Vietnam Veterans Day on 18 August is an opportunity for health practitioners to focus on how they can support the mental health of the 60,000 Australians who were deployed to Vietnam.
A world-leading, novel approach to managing problem anger that harnesses wearable and smartphone technology – developed by Phoenix Australia – has won a sought-after NHMRC Ideas Grant.
Each year, the National Health and Medical Research Council’s (NHMRC) Ideas Grant scheme supports innovative research projects. More than 2,995 applications were received during the latest round of awards and only 9.8 per cent received funding.
These grants are highly competitive and highly coveted and demand significant scientific rigour and creativity. Obviously, with that in mind, we are honoured to have achieved this grant,”
– Professor David Forbes, Director of Phoenix Australia
The grant has been awarded to support a four-year project – ‘Developing a Just-In-Time-Adaptive-Intervention for problem anger’. Led by Professor Forbes and Dr Olivia Metcalf, the project is a collaboration with Harvard University and the University of Melbourne.
The goal is to develop a smartphone app that will deliver evidence-based, tailored interventions to support the many thousands of people who live with problem anger as a result of experiencing trauma. It is the first time that this type of intervention has been researched and tested specifically for problem anger management.
Problem anger is an under-recognised issue in mental health. We don’t understand it very well and it can be difficult to engage individuals in treatment,” says Dr Metcalf.
“Anger is a normal human emotion but for some individuals, anger occurs at an intensity or frequency that causes harm to the person themselves, to the people around them, or both, and interferes with their ability to work effectively. And they are unable to apply positive coping strategies to manage their anger.”
Problem anger is highly prevalent in trauma survivors, affecting 10 to 20 per cent of trauma survivors, according to Professor Forbes.
Employing the benefits of smartphone technology
Phoenix Australia has already completed a number of small pilot studies that have shaped this latest program of research. The studies showed that a smartphone-delivered intervention was feasible to reach and assist people who can be difficult to engage in face-to-face treatments.
“There are many smartphone apps available but very few of them are evidence-based. For the first time, this project will scientifically test whether elements that we think should work actually do in given contexts and environments,” says Dr Metcalf.
“Smartphone apps for mental health haven’t always delivered on their promises. We need a better way of understanding what components are most effective at what time. This is what makes a just-in-time-adaptive-intervention different from every other app out there at the moment.”
The four-year research project begins in March 2021 and features a number of phases. The first phase will seek to effectively and objectively measure anger through physiological indicators. Participants will use wearable and sensor technology, for example, Fitbits and specialised watches that measure physiological features such as heart rate and blood pressure.
“Anger is a strongly physiologically experienced emotion, so can we harness that information and use it to help inform our interventions? Can we reliably detect from passively collected physiological data if an individual is on the cusp of anger, or currently experiencing anger?” says Dr Metcalf.
Sensor data, self-report data, locations, time of day and sleep data will all be used and analysed to develop and deliver interventions by a smartphone app.
The research will be supported by Harvard University biostatisticians who will use a micro-randomised trial, randomising different intervention options to individuals throughout the day to refine and improve the content.
“The data will enable us to focus on the interventions that have a positive effect on reducing anger,” says Dr Metcalf.
An individualised approach to managing anger
The smartphone app will primarily deliver prompts, messages and suggestions based on the individual’s current context. So, if in real time the intervention detects the individual is not experiencing any anger, it might suggest preventative activities that can be done throughout the day to maintain that positive state of mind and prevent an anger outburst.
“If the data detects the individual is experiencing some level of anger but it hasn’t yet escalated, it would deliver an intervention designed to reduce anger, such as controlled breathing to lower physical arousal or statements about how to change the angry thinking state,” says Professor Forbes.
“If the data detects the individual is at a risky level of anger, they are going to a risky location where they often experience a lot of anger, or they’ve had a poor night’s sleep or consumed a lot of alcohol – it would deliver an intervention designed to be a circuit breaker. This might be suggestions to leave a situation or to not go to a place that is high risk.
“There are four domains of intervention that get ramped up depending on where a person is in their anger elevation. This technology is all about adapting and tailoring to individual profiles of anger and various risk factors and, currently, there is nothing that wraps itself around those risk factors over the course of 24 hours. This is unique in addressing an unmet need in a high risk population that is reluctant to seek face-to-face care and where there are few interventions available.”
The project secured NHMRC funding because the approach has not been used in psychiatry before, the build of the smartphone app has not been done before, and the data being leveraged is cutting-edge.
“At the end of the project we hope to have a fully-optimised app available to use and ready for clinical trial testing,” says Dr Metcalf.
“It will also be available for clinicians to use to support those in treatment and to augment face-to-face treatments for problem anger. It will help clinicians and researchers understand exactly what this issue is and how best to manage it.”