UK female forces veterans
Iona Mind and the University of Exeter bring clinical expertise, technology and women’s lived experience together to advance digital mental health support for female Armed Forces veterans.
What the research deliveredUniversity of Exeter×
01 / Background
A research collaboration with a practical purpose.
Funded by the Office for Veterans’ Affairs, the programme delivered IonaFFV, a CBT app adapted with female veterans; two peer-reviewed publications; and practical recommendations for designing, evaluating and introducing digital mental health support.
The programme aimed to help close the treatment gap for female forces veterans by understanding their experiences and developing support that reflects their needs.
Development and pilot evaluation of an artificial intelligence (AI)-supported mobile Cognitive Behavioural Therapy (CBT) intervention for the treatment of depression and anxiety in female veterans.
Female veterans can face particular challenges during and after military service. These may include stigma, experiences of sexual trauma, discrimination, and concerns that services will not understand their experiences.
The move to civilian life can bring changes in identity, gender-related expectations and practical problems such as finding housing or work. Support needs to reflect these experiences.
Low-intensity cognitive behavioural therapy (CBT) is one possible way to improve access to support for mental health difficulties. It uses evidence-based CBT techniques in shorter, more flexible sessions, helping people learn practical skills they can use themselves.
Digital delivery may make support easier to access privately and at a time that suits the individual. The collaboration turned these principles into IonaFFV, adapting the app around female veterans’ experiences and developing the technology and research methods to evaluate it.
The collaboration’s contribution
The programme connects women’s lived experience with working digital tools and practical knowledge that researchers, designers and services can build on.
01 / Digital development
Veterans’ feedback translated into changes to IonaFFV’s language, imagery, navigation and signposting. The work brought women’s transition to civilian life into the design of support for low mood and worry.
Explore the adaptation study02 / Published research
Papers in JMIR Human Factors and BMJ Open document the adaptation and acceptability study and the feasibility trial protocol, making the programme’s methods and findings available to the wider research community.
Read the publications03 / Research methods
The team developed IonaFFV and a matched digital comparison app for a double-blind feasibility trial. This work contributes technology and practical lessons for studying engagement and evaluating digital interventions.
Explore the trial framework04 / Service development
Fourteen interviews with clinicians, commissioners and female veterans identified priorities for introducing digital support into services, including user involvement, digital inclusion, governance and clear routes to adoption.
Explore the implementation research02 / Research outputs
A connected programme of app development, published research, trial evaluation and implementation research. Explore each output and the contribution it makes.
Read paper
Designing digital support with female forces veterans
Female veterans helped adapt IonaFFV, a smartphone app based on CBT for low mood and worry. Their feedback shaped language, imagery, navigation and signposting. The CBT activities and features designed to encourage regular use were received positively. In the acceptability study, 19 of 20 respondents agreed that the app was easy to learn and use. The findings demonstrate the value of involving female veterans in the design process.
Female veterans can face barriers seeking mental health support. This can mean that existing services do not always meet their needs, and they may be less likely to engage with services. Support designed with female veterans may therefore be more relevant, acceptable and easier to use.
Female veterans first reviewed the app in discussion groups and suggested ways to improve it. The updated app was then shared with a wider group of female veterans, who gave feedback on how acceptable and easy it was to use. Participants suggested using images and quotations that better reflected women’s lives after leaving the Armed Forces, rather than focusing mainly on service in the Armed Forces. They also recommended clearer information about other sources of help.
The CBT activities and features designed to encourage regular use were received positively. The study shows that involving female veterans in adapting mental health support can help make it feel more relevant and engaging.
Study design and participants: A five-phase mixed methods study of adaptation, acceptability and usability. Five female forces veterans took part in the focus group; 21 completed the later demographic questionnaire, with responses varying by usability question. The small, self-selected sample limits generalisability; clinical effectiveness was outside this study’s scope.
Adaptation and Acceptability of a Low-Intensity Cognitive Behavioral Therapy App to Support Low Mood and Worry Management in Female Forces Veterans: Mixed Methods Study.
Paul Farrand, Andy Bacon, Melika Janbakhsh, Natalie Flay, Elizabeth Turnbull, Jonathan Baker.
JMIR Human Factors (2026); 13:e84365. DOI: 10.2196/84365.
Open access under CC BY 4.0. PDF reproduced unchanged; first-page preview reduced from the original.
Read protocol
Strengthening the evaluation of digital mental health support
This published protocol sets out a double-blind feasibility randomised controlled trial comparing IonaFFV with a matched digital sham app. It provides a transparent framework for studying recruitment, engagement and acceptability, and informing future evaluation.
Female veterans are more likely than male veterans to experience low mood and anxiety, but many do not use veteran-specific mental health services. Researchers have therefore developed IonaFFV, a smartphone app designed to help female veterans manage these difficulties.
The published protocol describes a double-blind feasibility randomised controlled trial. It examines recruitment, retention, app engagement, acceptability and study procedures to inform further evaluation and a future definitive trial. Publishing the protocol makes the study design and methods transparent.
The planned study compared six weeks of access to IonaFFV with a sham app, with follow-up at ten weeks after randomisation. The sham was designed to offer comparable functionality without the active CBT techniques.
Study context: This publication describes the planned trial methods. Findings from the feasibility trial are reported separately in the manuscript under review.
Cognitive–behavioural therapy smartphone app for low mood and worry management in female armed forces veterans in Great Britain: protocol for a feasibility randomised controlled trial.
Melika Janbakhsh, Elizabeth Turnbull, Jonathan Baker, Andy Bacon, Paul Farrand.
BMJ Open (2026); 16:e112494. DOI: 10.1136/bmjopen-2025-112494.
Trial registration: ISRCTN50744553.
Open access under CC BY 4.0. PDF reproduced unchanged; first-page preview reduced from the original.
Practical lessons from the feasibility trial
The study generated practical lessons for recruiting female veterans, understanding app use and designing future trials. The comparison app was found to be engaging and acceptable, contributing to the development of a credible comparator for digital mental health research.
Female veterans are more likely than male veterans to experience low mood and worry. Although many use mainstream NHS mental health services, fewer use services designed specifically for veterans. To make support easier to access, researchers adapted a smartphone app called IonaFFV based on CBT to help manage low mood and worry.
The app was originally designed for the general adult population and was adapted for female forces veterans. Researchers set targets for recruitment and app use to help decide whether a larger trial should go ahead. Recruiting participants was difficult, partly because some people who were not female forces veterans tried to join the study.
The comparison app, developed for female Armed Forces veterans, was found to be engaging and acceptable. However, the study did not meet enough of its targets to show that a larger trial could go ahead without changes to the study design.
Study scope: This feasibility study informs the design of a larger trial, rather than establishing clinical effectiveness. The research team’s summary is provided while the manuscript is under review.
Smartphone CBT App for Managing Low Mood and Worry: Randomized Controlled Feasibility Trial on Female Armed Forces Veterans in Great Britain.
Paul Farrand, Melika Janbakhsh, Elizabeth Turnbull, Melanie Ponomarenko, Jonathan Baker, Andy Bacon.
Publication status: under review, as of November 2026.
View poster
What it takes to put digital mental health research into practice
The study produced practical recommendations to help digital mental health support become more widely available for the Armed Forces veteran community. Interviews with clinicians, commissioners and female veterans identified how governance, service readiness and user trust can support adoption.
To help improve access to support, a smartphone app that offers low-intensity CBT has been developed for female forces veterans. The research team also wanted to understand what helps or prevents services from offering digital mental health support.
They interviewed clinicians, people who commission mental health services, and female forces veterans. The findings highlight governance, stakeholder alignment, digital inclusion, system readiness and user trust, alongside clinical evidence.
The study produced practical recommendations to help digital mental health support become more widely available for the Armed Forces veteran community. This qualitative research focused on implementation and adoption.
Evidence is necessary but not sufficient for the adoption of digital health interventions; Example of a mental health app for female forces veterans.
Melanie Ponomarenko, Andy Bacon, Melika Janbakhsh, Elizabeth Turnbull, Jonathan Baker, Paul Farrand.
Presented at the Centre for Evidence for the Armed Forces Community annual conference, London (2026).
03 / Key findings
The programme provides concrete design principles and research methods to help shape the next generation of digital mental health support for female Armed Forces veterans.
From recognising life after service to planning adoption, these findings give researchers, designers and services specific priorities to apply in their work.
Involve female Armed Forces veterans throughout the design and development of the intervention or service. This can improve fit with users’ needs and increase engagement.
Adaptation & acceptability studyUse Armed Forces imagery and quotes to support initial engagement but reduce ongoing references to the Armed Forces as users engage further. This reflects women’s transition from serving personnel to veteran life.
Adaptation & acceptability studyRetain most existing app features, but improve signposting to relevant information and support; make navigation simpler and more intuitive; and make progress tracking more meaningful and helpful.
The core CBT techniques were retained. Many features were perceived as actively supporting continued engagement.
Adaptation & acceptability studyDigital features can support female forces veterans to engage with intervention techniques. Participants also valued human support, including regular, scheduled contact alongside in-app support.
These participant preferences can inform the design of future support.
Adaptation & acceptability studySuccessful implementation is likely to depend on appropriate governance and information governance arrangements, alignment among key stakeholders, a clear route to adoption, and realistic development and evaluation timescales.
Implementation research posterThe feasibility work highlights the need to protect online recruitment, including considering measures such as CAPTCHA to reduce the impact of malicious bots.
The research team also reports that a digital sham control can achieve similar engagement, functionality and acceptability to the active intervention, supporting its use as a credible comparator. These trial findings are currently under review.
Feasibility manuscript · under review04 / Press & interviews
Listen to the interview and explore coverage of the research programme.
BBC Radio, Pippa Quelch interview from Friday 24th February 2023
The University’s press release introducing the research and its collaboration with Iona Mind.
Read the press release (opens in a new tab)Coverage of the project in the University of Exeter’s independent student newspaper.
Read the article (opens in a new tab)The official funding listing includes Exeter’s research under the Health Innovation Fund.
View the funding listing (opens in a new tab)05 / Research team
Led by Professor Paul Farrand and Jonathan Baker, the collaboration brings together expertise in psychological therapies, digital product development and research with the Armed Forces community.
University of Exeter
PhD, PGDip, BSc(Hons)
Principal investigator
Professor of Evidence-Based Psychological Practice and Research within CEDAR; Psychology at the University of Exeter, and Co-Director of the Low Intensity CBT portfolio.
His work focuses on adapting psychological interventions to improve acceptability and engagement, with the Armed Forces community featuring prominently.
Paul Farrand is Professor of Evidence-Based Psychological Practice and Research within CEDAR; Psychology, a specialised group that focuses on psychological therapies research, training and implementation at the University of Exeter. He is Co-Director of the Low Intensity CBT (LiCBT) portfolio and has published over 120 peer-reviewed papers.
Given his international reputation and research in LiCBT, he is supporting implementation of LiCBT to improve access to evidence-based psychological therapies in the USA, Australia, Sweden, Quebec and Saudi Arabia and has membership of national NHS committees.
A large part of this work involves adapting LiCBT digital and written interventions to enhance acceptability and engagement for different groups with diversity. The Armed Forces community features prominently, with research supporting adaptation, training, service development and implementation for Armed Forces veteran-specific community and charity sector organisations in Great Britain, and for serving personnel in the Canadian Armed Forces.
Iona Mind
MA (Cantab)
Co-principal investigator
Co-founder and chief executive of Iona Mind, and a graduate of Trinity College, University of Cambridge. Jonathan helped turn the programme’s research into working digital tools, undertaking app adaptations informed by female veterans.
Working with Professor Paul Farrand on the study’s clinical and technical panel, he implemented the adaptation framework in IonaFFV while maintaining the underlying CBT approach. His wider contributions include analysing app engagement data and helping develop a matched digital placebo for controlled research.
He co-authored the programme’s publications in BMJ Open and JMIR Human Factors, which credit his work on app development, the description of the technology, interpretation and manuscript development.
Jonathan Baker is a technology entrepreneur and co-founder and chief executive of Iona Mind. He is also chief executive of AlgoViral, a social media marketing company and developer of getusers.ai, an AI agent for social media growth.
A graduate of Trinity College, University of Cambridge, he previously co-founded Simudyne, an AI simulation platform, serving as chief operating officer with responsibility for deploying its technology at global banks such as Barclays. He led the development of digital mental health tools at Iona Mind. Under his leadership, the company was selected for and funded by Y Combinator and raised venture capital from investors including Global Founders Capital, Rocket Internet, Session VC and Notion Capital.
He collaborates with Professor Paul Farrand and the University of Exeter on digital mental health research. His research contributions have included software development, statistical analysis of app log data to understand user engagement, and helping develop a matched digital placebo for controlled research.
He has co-authored peer-reviewed papers in journals such as BMJ Open, JMIR mHealth and uHealth, JMIR Human Factors and Academia Mental Health and Well-Being.
Research collaborators & co-authors
We thank the female forces veterans, clinicians, commissioners and stakeholder contributors whose perspectives shaped this research.
Continue the conversation
For questions about the programme, its findings or research collaboration, contact the research team.
Contact Professor Paul FarrandThis website shares research. It is not a treatment service or a route to enrol in a study.