AIMS for Anger Management

Problematic anger as a symptom of posttraumatic stress disorder (PTSD) is prevalent in military populations, including Veterans. Existing anger management programs may be underutilized due to barriers to accessing standard care. Mobile applications (apps) for anger management could increase access to care while using minimal resources. The current mixed-methods pilot study evaluated the satisfaction and helpfulness of the Anger and Irritability Management Skills (AIMS) app, a self-manageable mobile app developed by the VA's National Center for PTSD for individuals struggling with anger. Veterans (N = 23) were recruited from the women's (n = 6) and men's (n = 15) residential Trauma Recovery Program at the VA Palo Alto Health Care System. Participants completed the Anger Expression Index (AEI) before and after using AIMS in a self-directed manner for 3 weeks. After 3 weeks, they also completed a satisfaction survey and participated in a qualitative focus group to share experiences and opinions about the app to inform future app updates. Paired samples t-tests were used to examine changes in AEI scores. Descriptive statistics were used to examine the perceived helpfulness of AIMS. Qualitative data were examined using Rapid Qualitative Analysis and themes were identified using matrix analysis. Perceived helpfulness of the AIMS app was rated, on average, between moderately to very helpful, and app satisfaction was rated between moderately to very satisfied. AEI scores significantly reduced from pre- to post-app use. Qualitative results revealed four themes: (1) symptom monitoring, (2) tailoring app use to fit users' needs, (3) potential as a self-management resource, and (4) potential as a supplement to care. Participants generally perceived AIMS to be helpful for managing their anger and they were satisfied with the app, indicating preliminary acceptability and helpfulness of the app. Future studies with a larger sample size to explore novel ways to increase app dissemination efforts and explore using AIMS in other healthcare settings are warranted.

Many public health agencies, including the U.S. Department of Veterans Affairs (VA), have identified the use of mobile technologies as an essential part of a larger strategy to address major public health challenges. The VA's National Center for PTSD (NCPTSD), in collaboration with VA's Office of Mental Health and Suicide Prevention and the Defense Health Agency inside the U.S. Department of Defense (DoD), has been involved in the development, evaluation, and testing of 15 mobile apps designed specifically to address the needs and concerns of veterans and others experiencing symptoms of posttraumatic stress disorder (PTSD). These applications include seven treatment-companion apps (designed to be used with a provider, in conjunction with an evidence-based therapy) and eight self-management apps (designed to be used independently or as an adjunct or extender of traditional care). There is growing evidence for the efficacy of several of these apps for reducing PTSD and other symptoms, and studies of providers demonstrate that the apps are engaging, easy-to-use, and provide a relative advantage to traditional care without apps. While publicly available apps do not collect or share personal data, VA has created research-enabled versions of many of its mental health apps to enable ongoing product enhancement and continuous measurement of the value of these tools to veterans and frontline providers. VA and DoD are also collaborating on provider-based implementation networks to enable clinicians to optimize implementation of mobile technologies in care. Although there are many challenges to developing and integrating mHealth into care, including cost, privacy, and the need for additional research, mobile mental health technologies are likely here to stay and have the potential to reach large numbers of those with unmet mental health needs, including PTSD-related concerns.