Using angling to improve mental health in military veterans with post-traumatic stress disorder

ISRCTN	ISRCTN43826813
DOI	https://doi.org/10.1186/ISRCTN43826813
ClinicalTrials.gov (NCT)	Nil known
Clinical Trials Information System (CTIS)	Nil known
Protocol serial number	NIHR203435
Sponsor	University of Essex
Funder	National Institute for Health Research

Submission date: 27/05/2022
Registration date: 07/06/2022
Last edited: 13/07/2022

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Mental and Behavioural Disorders

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Record updated in last year

Plain English summary of protocol

Background and study aims
The aim of this study is to test whether angling in a natural and social setting will improve the mental health of military veterans with post-traumatic stress disorder (PTSD). Anyone who has experienced a traumatic event or episode in their life might develop PTSD but it is particularly noted in military veterans who have seen combat. PTSD is characterised by persistently feeling under threat and experiencing vivid memories, nightmares and ‘flashbacks’ of the trauma that may occur at any time.
Many people with PTSD avoid thinking or talking about their trauma, and situations that could provoke anxiety. This often results in losing partners, friends and employment. Despite this, people with PTSD, especially military veterans, often do not seek help or drop out early if they do. The aim of this study is to evaluate a new, engaging way to help people with PTSD recover their wellbeing. The researchers have worked with veterans who have lived with PTSD for many years and with veterans’ support charities to develop a new intervention.

Who can participate?
Military veterans with PTSD

What does the study involve?
The new intervention involves learning to fish and socialising in small groups in a tranquil, rural setting. It takes place over the course of 2 days and 1 night. The idea behind this approach is threefold: First, being amongst people with similar experiences makes it easier to share concerns and memories. Second, natural environments are restorative and free from attention-grabbing triggers (such as unpredictable urban sounds that trigger flashbacks). Third, developing a skill encourages post-traumatic growth.

What are the potential risks and benefits of taking part?
The benefits may include a decrease in symptoms associated with PTSD and other conditions such as anxiety and depression and an increase in a positive feeling of wellbeing and collegiality. Risks include the usual hazards associated with being outside in nature by the waterside (e.g. slips, trips and falls; waterside safety; immersion in water; waterborne infections; exposure to animal waste; thunder and lightning).

Where is the study run from?
University of Essex (UK)

When is the study starting and how long is it expected to run for?
January 2022 to November 2022

Who is funding the study?
National Institute for Health Research (UK)

Who is the main contact?
Dr Nick Cooper
anglingforgood@essex.ac.uk

Contact information

Dr Nicholas Cooper
Principal investigator

Department of Psychology
University of Essex
Wivenhoe Park
Colchester
CO4 3SQ
United Kingdom

Phone	+44 (0)7791 518833
Email	ncooper@essex.ac.uk

Study information

Primary study design	Interventional
Study design	Single-centre interventional single-blinded randomised wait-list controlled trial
Secondary study design	Randomised controlled trial
Study type	Participant information sheet
Scientific title	A nature-based intervention to improve mental health: efficacy of an angling intervention for military veterans with post-traumatic stress disorder
Study objectives	A nature-based, group-delivered angling intervention improves the mental health of military veterans with post-traumatic stress disorder (PTSD) relative to controls.
Ethics approval(s)	Approved 14/03/2022, University of Essex Ethics Committee (REO Research Governance Team, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK; +44 (0)1206 872169; reo-governance@essex.ac.uk), ref: ETH2122-0861
Health condition(s) or problem(s) studied	Post-traumatic stress disorder
Intervention	Participants engage in a 2-days/1-night social fishing event in a natural setting. Participants are randomised into either the fishing group or a waitlist control group (do nothing during primary data collection), who then engage in the fishing intervention at a later date. Simple randomisation is used with stratification (gender, PCL-5 score).
Intervention type	Behavioural
Primary outcome measure(s)	PTSD symptoms measured using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) at baseline, 2 weeks and 4 weeks post intervention.
Key secondary outcome measure(s)	Measured at baseline, 2 weeks and 4 weeks post intervention: 1. Anxiety measured with the Generalised Anxiety Disorder Assessment (GAD-7) 2. Depression measured with the Patient Health Questionnaire (PHQ)-9 3. Psychological growth measured using the Psychological Wellbeing Post-Traumatic Changes Questionnaire 4. General social functioning measured using the Work and Social Adjustment scale 5. Wellbeing measured using the Warwick-Edinburgh Mental Wellbeing Scale 6. Loneliness measured using the UCLA Loneliness Scale and the emotional Loneliness Scale
Completion date	07/11/2022

Eligibility

Participant type(s)	Patient
Age group	Adult
Sex	All
Target sample size at registration	48
Key inclusion criteria	Military veteran with PTSD
Key exclusion criteria	1. Not a military veteran 2. Currently undergoing psychotherapy
Date of first enrolment	06/06/2022
Date of final enrolment	08/08/2022

Locations

Countries of recruitment

United Kingdom
England

Study participating centre

University of Essex

Wivenhoe Park
Colchester
CO4 3SQ
United Kingdom

Results and Publications

Individual participant data (IPD) Intention to share	Yes
IPD sharing plan summary	Stored in publicly available repository
IPD sharing plan	Anonymised data will be shared in a publically available repository, the OSF data repository (https://osf.io/). The researchers will store fully anonymised raw SPSS data files. Consent for this is in the PIS and ethics forms. Data will be available after publication and will be freely available at any time thereafter from OSF.

Study outputs

Output type	Details	Date created	Date added	Peer reviewed?	Patient-facing?
Participant information sheet	Participant information sheet	11/11/2025	11/11/2025	No	Yes
Study website	Study website	11/11/2025	11/11/2025	No	Yes

Editorial Notes

13/07/2022: The following changes have been made:
1. The recruitment end date has been changed from 11/07/2022 to 08/08/2022.
2. The overall trial end date has been changed from 17/10/2022 to 07/11/2022 and the plain English summary updated accordingly.
3. The intention to publish date has been changed from 01/10/2023 to 01/11/2023.
4. The trial website has been added.
30/05/2022: Trial's existence confirmed by the University of Essex Ethics Committee.