A smartphone and wearable digital mental health tool to manage anger in adults who have experienced trauma: mixed methods pilot study (Preprint)

BACKGROUND Dysregulated anger, also known as problem anger, affects up to 30% of individuals who have experienced psychological trauma. Novel digital mental health tools leveraging wearable and smartphone data hold significant potential to treat a range of post-trauma mental health issues, but more research is needed into how feasible and acceptable these data sources are to build digital mental health tools driven by artificial intelligence/machine learning algorithms. OBJECTIVE Examine the acceptability and feasibility of using wearable and smartphone devices to monitor physiological and psychological outcomes among trauma-exposed adults with high levels of problem anger, to inform development of future AI/ML driven digital tools. METHODS Mixed methods study of feasibility and acceptability of using a commercial wearable and four ecological momentary assessment (EMA) prompts per day, for ten days. We also examined quantitative changes in heart rate variability, anger and post-traumatic stress disorder symptoms among participants over the study period. RESULTS We recruited 98 participants (80% female; mean age 38 years). Quantitative and qualitative data revealed that regular EMA use combined with a wearable was feasible and acceptable in the sample. We observed reductions in problem anger ([CI 95% (-3.55, -2.18)]; p < 0.001) and posttraumatic stress disorder symptoms ([CI 95% (-1.24, -0.08)]; p = 0.025) but no change in heart rate variability (p = 0.232) over the 10 days of monitoring. Qualitative findings suggested that by regularly checking in on their anger symptoms participants improved their self-awareness and ability to self-manage their mood. In addition, using the wearable helped them make a mind-body connection and notice the physiological signs of mood. However, despite the perceived value of the tool, the high level of data missingness has implications for future AI/ML driven digital tools. CONCLUSIONS These findings provide valuable pilot data around the use of ecological momentary approaches and wearables for building personalised digital mental health tools. CLINICALTRIAL N/A INTERNATIONAL REGISTERED REPORT RR2-10.1371/journal.pone.0278926