1. Introduction
TBI, traumatic brain injury
This pilot study assessed the feasibility of using SwapMyMood, a smartphone application supporting evidence-based strategies for emotion regulation and problem-solving as a supplement to conventional care for military service members and veterans (SM/Vs) experiencing chronic symptoms of mild traumatic brain injury (mTBI) and co-occurring psychological conditions. Eight military SM/Vs were recruited from an intensive outpatient program. Participants were block randomized to an experimental group (conventional care plus use of the SwapMyMood app) or a conventional care only group for six weeks. Conventional care included instruction on problem-solving and emotion regulation strategies using traditional paper manuals and protocols. Effects on the knowledge and use of strategies and related goal attainment were measured. Patient-reported outcomes were measured via several validated problem-solving and emotion regulation scales. No differences were found between groups in goal attainment, global executive function, problem-solving, emotion regulation, and knowledge of how to use the problem-solving and emotion regulation strategies targeted. Experimental group participants rated the application positively, demonstrating feasibility of integration of the app into clinical care. The implementation of SwapMyMood is feasible in a clinical setting. SwapMyMood may be a clinically effective supplemental tool for supporting executive function in SM/Vs with mTBI and co-occurring psychological conditions.Between 2000 and 2022, 458,894 military service members were diagnosed with traumatic brain injury (TBI), with the majority being mild TBI (mTBI) [Several studies support the use of interventions that concurrently address cognition and co-occurring psychological conditions following mTBI, including the use of metacognitive strategy instruction (thinking about one’s thinking) [Barriers to the successful use of interventions by individuals with TBI include lack of access to the recommended frequency of treatment and challenges applying interventional tools to environments outside of supportive treatment settings [SwapMyMood addresses barriers to traditional metacognitive strategy instruction by offering personalized solutions to individualized challenges that have shown to be effective for real-time situational coping. It supports users in recalling and implementing multi-step, executive functioning strategies. The app also provides feedback about actions that have previously been successful in helping the user with problem-solving and emotion regulation (The research questions for this feasibility study are: (1) will the addition of the use of SwapMyMood result in at least equivalent clinically meaningful change in self-reported executive functioning and goal attainment compared to use of Executive Plus/STEP Program paper manuals alone in SM/Vs with mTBI and co-occurring psychological conditions?; (2) will SM/Vs with mTBI and co-occurring psychological conditions rate SwapMyMood usability as acceptable?; and (3) is the study design feasible for conducting this research within a clinical setting? The research protocol was embedded in a clinical program to provide insight on intervention implementation in a real-world healthcare setting. 