PTSD Coach is a mobile application (app) developed by the Veteran’s Administration based on cognitive behavioral therapy (CBT) to be used as a stand-alone psychoeducation resource or to augment clinical care for post-traumatic stress disorder (PTSD).
PTSD Coach is available on iTunes and Google Play app marketplaces. Developed using a participatory design with iterative input from target end-users, PTSD Coach includes features to support immediate alleviation of distress and management of symptoms. PTSD Coach includes four components: Learn, Self Assessment, Manage Symptoms, and Find Support. The Learn module contains information about PTSD and its treatment, and addresses common questions and concerns. The Self-Assessment module allows users to take the PTSD Checklist-Civilian assessment (PCL-C), receive feedback about their responses, and schedule future assessments. In Manage Symptoms, users input information about experienced distress and are offered a coping technique based on information provided. Users can access coping techniques until distress is alleviated. The Find Support function provides users with information about emergency and crisis support services and contact information for professionals and personal contacts.
Link to commercial site here.
Cognitive Behavioral Therapy (CBT)
Post-Traumatic Stress Disorder
Young Adults (18-30)
Summary: This preliminary evaluation discusses the feasibility and acceptability of PTSD Coach. Of the 55 patients of VA residential PTSD treatment programs who expressed interest in participating, the authors discussed results from 45 participants in an initial feasibility study. Participants without a smartphone were loaned an iPod Touch preinstalled with PTSD Coach, participants who owned a smartphone could borrow an iPod Touch or use their phone. The study lasted three days. Participants were given a list of mandatory tasks to complete during the study and were otherwise able to use PTSD Coach as they pleased. After three days, participants took a survey about their experiences and participated in a focus group. Participants reported being satisfied with PTSD Coach and finding it helpful. Those participants who owned a smartphone reported being more satisfied than those who did not own a smartphone. Participants valued the mobility, simplicity, accessibility, and customizability of the app and noted features that they did not like, such as the visuals that accompany the breathing exercises and not being able to access specific coping tools. Finally, many participants reported that they would recommend PTSD or had already recommended PTSD Coach to others.
Take Away: This study demonstrated the acceptability of PTSD Coach for Veterans in treatment for PTSD. More research is needed to evaluate how PTSD Coach affects symptoms and to evaluate feasibility of implementation of PTSD coach in real-world settings.
Summary: This paper discussed user ratings and reviews and aggregate use data to examine the reach, use, reception, and impact of PTSD Coach among those who have used the app. The authors used an integrated analytics function to collect aggregate usage data for all unique downloads (N=153,834) and collected user opinions from app reviews (N=156) and star ratings (N=409) from the iTunes and Google Play app marketplaces. The authors also used user reports of PTSD symptoms and distress from the assessment and momentary distress rating functions of the app. Use analytics and user reviews suggest that the app was used as intended to receive assistance for symptoms as they occur. Users accessed PTSD Coach an average of 6.3 times before they stopped using the app. Usage of PTSD Coach fell over time, with 10.6% of users who downloaded PTSD Coach having used it after one year. Mean session length for all users was 47.7 seconds and mean total time spent using PTSD Coach for all users was around five minutes. Reviews and ratings of PTSD Coach were primarily positive. The most common themes from reviews involved the helpfulness and usefulness of the app, gratefulness for the app, and gratitude and appreciation for the VA. Reviews from iOS devices were more positive than those from Android devices and Android users mentioned technical problems in their reviews (46.6%) far more than iOS users (7.5%). Data from the momentary distress assessments, indicated that first time users, on average, experienced a significant decrease in distress of 1.6 points after using a symptom management tool. Return users experienced a significant decrease of 2.3 points in distress on average.
Take Away: This study describes real-world usage and evaluation of PTSD Coach, showing that users generally rate the app positively and that some use the app long-term. Rigorous evaluation of the app and its effects is needed.
Feasibility, acceptability, and potential efficacy of the PTSD Coach app: A pilot randomized controlled trial with community trauma survivors.
Summary: Participants were randomized to use PTSD Coach for a month or to a waitlist control group. Researchers recruited 49 participants using fliers and internet postings. Participants had to be at least 18 years old, speak English, not be currently receiving PTSD treatment, have an active e-mail address, and have a score of at least 25 on the PCL-C. Participants completed assessments at baseline, immediately post-treatment, and one month post-treatment. Researchers used the PCL-C to assess PTSD symptoms. Participants were also asked specific questions about their use of and experiences with PTSD Coach to assess feasibility and acceptability. Participants could use PTSD Coach on their phones; those who did not have smartphones could borrow an iPod Touch. Participants who completed all three assessments received $50 in gift cards. Five participants dropped out before completing the study. Participants reported using PTSD Coach an average of 2.65 times a week in the PTSD Coach condition and 2.5 times a week in the waitlist condition. Participants reported that the Learn and Manage Symptoms functions of the app were useful and that they learned new ways to cope with PTSD symptoms. About half of participants who used the app found that Manage Symptoms was the most useful part of the app. Five participants reported that the app was not useful. Participants in both conditions experienced reductions in PTSD symptoms. Researchers were hesitant to interpret efficacy results because of the low statistical power, low sample size, and unrepresentative sample.
Take Away: The results of this pilot support the feasibility and acceptability of PTSD Coach as an intervention for PTSD, but more rigorous trials of the efficacy of the intervention are needed.
Using PTSD Coach in primary care with and without clinician support: A pilot randomized controlled trial.
Summary: This pilot evaluated the feasibility and efficacy of PTSD Coach as a stand-alone self-managed experience versus as an augment to clinician-delivered cognitive-behavioral support. Patients were referred to researchers by primary care clinicians and screened for eligibility. Eligible participants were in VA primary care, had a PCL score greater than 40, were not intending to begin PTSD care, had not attempted suicide in the past two months, had not received outside mental health counseling for PTSD in the past two months, and had not had a change in dosage of psychotropic medication. Twenty participants were randomized to receive self-managed PTSD Coach (SM PTSD Coach) or clinician supported PTSD Coach (CS PTSD Coach), stratified by PCL score. Participants could borrow an iPod Touch or use their own device to access PTSD Coach. SM PTSD Coach participants attended one 10-minute session involving a basic introduction to PTSD Coach. CS PTSD Coach participants attended four 20-minute sessions based on the structure of CBT. The intervention lasted eight weeks and participants completed baseline, post-treatment, 12-week follow-up, and 16-week follow-up assessments. Assessments evaluated PTSD symptomology (PCL-S), depressive symptoms (PHQ-9), quality of life (WHO-QOL), and healthcare utilization. Participants received $120 for completing all assessments. Clinicians reported being satisfied with PTSD Coach and reported high usability and engagement. Participants in both conditions experienced reductions in PTSD symptoms; 70% of CS PTSD Coach and 38% of SM PTSD Coach participants reported clinically significant reductions (≥10 points) in PCL scores. CS PTSD Coach participants were more likely to accept mental health referrals and attend PTSD-focused treatment sessions than SM participants.
Take Away: This pilot demonstrates preliminary support for the feasibility and efficacy of PTSD Coach as a stand-alone self-management tool and as an augment to clinician-delivered care. Using the app as an augment to care can improve mental health care utilization and treatment adherence. Results warrant larger scale clinical trials of PTSD Coach in different care capacities.
Summary: Researchers recruited 120 adults with PTSD who were not currently receiving treatment using fliers and social media. Participants were assigned to use PTSD Coach for 3 months or to a waitlist control group who were told how to download PTSD Coach after 3 months. Participants completed assessments of PTSD symptoms, PTSD symptom coping self-efficacy, depression, and psychosocial functioning. Participants with an Apple device were given directions for how to download a research version of the app where researchers could track app usage. Researchers were unable to track app usage for participants with Android devices, who downloaded PTSD Coach from the Google Play marketplace. Participants who received PTSD Coach also answered one question about how many days they used PTSD Coach per week. PTSD Coach participants experienced significantly greater reductions in PTSD symptoms, depression, and psychosocial functioning between baseline and posttreatment, though mean scores were not significantly different between groups. Significantly more participants in the PTSD Coach group experienced a clinically significant decrease in PTSD symptoms (more than 10 points on the PTSD Checklist-Civilian) than the control group. Improvements in depression and psychosocial functioning were maintained at 6 months. Researchers were unable to evaluate between group differences at 6 months because waitlist participants were able to access PTSD coach after 3 months. Participants who downloaded PTSD Coach from iTunes used PTSD Coach 1.29 days per week, on average. Participants reported using PTSD Coach 2.27 days per week on average.
Take Away: PTSD Coach may improve PTSD symptoms, depression, and psychosocial functioning compared to waitlist control.
Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app.
Summary: Researchers used the Consolidated Framework for Implementation Research (CFIR) to analyze primary care patients and stakeholder perceptions of delivering Clinician-Supported PTSD Coach (CS-PTSD Coach) in primary care to help shape future implementation efforts. First, 9 stakeholders (providers and leadership) from 3 primary care clinics that serve patients with PTSD were surveyed and interviewed about the importance of CFIR constructs to the implementation of CS-PTSD Coach in primary care. Stakeholders indicated relative priority, available resources, compatibility, patient needs and resources, implementation climate, leadership engagement, and intervention knowledge and beliefs were important to CS-PTSD Coach implementation. Stakeholder interview responses reflected survey ratings of implementation constructs. Based on stakeholder feedback, researchers drafted a CS-PTSD Coach manual. Next, 3 primary care providers delivered CS-PTSD Coach to 9 veterans with PTSD for 8 weeks. After 8 weeks, patients completed a survey and interview about treatment satisfaction and primary care providers completed an interview about their experiences delivering CS-PTSD Coach. All patients reported good to excellent satisfaction with CS-PTSD Coach overall and with format and content of CS-PTSD Coach. Recommendations from primary care providers generally related to reducing the complexity of the intervention (e.g. streamlining of homework assignments), improving patient engagement (e.g., greater emphasis on collaborative goal setting, clarification of coping strategies), and meeting patient needs and resources (e.g., more information about flexibility with the protocol and conducting clinical sessions over the phone). Information from patients and primary care providers was used to refine the CS-PTSD Coach Manual.
Take Away: Researchers used the CFIR to guide development of a manual for delivering CS-PTSD Coach in primary care with feedback from primary care patients with PTSD and primary care stakeholders.