REPS

Rational Thinking, Emotion Regulation, and Problem Solving (REPS): Development and Evaluation of a Mobile App to Enhance Warfighter Mental Fitness and Readiness

Principle Investigator: Marjan G. Holloway, Ph.D.

Co-Investigator: Joseph Grammer, BS, BA

Co-Investigator: Steven MacDonald Hart, Ph.D.

Co-Investigator: Sarah McInerney, Ph.D.

Funded By: The Defense Suicide Prevention Office (DSPO)

History

Based on 50 years of evidence for cognitive behavior therapy (CBT) and rational emotive behavior therapy (REBT), the REPS program was developed to improve rational thinking, emotion regulation, and problem-solving in Service members. Originally, Military Training Instructors delivered the traditional, in-person REPS program early in a service member's career. Pilot testing conducted prior to the COVID-19 pandemic demonstrated the feasibility, acceptability, and appropriateness of REPS among enlisted personnel, instructors, and leadership. Consequently, the USUHS study team contracted with The Information Application Group, Inc (TIAG) to develop the REPS mobile application.

Purpose

  • The purpose of the current project is to disseminate the REPS App, evaluate its impact on mental fitness outcomes, and collect valuable implementation-related data through a hybrid type 1 effectiveness-implementation trial. The effectiveness-implementation trial will proceed in two phases. 

  • Phase 1, Field Testing, we will ask N = 30 enlisted Service members and members of key stakeholder groups (e.g., officer-level leadership, mental health providers) to use the app for approximately 1 week and then complete online questionnaires, with a subset invited to participate in semi-structured debriefing interviews. 

  • Phase 2, Evaluation, we will ask N = 509 enlisted Service members to use the app for approximately 1 month and complete online questionnaires at baseline, 1-month, and 3-month follow-up timepoints, with a subset invited to participate in semi-structured focus groups to provide additional feedback. 

  • For both Phase 1 and Phase 2, primary outcomes will include measures of mental fitness, including rational thinking, emotion regulation, and problem-solving. Secondary outcomes will consist of automatic thoughts, emotion dysregulation, coping self-efficacy, psychological distress, and perceived stress. Data on implementation, including adoption, acceptability, appropriateness, feasibility, fidelity, and quality, will also be collected.

Current Status:

  • The Suicide CPR team, in collaboration with TIAG, has created a working prototype of the REPS App.

  • First draft of the REPS App IRB protocol has been completed. 

  • The suicide CPR team is now working with USU IT to publish a Google Firebase platform to collect implementation-related data for the REPS App.

Military Relevance

Enlisted military personnel face numerous challenges across the span of their service, including acculturation, deployment-related stress, competing demands, and high operational tempo. These warfighters must develop mental fitness and readiness skills to navigate a dynamic, fast-paced military environment while also managing the daily challenges and stressors of their personal lives. Foundational skills in mental fitness, similar to other warfighting skills, can be taught in a structured manner and practiced over time to reinforce habit formation and self-efficacy in adjusting to life change.

Scholarly Dissemination:

  • Suicide Care, Prevention, and Research Initiative. (2023). Chaplains-CARE program in military suicide prevention: Final report. Bethesda, MD: Uniformed Services University of the Health Sciences.

  • Lee-Tauler, S. Y., Grammer, J., LaCroix, J. M., Walsh, A. K., Clark, S. E., Holloway, K. J., Sundararaman, R., Carter, K. M., Crouterfield, B., Hazlett, G. R., Hess, R. M., Miyahara, J. M., Varsogea, C. E., Whalen, C., & Ghahramanlou-Holloway, M. (2023). Pilot evaluation of the online ‘Chaplains-CARE’ program: Enhancing skills for United States military suicide intervention practices and care. Journal of Religion and Health, 62(6), 3856–3873 .https://doi.org/10.1007/s10943-023-01882-9

Relevant Products And Resources

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REPS APP

Fully functional and freely available mobile application, titled “REPS for Mental Fitness,” available on Google Play Store and Apple Store.

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Study Results

Feasibility and usability study results (e.g., acceptability, engagement, retention)

Pilot and evaluation trial datasets for evaluating primary and secondary outcomes

Implementation metrics

De-identified datasets suitable for secondary analysis, consistent with federal data-sharing policies

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Future Directions

Recommendations for integration of app within existing military health and readiness programs

Lessons learned reports on barriers and facilitators to adoption in operational settings