Aggression in Military Personnel (MERA)

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: Not yet recruiting
• Conditions: Anger; Aggression; Posttraumatic Stress Disorder (PTSD)
• Intervention / Treatment: Behavioral: Manage Emotions to Reduce Aggression (MERA); Behavioral: Self-Monitoring

• Study Type: Interventional
• Enrollment (Estimated): 106
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Shannon R Miles, PhD; Phone Number: 106728 8139-972-2000; Email: shannon.miles@va.gov
• Study Contact Backup: Name: Michelle Gaudet; Phone Number: 813-485-2968; Email: Michelle.Gaudet@va.gov

Participation Criteria

Eligibility Criteria

• 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.

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Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
Overt Aggression Scale - Modified (OAS-M)	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	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

• Sponsor: James A. Haley Veterans Administration Hospital
• Investigators: Principal Investigator: Shannon Miles, PhD, James A. Haley Veterans' Hospital

Publications and helpful links

General Publications

• Yudofsky SC, Silver JM, Jackson W, Endicott J, Williams D. The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry. 1986 Jan;143(1):35-9. doi: 10.1176/ajp.143.1.35.
• Spielberger CD. STAXI-2: State-trait anger expression inventory - 2. 1999. Lutz, FL: Psychological Assessment Resources, Inc.
• Miles SR, Kent TA, Stanley M, Thompson KE, Sharp C, Niles BL, Young-McCaughan S, Mintz J, Roache JD, Litz BT, Hale WJ, Stanford MS, Keane TM, Peterson AL; Consortium to Alleviate PTSD. Manage Emotions to Reduce Aggression: A Pilot Study of a Brief Treatment to Help Veterans Reduce Impulsive Aggression. J Nerv Ment Dis. 2020 Nov;208(11):897-903. doi: 10.1097/NMD.0000000000001229.

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2026
• Primary Completion (Estimated): January 1, 2029
• Study Completion (Estimated): September 1, 2029

Study Registration Dates

• First Submitted: October 27, 2026
• First Submitted That Met QC Criteria: November 5, 2026
• First Posted (Actual): November 12, 2026

Study Record Updates

• Last Update Posted (Actual): November 12, 2026
• Last Update Submitted That Met QC Criteria: November 5, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Keywords: PTSD; aggression; anger; service member
• Additional Relevant MeSH Terms: Trauma and Stressor Related Disorders; Aberrant Motor Behavior in Dementia; Mental Disorders; Behavioral Symptoms; Stress Disorders, Traumatic; Behavior; Social Behavior; Aggression; Stress Disorders, Post-Traumatic; Investigative Techniques; Therapeutics; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Blood Chemical Analysis; Clinical Chemistry Tests; Diagnostic Techniques, Endocrine; Monitoring, Physiologic; Self-Testing; Self Care; Blood Glucose Self-Monitoring
• Other Study ID 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