A Randomized Controlled Trial of a Smartphone App for addressing distress and wellbeing in a high-trauma risk population

Participants will be randomised to one of two smartphone applications: 1) the intervention app (Build Back Better App- Intervention) or 2) a control Mood Monitoring application (Build Back Better App - Control). The Intervention condition: Build Back Better App The app: Build Back Better, was developed by researchers from the Workplace Mental Health Research Team at the Black Dog Institute and University of New South Wales (UNSW, Randwick, Australia) designed to reduce symptoms of common mental health disorders such as anxiety, depression and distress, and increase overall wellbeing. The app Build Back Better has been adapted from a previously developed app, HeadGear, a smartphone application-based intervention centred on behavioural activation and mindfulness therapy, designed to prevent depression and anxiety and improve wellbeing amongst workers in male-dominated industries (MDIs) (Deady et al., 2020)). Similar to HeadGear, the Build Back Better app focuses on the delivery of evidence-based therapy techniques through in-app activities such as psychoeducational videos, cognitive challenging, mindfulness exercises, value-driven activity planning, goal-setting, and coping skill development (gratitude, problem solving, sleep hygiene, grounding, alcohol reduction, assertiveness) presented in the form of videos (and voiceovers), audio tracks or activities. Other components of the app include a mood monitoring widget and support service helplines. The Build Back Better app-content is designed for day-to-day use, tailored to the needs of emergency service workers population incorporating app design preferences identified by this population. The app-content is tailored by the individual based upon user preferences, i.e. what complaints users are currently experiencing and what they would like to work on in the app. Participants in the intervention condition will be encouraged to engage with the app for around 10-15min each days for at least 4 consecutive weeks (the time period between baseline and post- assessment). After completion of final assessment (the 3 month assessment) participants will be encouraged to keep using the app. Engagement with the app will be monitored throughout the study by automatically records of: number of times App opened, number of ‘app-activities’ completed, number and level of mood logged, total time spent in App. However no active adherence strategies will be used to improve app engagement during the trial. Between August 2021 and December 2021, a pilot research study (Meuldijk et al. 2022, in preparation) was conducted to examine feasibility and efficacy of the smartphone app Build Back Better among a sample of ESWs (n=63) recruited directly from rural firefighters, disaster response, surf lifesaving, police, and corrections services across four Australian states and territories. Approval was obtained from UNSW Research Ethics Committee [UNSW HREC Reference number HC210399] all participants provided informed consent. The results of this pilot study helped to refine the app design and informed progression to the main trail.