Aggression in Military Personnel (MERA)

November 5, 2026 updated by: Shannon Miles, James A. Haley Veterans Administration Hospital

Reducing Aggression in Military Personnel: A Randomized Clinical Trial

We propose to study if Manage Emotions to Reduce Aggression (MERA) is helpful in reducing anger and aggression in active duty service members by comparing it to self monitoring of one's anger and aggression. The proposed study has two treatment groups. The first group will receive MERA and then monitor their anger and aggression for 3 more weeks. The second group will be asked to monitor their anger and aggression for 3 weeks prior to receiving MERA. All service members will receive MERA and will be asked to self-monitor, but the order in which they are asked to complete these tasks will be randomized.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
106

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Active duty service member 18 years or older.
  2. Currently meets criteria for full or subthreshold PTSD, determined by the Clinician-Administered PTSD Scale for DSM-5-R (CAPS-5-R; Jackson et al., 2024) endorsing trauma exposure and a score of > 3 on at least 1 Cluster B, 1 Cluster C, 1 Cluster D, and 1 Cluster E symptom. Symptoms must be present for at least 1 month with clinically significant distress and/or functional impairment (items 23-25 with scores of > 2).
  3. Engaged in at least 3 self-reported aggressive acts (e.g., yelling, throwing objects, hitting objects/people) in the last month, measured by the 20-item Overt Aggression Scale (OAS; Yudofsky et al., 1986).
  4. Impulsive aggression is primary form of aggression, determined by the Impulsive Premeditated Aggression Scale (IPAS; Standford et al., 2001).
  5. Clinically significant anger determined by scores of >12 on the Dimensions of Anger Reactions (DAR-5; Forbes et al., 2014) scale.

Exclusion Criteria:

  1. Currently suicidal or homicidal ideation severe enough to warrant immediate attention (as determined by the Depressive Symptoms Index - Suicidality Subscale and the Self-Injurious Thoughts and Behaviors Interview short form) and corroborated by a clinical risk assessment by a credentialed provider.

  2. Unable to complete self-report measures based on clinical judgement.

  3. Current manic episode as indicated on the Mood Disorder Questionnaire (MDQ; Hirschfeld et al., 2000) or experiencing psychotic symptoms as indicated on the Prodromal Questionnaire (PQ-16; Ising et al., 2012) requiring immediate stabilization or hospitalization (as determined by clinical assessment and judgment).

  4. Had a psychotropic medication change within 4 weeks prior to the baseline assessment. Service members receiving general mental health services or engaging in usual care will be allowed to participate.

    -

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Manage Emotions to Reduce Aggression (MERA) X Self-Monitoring

MERA followed by Self-Monitoring.
Behavioral: Manage Emotions to Reduce Aggression (MERA)

Three session treatment that teaches the adaptive value of emotions and emotion regulation skills.

Behavioral: Self-Monitoring

Three weeks of tracking anger and aggression and weekly check-ins with study team to assess for risk level.
Active Comparator: Self-Monitoring X Manage Emotions to Reduce Aggression (MERA)

Self-monitoring followed by MERA.
Behavioral: Manage Emotions to Reduce Aggression (MERA)

Three session treatment that teaches the adaptive value of emotions and emotion regulation skills.

Behavioral: Self-Monitoring

Three weeks of tracking anger and aggression and weekly check-ins with study team to assess for risk level.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Overt Aggression Scale - Modified (OAS-M)
Time Frame: Baseline to 4-week, 8-week, and 20-week post treatment assessments.

Overt Aggression Scale (OAS; Yudofsky et al., 1986) is a 16-item self-report measure that assesses frequency of verbal and physical aggression against self, other, and objects. Investigators added 3 items to assess aggression while driving and in virtual communication (e.g. aggression while texting or emailing) and gave a blank for other aggressive behavior. Investigators adapted the instructions to rate aggression over the past week. There are 20 items on the OAS-M. Pilot data demonstrated that this adapted measure is sensitive to detect changes in aggression frequency during the 3 weeks of MERA (Miles, Kent, et al., 2020). Self-reported aggressive acts will be summed to create an OAS total frequency count of aggressive acts at each assessment, with greater scores indicating more acts of aggression in the past week.
Baseline to 4-week, 8-week, and 20-week post treatment assessments.
State-Trait Anger Expression Inventory-2: State Anger (STAXI-2 S-Anger) Subscale
Time Frame: Baseline to 4-week, 8-week, and 20-week post treatment assessments.

State-Trait Anger Expression Inventory-2 Subscale-Anger (STAXI-2 S-Anger; Spielberger, 2010) is a 15-item subscale from the STAXI-2 that measures anger. Investigators adapted the instructions to measure anger in the past week. Items in this subscale ask participants to indicate how much they are experiencing certain feelings and desires on a four-point scale ranging from 1 (not at all) to 4 (very much so). Scores are summed to assess the overall intensity of anger felt in the past week. The total score range is 15-60, with greater scores indicating higher levels of anger.
Baseline to 4-week, 8-week, and 20-week post treatment assessments.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
James A. Haley Veterans Administration Hospital

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Shannon Miles, PhD, James A. Haley Veterans' Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
December 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
January 1, 2029

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 1, 2029

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
October 27, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 5, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 12, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 12, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 5, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
November 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • IRBnet #: 1937626
  • HT94252510651 (Other Grant/Funding Number: Department of War)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Sharing of the data collected in the conduct of the proposed project will be deposited into the National Institutes of Mental Health (NIMH) Data Archive (NDA) and the UT Health San Antonio Institutional Review Board (IRB)-approved STRONG STAR Repository (HSC2010-475H) for future use.

IPD Sharing Time Frame

One year after the end of the study.

IPD Sharing Access Criteria

Any future research using Repository data will require a research protocol for the proposed study reviewed and approved by an authorized official responsible for protecting human subjects of research. The data protections for privacy and confidentiality described in the consent form will apply to any future use of stored data.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF
  • ANALYTIC_CODE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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