A Just-in-Time Adaptive Intervention (Shift) to Manage Problem Anger After Trauma: Co-Design and Development Study

Problem anger is common after experiencing trauma and is under-recognized relative to other posttraumatic mental health issues. Previous research has shown that digital mental health tools have significant potential to support individuals with problem anger after trauma.

The objective of this study was to describe the co-design and development of a just-in-time adaptive intervention (JITAI) targeting problem anger in individuals who have experienced trauma.

We used a participatory design process following the double-diamond framework. Phase 1 involved one-on-one qualitative interviews with trauma-exposed individuals with problem anger (n=10). Using an inductive approach (interpretative phenomenological analysis), we thematically coded interview data to create design principles for this population and generate potential content for the intervention. Phase 2 involved academic and clinical experts in trauma and experts in digital health reviewing the Phase 1 results and an evidence-based cognitive behavioral approach to treating anger. We then created intervention content and prototypes, which we then took to workshops with all participants for feedback, using group discussions and ratings of desirability and feasibility.

From Phase 1, core considerations for a JITAI included look and feel preferences, self-led and personalized support and content, and different support needed for each anger stage. A JITAI was developed with the following components: (1) personalized schedules and content onboarding; (2) psychoeducation about problem anger; (3) crisis support; (4) mood monitoring via anger check-ins; (5) self-led and personalized circuit breakers; (6) cognitive-behavioral based skills; (7) and a digital Coach embedded in the app. Some suggested features, such as social networking and sharing data with loved ones, were not pursued due to feasibility reasons relating to participant safety or technical costs.

The resulting JITAI, termed "Shift," is the first digital mental health tool designed with end users to manage anger after trauma.