Examining the Efficacy of the Man Therapy Platform in Reducing Problematic Anger Among Military Service Members With and Without a TBI History

Examining the Efficacy of the Man Therapy Platform in Reducing Problematic Anger Among Military Service Members With and Without a TBI History: A Randomized Controlled Trial

The goal of this randomized controlled trial is to determine if an interactive digital solution, Man Therapy, reduces indices of problematic anger in male military service members who screen positive for problematic anger.

The man questions this study aims to answer are:

• Does Man Therapy reduce indices of problematic anger?
• Does Man Therapy reduce psychosocial correlates of anger?

Researchers will also examine if the effects of those aims differ based on a participant's history of a mild TBI, the mechanism of a primary mild TBI, and/or the number of mild TBIs.

Researchers will compare Man Therapy to a waitlist control. This will help determine if Man Therapy works better than no treatment.

Participants will:

• Complete a baseline survey
• Be randomized to intervention or waitlist control
• If randomized to intervention, participants will receive the intervention and complete a survey immediately after the intervention and at 1-, and 3-months following the intervention
• If randomized to waitlist control, participants complete surveys at 1-, and 3-months and have the opportunity to complete the intervention following the 3-month survey

Study Overview

• Status: Not yet recruiting
• Conditions: Anger; Traumatic Brain Injury; Mild Traumatic Brain Injury (mTBI)
• Intervention / Treatment: Behavioral: Man Therapy

Detailed Description

Problematic anger is highly prevalent among military service members. Among service members, problematic anger prospectively predicts suicidal ideation, even after controlling for other psychiatric disorders. Existing approaches designed to reduce anger have not been shown to satisfactorily impact clinical outcomes across populations, and among service members receiving treatment for PTSD, anger is one of the few symptoms that persists even if a PTSD diagnosis subsides. Thus, there is a need to adapt existing problematic anger treatments for service members.

Man Therapy is an interactive digital solution that uses humor and straightforward language to circumvent traditional barriers to accessing mental health care. The aim of this study will evaluate the efficacy of the Man Therapy platform compared to waitlist control in reducing indices of problematic anger among male military service members with problematic anger. Participants will be randomized following the pre-intervention assessment. Participants randomized to receive Man Therapy will view the interactive digital solution in a single session. Assessments will occur pre-intervention, post-intervention, and at 1- and 3-month follow-ups. Waitlist controls will receive the intervention after the 3-month follow-up. The goal is to reduce indices of problematic anger and psychosocial correlates of anger.

Aim 1: To evaluate the efficacy of Man Therapy relative to waitlist controls in reducing indices of problematic anger among male military SMs who present with problematic anger (N = 226).

Hypothesis 1: Compared with waitlist controls at 1- and 3-month follow-ups, Man Therapy will result in lower levels of anger, as measured by the State-Trait Anger Expression Inventory-2 (STAXI-2) subscale of "State Anger (S-Anger)."

Objective 2: To evaluate the efficacy of Man Therapy relative to waitlist controls in reducing psychosocial correlates of anger (e.g., suicidal ideation, PTSD symptoms, poor interpersonal functioning) among male military SMs with problematic anger.

Hypothesis 2: Compared with waitlist control at 1- and 3-month follow-ups, Man Therapy will result in lower levels of (a) PTSD symptoms (PTSD Checklist for DSM-5 [PCL-5]), (b) suicidal ideation (Depressive Symptom Index-Suicidal Ideation [DSI-SS]34), and (c) poor interpersonal functioning (Interpersonal Needs Questionnaire-15 [INQ-15]).

Objective 3: To examine if the effects in Objectives 2 and 3 differ based on a participant's history of a mild TBI, the mechanism of primary mild TBI, and/or the number of mild TBIs.

Hypothesis 3: Compared with those without TBI, those with history of TBI will have higher levels of anger, as measured by the State-Trait Anger Expression Inventory-2 (STAXI-2), higher levels of PTSD symptoms (PTSD Checklist for DSM-5 [PCL-5]), more severe suicidal ideation (Depressive Symptom Index-Suicidal Ideation [DSI-SS]), and poorer interpersonal functioning (Interpersonal Needs Questionnaire-15 [INQ-15]).

• Study Type: Interventional
• Enrollment (Estimated): 226
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dr. Ian Stanley PhD; Phone Number: 720-848-6777; Email: emed_ManTherapy@cuanschutz.edu
• Study Contact Backup: Name: Julia Finn, MPH; Phone Number: 720-848-6777; Email: emed_ManTherapy@cuanschutz.edu

Study Locations

• United States
  • Colorado
    • Colorado Springs, Colorado, United States, 80913
      • Fort Carson
      • Contact: Julia Finn, MPH; Phone Number: 720-848-6777; Email: emed_stanleylab@cuanschutz.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Military service member
• Identify as male
• Aged 18+ years
• Positive problematic anger screen (DAR-3 >8)
• Ability to read, write, and speak English

Exclusion Criteria:

• Active psychosis or acute mania necessitating clinical intervention
• Acute thoughts of self- or other-harm necessitating imminent clinical intervention (e.g., hospitalization)
• Unable to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Man Therapy; Behavioral: Man Therapy Participants randomized to this arm will be offered Man Therapy, which is an interactive digital solution designed to reduce problematic anger.	Behavioral: Man Therapy; Man Therapy is an interactive digital solution that uses humor and straightforward language to circumvent traditional barriers to accessing mental health care, such as stigma. A core Man Therapy module focuses on anger, helping recipients to understand its causes and associated mitigating and potentiating factors, as well as teaching recipients accessible, easy-to-implement anger mitigation strategies, such as cognitive retraining and paced breathing. Participants will be given a list of content regarding anger to view and interact with in the Man Therapy website and encourages to explore the website further. They will then review and interact with materials for at least 20 minutes and up to 45 minutes in a single session.
No Intervention: Waitlist Control; Waitlist Control: Waitlist controls will be offered Man Therapy after the 3-month follow-up assessment. Using a waitlist control facilitates a comparison between the immediate effects of the Man Therapy intervention on problematic anger and co-occurring conditions and the natural progression of the conditions without intervention, as well as providing the control group with access to the intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State Anger (S-Anger) Subscale as Measured by State-Trait Anger Expression Inventory-2 (STAXI-2)	The STAXI-2 is a 57-item self-report measure of various dimensions of problematic anger. The STAXI-2 can generate scores on the following six subscales: state anger (S-Anger), trait anger (T-Anger), anger expression-out (AX-O), anger expression-in (AX-I), anger control-out (AC-O), and anger control-in (AC-I). Respondents rate each item on a 4-point scale from "almost never" to "almost always." Scores are summed within each subscale and higher scores represent more problematic anger.	From enrollment to the completion of a 3-month follow-up assessment.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PTSD symptoms (PTSD Checklist for DSM-5 [PCL-5])	The PCL-5 is a 20-item self-report measure of PTSD symptoms per DSM-5 diagnostic criteria. Participants rate how much they have been bothered by each symptom over the past month, using a 5-point scale (0 =Not at all, 1 = A little bit, 2 = Moderately, 3 = Quite a bit, 4 = Extremely). Responses are summed to generate a total score and symptom cluster scores corresponding to DSM-5 diagnostic criteria (i.e., intrusions, avoidance, negative alterations in cognitions and mood, hyperarousal); higher scores reflect more severe PTSD symptomatology.	From enrollment to the completion of the 3-month follow-up assessment.
Suicidal Ideation (Depressive Symptom Index-Suicidal Ideation [DSI-SS])	The DSI-SS is a 4-item self-report measure of the severity of suicidal ideation occurring over the past 2 weeks. Respondents rate each item on a 4-point scale ranging from 0 to 3 (e.g., Item 1: 0 = I do not have thoughts of killing myself; 1 = Sometimes I have thoughts of killing myself; 2 = Most of the time I have thoughts of killing myself; 3 = I always have thoughts of killing myself). Responses are summed to generate a total score ranging from 0 to 12; higher scores indicate more severe suicidal ideation.	From enrollment to the completion of the 3-month follow-up assessment.
Poor Interpersonal Functioning (Interpersonal Needs Questionnaire-15 [INQ-15])	The INQ-15 is a 15-item self-report measure of poor interpersonal functioning, including thwarted belongingness and perceived burdensomeness. These constructs, collectively assessing social disconnectedness, are proposed by the interpersonal theory of suicide to lead to the development of suicidal desire. Respondents rate each item (e.g., "These days, I rarely interact with people who care about me") on a 7-point scale ranging from 1 to 7 (e.g., 1 = Not at all true for me, 4 = Somewhat true for me, 7 = Very true for me). Scores are summed (range: 15-105) and higher scores indicate worse interpersonal functioning.	From enrollment to the completion of a 3-month follow-up assessment.

Collaborators and Investigators

• Sponsor: University of Colorado, Denver
• Collaborators: United States Department of Defense
• Investigators: Principal Investigator: Ian Stanley, PhD, University of Colorado Anschutz School of Medicine

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): November 30, 2028
• Study Completion (Estimated): December 1, 2028

Study Registration Dates

• First Submitted: May 13, 2026
• First Submitted That Met QC Criteria: May 19, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 29, 2026
• Last Update Submitted That Met QC Criteria: May 26, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Anger; Traumatic Brain Injury
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Craniocerebral Trauma; Trauma, Nervous System; Head Injuries, Closed; Wounds, Nonpenetrating; Brain Injuries; Brain Injuries, Traumatic; Brain Concussion
• Other Study ID Numbers: 25-1301; HT9425-25-1-0484 (Other Grant/Funding Number: Department of Defense)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: This trial involves sensitive participant information, including information regarding problematic anger, PTSD, and TBI and requires careful handling to prevent any negative impact on participants or their families.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No