduate employment experience, and have undergone formal training in the GEARS program. Peer facilitators will have participated in a GEARS group; observed another group; and have completed a Diploma of Counselling or equivalent prior to being able to deliver a program. All peer facilitators will be supervised during their delivery of the program by Dr Lane. Mode of delivery – GEARS will only be done in a group format, and a combination of face-to-face and videoconferencing methods will be used for delivery of the sessions. Number of Times – the GEARS consists of 12x120 minute sessions, delivered consecutively on a weekly basis. There will be an additional follow up for completion of the longitudinal evaluation at three and nine months post completion of the program. Location of Intervention – the GEARS will be run at community outpatient facilities in Adelaide, Hobart, and other sites depending on popularity and need. Remote delivery via videoconferencing will also be used for participants in regional areas. Allocation of participants to groups is non-randomised as it is dependent on their physical location and availability of programs at the time of enrollment. Adherence / Fidelity – will be monitored through attendance records kept by group administrators from MESHA, or any other applicable organisation.