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Program Profile: PTSD Coach Smartphone App for Posttraumatic Stress Disorder Symptoms

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on September 25, 2018

Program Summary

This is a smartphone app intervention designed to help manage and reduce posttraumatic stress disorder (PTSD) symptoms. The program is rated Promising. Over time, symptoms of PTSD, such as depression, and psychosocial functioning, reduced more for the treatment group, compared with the control group. However, there was no statistically significant difference in users’ confidence in managing their PTSD symptoms and reaching out for support.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Target Population
PTSD Coach aims to help individuals that have posttraumatic stress disorder (PTSD) symptoms manage and better understand their symptoms. Because smartphones are used by 68 percent of U.S adults, PTSD Coach is an accessible way for individuals to manage PTSD symptoms (Anderson 2015). Individuals can develop PTSD symptoms from various events, including physical and sexual assaults.

Program Components
PTSD Coach was created by the U.S Department of Defense and U.S. Department of Veterans Affairs National Center for PTSD-Dissemination and Training Division. A focus group consisting of PTSD patients and clinical staff was used to develop features and content for the app (Kuhn 2014). The PTSD Coach is a skills-based app that includes four major sections:
  • Learn: This section provides psychoeducational information about PTSD, including symptoms, prevalence rates, and how PTSD develops. The section also provides various treatment options and addresses questions and concerns. The section includes a subsection on professional care, with information on how to find help and what to expect from treatment.
  • Self-Assessment: This section includes the PTSD Checklist-Civilian version (PCL-C), a widely used and validated self-report measure of PTSD symptoms. Once the PCL-C is completed, users are provided feedback about the severity of their symptoms and information about changes in symptom severity. In this section, users can also track symptoms over time using a graph of past assessments. Future assessments can also be scheduled at set intervals with reminders for when the assessments are due.
  • Manage Symptoms: In this section, users can find coping tools to help address acute PTSD symptoms. Users rate their distress, and depending on their degree of distress, are offered a cognitive behavioral therapy-based coping tool such as paced breathing, progressive muscle relaxation, self-coping statement, or pleasant event options. After completing the coping tool, users can re-rate their distress and receive feedback. If distress is lower, users are encouraged to continue to use the tool; however, if distress remains the same or is higher, users are encouraged to try another tool.
  • Find Support: Users can reach out to supportive outlets, including an emergency (911) and a crisis support option. Users can also select phone contacts to include as their supporters. Links and phone numbers for finding face-to-face care with qualified professionals are provided.

Evaluation Outcomes

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Study 1
PTSD Symptoms
Kuhn and colleagues (2017) found that there was a statistically significant difference over time in posttraumatic stress disorder (PTSD) symptoms between PTSD Coach app users in the treatment group and nonusers in the control group. PTSD symptoms for treatment group users decreased more over time, compared with nonusers in the control group.

Symptom Coping Self-Efficacy
There was no statistically significant difference over time in PTSD symptom coping self-efficacy (which measures users’ confidence in managing PTSD symptoms and reaching out for support) found between the treatment and control groups.

Depression
There was a statistically significant difference in measures of depression between PTSD Coach app users in the treatment group and non-users in the control group. Measures of depression for treatment group users decreased more over time, compared with nonusers in the control group.

Psychosocial Functioning
There was a statistically significant difference between PTSD Coach app users in the treatment group and nonusers in the control group. Measures of psychosocial functioning for treatment group users improved more over time, compared with nonusers in the control group.
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Evaluation Methodology

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Study 1
Kuhn and colleagues (2017) conducted a randomized controlled trial to evaluate the impact of a smartphone app (PTSD Coach) used to assist individuals in managing their posttraumatic stress disorder (PTSD) symptoms. Study participants were recruited through flyers, media coverage, social media, and Craigslist. Participants were screened for eligibility using an online questionnaire or by phone.  For the study, participants were eligible to use the PTSD Coach app if they met the following criteria: 1) were at least 18 years old, 2) were fluent in English, 3) owned a mobile device capable of using the PTSD Coach app, 4) had been exposed to a traumatic event more than 1 month ago, 5) scored 35 or greater on the PTSD Checklist-Civilian version (PCL-C), and 6) were not currently being treated for PTSD.

The study used 120 adults who were randomized into either the treatment or control group. Participants in the treatment group (n=62) were assigned to use the skills-based PTSD Coach app. Users assigned to the PTSD Coach app were instructed to download the app to their smartphone (i.e., any IOS or Android device). The treatment group was 74 percent female and had an average age of 39. The trauma index for the treatment group included 50 percent physical assaults, 16 percent sexual assaults, 26 percent serious accidents, 2 percent life-threatening illness or injury, 2 percent combat exposure, and 3 percent other. The study used a wait-list condition (n=58), where participants received a delayed intervention. Participants in the control condition were only able to download the app after the treatment period. The control group was 63 percent female and had an average age of 39 years old. The trauma index for the control group included 43 percent physical assault, 12 percent sexual assault, 16 percent serious accident, 10 percent life-threatening illness or injury, 5 percent disaster, 3 percent combat exposure, and 10 percent other. At baseline, there were no significant differences between the treatment group and the waitlist condition.

PTSD symptoms were measured using the PTSD Checklist-Civilian version (PCL-C)-C tool, a 17-item self-report measure of DSM-IV PTSD symptoms. PTSD coping self-efficacy was assessed using a nine-item self-report tool that measures confidence in managing PTSD and in reaching out for support. Depression was assessed using the Patient Health Questionnaire Depression Scale (PHQ-8), an eight-item self-report tool that measured depression symptom severity and potential diagnosis. Psychological functioning was measured using the Brief Inventory of Psychological Functioning (B-IPF), which rates how much trouble a person had in the past month in relationships or other important areas of functioning.  An analysis of variance (ANOVA) was conducted to measure the posttreatment effects. No subgroup analyses were conducted.
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Cost

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The PTSD Coach app is free, publicly available, and compatible with all smartphones. Users can access it through the App Store or Google Play Store.
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Implementation Information

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More information about the PTSD Coach app can be found at the U.S. Department of Veterans Affairs website: https://www.ptsd.va.gov/public/materials/apps/PTSDCoach.asp
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Kuhn, Eric, Nitya Kanuri, Julia E. Hoffman, Donn W. Garvert, Josef I. Ruzek. 2017. “A Randomized Controlled Trial of a Smartphone App for Posttraumatic Stress Disorder Symptoms.” Journal of Consulting and Clinical Psychology 85(3):267–73.
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Additional References

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These sources were used in the development of the program profile:

Anderson, Monica. 2015. “Technology Device Ownership: 2015”. Pew Research Center.
http://www.pewinternet.org/2015/10/29/technology-device-ownership-2015

Kuhn, Eric, Carolyn Greene, Julia Hoffman, Tam Nguyen, Laura Wald, Janet Schmidt, Kelly M. Ramsey, and Josef Ruzek. 2014. “Preliminary Evaluation of PTSD Coach, a Smartphone App for Post-Traumatic Stress Symptoms” Military Medicine (12):12–18.
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Program Snapshot

Age: 18+

Gender: Both

Race/Ethnicity: Black, American Indians/Alaska Native, Hispanic, White

Setting (Delivery): Home, Other Community Setting

Program Type: Cognitive Behavioral Treatment, Victim Programs

Targeted Population: Victims of Crime

Current Program Status: Active