# Manage Emotions to Reduce Aggression - MERA: A Brief Aggression Treatment for Veterans with PTSD Symptoms

> **NIH VA I01** · JAMES A. HALEY VA MEDICAL CENTER · 2023 · —

## Abstract

This randomized clinical trial (RCT) tests the efficacy of an emotion regulation treatment, Manage
Emotions to Reduce Aggression (MERA), to decrease aggression in Veterans with posttraumatic stress
disorder (PTSD) and improve PTSD treatment initiation. Background: Veterans with PTSD symptoms
report difficulty controlling their aggression which can lead to devastating interpersonal and societal
consequences, such as incarceration, family violence, and disruption of social support. Veterans with
PTSD primarily engage in impulsive aggression (emotional, reactive, and uncontrolled) rather than
premeditated aggression (deliberate, instrumental, and planned). Emotion dysregulation, or
underdeveloped skills in emotional awareness, emotional acceptance, behavioral control, and/or content-
appropriate regulation strategies, fully mediates the relationship between PTSD severity and impulsive
aggression in Veterans. Additionally, Veterans report fearing their emotions as one reason they do not
initiate PTSD evidence-based psychotherapy. Emotion regulation appears to influence both aggression
and treatment initiation for Veterans with PTSD. Thus, this proposed study targets emotion regulation with
the goal of reducing impulsive aggression and preparing Veterans for PTSD evidence-based
psychotherapy. Research Plan: Our goal is to test the efficacy of an innovative emotion regulation
training, MERA, with a RCT of 204 Afghanistan and Iraq Veterans with PTSD and impulsive aggression.
MERA is provided in three sessions to address logistical barriers faced by younger Veterans who are
reintegrating into their communities. MERA incorporates education, cognitive-behavioral and acceptance-
based skills training. It also includes information about what emotional experiences to expect from PTSD
treatments. Three sessions of present centered therapy will serve as an active control group which is
consistent with treatment as usual. MERA and present centered therapy will be compared on changes in
aggression from Session 1 to the 2-month posttreatment changes. We predict Veterans who complete
MERA will have greater reductions in IA and emotion dysregulation as compared to Veterans who
complete present centered therapy. Finally, rates of PTSD evidence-based psychotherapy initiation
(attend 1 session), will be examined via a chart review 6 months post treatment. We predict Veterans who
complete MERA will initiate PTSD evidence-based psychotherapies at a greater rate than Veterans who
complete present centered therapy. Significance: This study supports 2 Veterans Affairs missions:
reduce aggression and increase PTSD treatment initiation. PTSD is one of the most commonly occurring
and costly psychiatric conditions among Veterans. Veterans with PTSD are more likely to engage in
aggressive behavior than civilians with PTSD or Veterans without PTSD. Reducing aggression is a critical
need for Veterans, their families, and society. Additionally, there are effective treatments that r...

## Key facts

- **NIH application ID:** 10703209
- **Project number:** 5I01CX002135-03
- **Recipient organization:** JAMES A. HALEY VA MEDICAL CENTER
- **Principal Investigator:** Shannon R. Miles
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10703209

## Citation

> US National Institutes of Health, RePORTER application 10703209, Manage Emotions to Reduce Aggression - MERA: A Brief Aggression Treatment for Veterans with PTSD Symptoms (5I01CX002135-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10703209. Licensed CC0.

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