PE Coach is an app created for those coping with and healing from posttraumatic symptoms and are engaging in Prolonged Exposure Therapy with a licensed therapist.. This app is used in conjunction with the client’s therapy and offers a user-friendly step-by-step guide to working toward recovery from trauma. PE Coach clearly explains potential impacts of traumatic experiences and why Prolonged Exposure can be helpful for specific trauma symptoms including avoidance and hypervigilance. PE Coach offers a comprehensive supplemental treatment plan including ongoing assessments, coping skills, psychoeducation, weekly exercises, and the necessary organization for recovery from trauma.
PE Coach was designed by the U.S. Veterans Administration’s National Center for PTSD and was initially designed for military trauma survivors. However, it is available to all, and can be downloaded for iPhone, Android phone, iPod Touch, iPad, or Android tablet mobile devices. PE Coach includes strategies to increase the likelihood that patients will complete their homework, which is an essential component of PE treatment.
Recommendations for Use
PE Coach is not designed for self-help but as a supplement to Prolonged Exposure (PE) Therapy with a licensed therapist. Patients are to use the app each week in conjunction with their treatment. PE involves not only individual therapy sessions, but careful documentation of symptoms, including thoughts and feelings, between sessions. Patients can use the app to record their therapy sessions, which can be especially useful for those with memory difficulty or those who find it useful to think more deeply about their concerns between sessions.
Sometimes patients have difficulty completing these between-session assignments, and this app is designed to assist with this. Homework assignments themselves are not optional, and must be completed to progress through the app. This app appears to be most helpful for those who are experiencing high levels of avoidance related to their traumatic experience and are open to challenging themselves to take steps toward slowly exposing themselves to identified triggers.
The content of this app closely reflects the work of Prolonged Exposure Therapy (Foa, Hembree, Rothbaum, 2007) translated to a digital medium. The information within the app is clear and high quality, though the psychoeducational readings are brief and could provide clearer detail and informationThe purpose of the app and what it is intended for is clearly communicated. The app provides a helpful introduction to Prolonged Exposure therapy, as well as first steps to take first upon downloading. Patients can use the app to review the purposes of PE therapy and the assignments. The app provides especially good explanations of PTSD and its symptoms and allows the patient to write notes, so they remember topics to discuss with their therapist in future sessions. The app also allows the patient to write about typically avoided locations, situations, and events so they can discuss these later with their therapist.
The app allows the patient, together with their therapist, to create an “in vivo hierarchy,” which is an important step in implementing PE therapy. This will typically be done in the therapy session and will allow the client to then track situations that are avoided, and to understand why such situations are avoided or cause symptoms. Such a hierarchy then allows the patient and therapist to explore the patient’s core fears and test specific beliefs related to the traumatic experience. Once an in vivo hierarchy is created and continually modified over the course of therapy, the app provides the mechanism for the client to track avoidance behaviors, distorted beliefs, and safety behaviors which are part of the PE treatment model.
There are brief reading materials that the patient can read or be assigned, including common reactions to trauma such as fear and anxiety, re-experiencing, avoidance, irritability and anger, guilt and shame, and use of alcohol and drugs. Understanding these symptoms can be helpful to the patient and allow them to recognize that these symptoms are common for those who have experienced trauma.
Ease of Use and User Experience
The app is comprehensive and relatively easy to use. The app reviews common traumatic symptoms and is presented in an easy to understand manner.. It was initially slightly confusing to know where to begin and how to set up weekly tasks, but after spending a brief amount of time familiarizing myself, I was able to learn the operation quickly. Navigation is intuitive and all aspects of the app are thoroughly labeled. A user with little to moderate technology experience would still be able to navigate the app with little coaching from their therapist.
The app allows the patient to keep all information about their treatment in one place, including the name and contact information for their therapist, their appointment schedule, their homework assignments, and an ongoing tracking chart for their symptoms using the Post Traumatic Stress Disorder Checklist (PCL-5) and the PHQ-9 for tracking depression symptoms. This can be helpful for both the patient and therapist, who can observe both progress and difficulties in recovery.
Visual Design and User Interface
The visual design and user interface of the app were visually appealing and audience appropriate. Color schemes were neutral yet welcoming. The app’s dimensions were well labeled which made the layout easy to understand and follow. The information was concise, which I think is a strength for both veterans and other populations experiencing trauma. Text within the app, and specifically within weekly reading assignments, was small and may be hard to read for some users. Important organizational features such as setting reminders and returning to the main page were easy to access, which was helpful for navigating.
This app has the potential for excellent therapeutic benefit for patients and therapists who are engaging in Prolonged Exposure Therapy.
The limitations of this app are not related to the app itself but to the limitations of Prolonged Exposure Therapy. PE is most effective when a “trauma” can be identified, discussed, and processed, consistent with the treatment modality. Individuals who cannot identify a specific trauma, such as those with amnestic experiences or traumatic brain injuries, may have challenges engaging in this treatment. Furthermore, many providers are not trained in PE and as this app does not train providers to do PE, the application of the app is limited by availability of appropriate providers.
Both military veterans and other patients who are very dedicated to their therapeutic work will use this app regularly and it will be a great assistance to their therapy, including psychoeducation, exposure assignments, and increased coping. The ongoing assessments and reminders will be helpful for sustaining motivation to use the app, completing assignments, and staying engaged in treatment. The app could be improved by providing introductory instructions while patients are familiarizing themselves with the app, providing more detailed psychoeducational readings or resources for continued reading, and expanding coping skill options to diversify internal resources. The app was well designed with military veterans in mind and gives consumers the guidance and resources needed to engage in trauma-informed therapy.
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Treatments that work: Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. Oxford University Press. https://doi.org/10.1093/med:psych/9780195308501.001.0001
Spinazzola, J., van der Kolk, & Ford, J. D. (2018). When nowhere is safe: Interpersonal trauma and attachment adversity as antecedents of post-traumatic stress disorder and developmental trauma disorder. Journal of Traumatic Stress, 31(5). 631-642. https://doi.org/10.1002/jts.22320