PTSD Coach: A Professional Review

Product Description

PTSD Coach is a completely free, self-help mobile app available for both Android and iOS phones for management of symptoms related to trauma and Post-Traumatic Stress Disorder (PTSD).  The app, first launched in 2011, was developed by the U.S. Department of Veterans Affairs’ (VA) National Center for PTSD in partnership with the Department of Defense National Center for Telehealth and Technology.  The app is not meant to replace professional mental health services and is focused on those who are seeking a form of self-help, and who may currently want to engage in care and/or are currently undergoing psychological or medical care, or may be interested in learning more about treatment options.  The app also provides information and resources to reduce barriers and stigma in obtaining mental health support. The app features scientifically-based coping strategies, brief assessments, and psychoeducation as well as access to crisis support services and also provides the ability to create a safety plan within the app.  

The user may engage with the app in any order or within any section as they choose—as there is no predetermined structure or content to navigate within the app.  As such, the user may engage with PTSD Coach for as long or as little time as they wish.  The app may be used indefinitely as content can be used in a range of symptom experiences with the use of the app being within just a few minutes or longer depending on the user’s engagement or interest. The user may also personalize the app with pictures, images, sounds, and music—and save coping strategies to a “favorite” section as well as connect the app to specific contacts and useful resources and national hotlines that the user chooses to include—if these are not provided already with in the app. 

Recommendations for Use

The app is for any adult who is experiencing symptoms of PTSD, has experienced trauma, and/or would like to learn more about PTSD. The app may also be helpful for those experiencing symptoms of anxiety and depression, which often co-occur with PTSD symptoms.  Caregivers or those whose loved one’s experience trauma symptoms may also find PTSD Coach helpful in learning more about the impacts of trauma and PTSD.  The app is designed to be a self-management or self-help tool, which is not meant to replace professional psychological care for PTSD.  The app can be used within mental health treatment as a tool to further augment psychological care.  The app provides those who have never sought mental health treatment with multiple supportive symptom management options and education about PTSD, which may assist those to become more familiar with symptom management tools.  Those who may have had treatment for PTSD may be familiar with the tools on the app and there is a variety of content that would support many CBT interventions used within mental health care.   

The app can be used as needed or daily given there may be multiple reasons an individual chooses to engage with the app, such as for example when the user is experiencing distress and/or are looking for support.   Users may experience more benefit from engaging with the app multiple times a week. The app has several features to customize and for users to save the tools they find most helpful in a “favorites” area making these tools quicker and easier to access when distressed.  Users may also track how helpful they perceive a tool given the app will ask users to rate how distressed they feel prior to a tool beginning and will check in again following the ending of the tool. In addition, users may find additional information by taking the self-assessment (found in the track progress section) periodically to track symptom progress and also in reading material to learn more about PTSD and types of treatment of PTSD symptoms (in the Learn section).  The app may also serve as a springboard for those who may wish to find more integrated or in-person care as the Learn section provides resources and readings about common questions that individuals may have when first seeking out psychological care.  

Clinicians may benefit from reviewing features of the app and consider use for adjunct supportive ideas for client use, which may be especially appropriate in the beginning phases of therapy.  Providers in fields associated with caring for individuals with PTSD may find the app helpful to provide resources to patients for example—within a primary care setting, adult educational settings (i.e. colleges or universities, or even within EAP programs). Researchers may also be interested in the app for research purposes given the potential far-reaching impacts and efficacy of the app in various settings and with multiple populations—as further research in the use of PTSD Coach for multicultural populations and in additional settings is needed.    

I encourage clinicians that may recommend this app to clients to review its content and perhaps engage in some of the exercises together with the client to model its usefulness as well as further tailor the use of the app to potential treatment or for additional support to try outside of session (i.e. body scan, grounding exercises, visualization—to name a few).    

Content

The content featured within PTSD Coach was created by expert clinicians and psychologists who specialize in the research and treatment of PTSD.  The app was launched in 2011 and has undergone multiple updates.  The featured content on the app is divided into four main modules, with quality content within each module.  The modules are: Manage Symptoms, Track Progress, Learn, and Get Support. Each section of the app provides appropriate and robust content as well as resources for the user.  The content across the four module is based on empirically supported and evidence-based findings within the scientific literature on PTSD.  There is robust content on this app and each module and section provide clear and focused information.  In addition, the content also underwent focus group studies to further increase the usefulness and appropriateness of the content within the app.  

The “Manage Symptoms” provides multiple coping strategies or “Tools” based on cognitive-behavioral interventions appropriate for self-management for symptoms of PTSD.  The user may engage with this section either by viewing as “symptoms” or by “tools.” Examples of some symptoms that may be common to those experiencing symptoms of PTSD include “reminded of trauma”, “avoiding triggers”, “disconnected from people”, “disconnected from reality.” Once a user chooses a symptom, they are guided to a type of tool that is focused on reducing distress. Additional tools or coping strategies on the app included breathing exercises, meditation, viewing soothing images, ambient sounds, ideas to connect with others, and leisure activities.  Many of the sections within a specific tool may offer more than one idea, so that if users do not find the first suggestion helpful there are other options available to try.  The most recent update to PTSD Coach (included within this section) include inspirational quotes, ambient sounds, soothing audio (which the user can upload tracks or music); however, it is unclear if these tools are based on CBT.   Users may also customize their tools by importing images, music, sounds, and pictures.  

The “Tracking Progress” module contains a self-assessment, the PTSD Checklist-Civilian (PCL-C), which provides results and the option to track progress and symptom management by users having the option to retake the assessment at a later time to determine if overall symptoms have improved. The app also provides users with the option to create reminders to schedule a time to take the assessment later and a reminder to review their safety plan. 

The “Learn” module provides a wealth of psychoeducational to assist users in learning about PTSD symptoms, how long it lasts, treatment options, information about counseling, resources to access a counselor or therapy, as well as psychoeducation tailored to topics related to family, marriage, children, and resources to support children who also may be experiencing PTSD symptoms.  

The “Get Support” module provides users with the ability to customize by adding personal supportive contacts, and national or local crisis number hotlines. This module also includes quick dialing access to emergency services (i.e. 911) and national crisis number hotlines (i.e., National Suicide Prevention Lifeline, National Domestic Violence Hotline, Veterans Crisis line-Text and Chat, national Sexual Assault Hotline).  In addition, the app recently added a self-guided creation of a Safety Plan within the app for suicidal ideation or high level of distress symptoms.  The safety plan can be located on the apps index section (the three bars on the left upper screen)

A number of studies have investigated the use of PTSD Coach to reduce distress and symptoms of PTSD.  In a preliminary study that app was perceived as moderately to highly helpful in a sample of veteran participants (Kuhn et al., 2014).  Miner et al. (2016) conducted a pilot study which suggested that participants found the app easy to use and accessible during one-month of using PTSD Coach. Kuhn et al. (2017) further examined the efficacy of PTSD Coach with a randomized, larger sample size and longer duration (three months) of using PTSD Coach to manage symptoms of PTSD. Results of this study suggested participant’s level of PTSD symptoms significantly decreased and improvements within participant’s symptoms of depression and psychosocial functioning also were observed.  Furthermore, overall improvements in symptoms were maintained three months later (Kuhn et al., 2017).   In addition, a study found that when PTSD coach was used with the support of a clinician, by veterans with PTSD in a VA primary care setting, participants showed a decrease of PTSD symptoms and tended to be more receptive to a referral for mental health (Possemato, Kuhan, Hoffman, et al., 2015).   Most recently, Tiet et al. (2019) found more than 70% of users who had used the app 1 to 2 times a week for three months and engaged in six brief telephone support calls reported a significant decrease in symptoms of depression and a higher quality of life.  Overall, these studies point to the usefulness of PTSD Coach in assisting participants to better manage symptoms.    

Ease of Use and User Experience

The app is very easy to use and straightforward. While it does not have a particular structure or guided integration of using the app, the app provides recommendations and guidance for how to make the most out of using the app (i.e., tracking progress and taking the short assessment for feedback, using the app when upset or distressed, personalizing the app, and engaging with the learning section of the app).  The app is customizable in multiple ways including being able to link supportive contacts from the user’s phone and any other phone numbers or links to being within the app for quick and organized access of natural supports, community supports, and national crisis lines as well as a calendar option for reminders.  Users can also upload photos or images, sounds/songs within the application that provide the user to have helpful and personal content available and organized when the user may be interacting with the app when in distress.  Interventions can also be saved as “favorites” making them much easier to find and quicker to access.  

The app is easy to use for those who are not as familiar with apps to those who may use apps all the time.  Users most likely will become comfortable using the app within the first time or two using the app.  The app only needs low bandwidth to initially download and once downloaded the app does not need internet to function.   

The app is set to provide anonymous usage data that does not collect any personal identifying information, location, or other sensitive data.  Usage data is never shared or sold.  The user may opt out of anonymous data being transmitted.  All data can be deleted from the user’s phone. During the time of the review the app functioned well, and no glitches or issues were observed.

Visual Design and User Interface

The interface of PTSD Coach provides a simple white and blue color scheme on the main screen and each module continues to follow this same visual design; however, the Manage page incorporates more colorful images that correspond to the content.  There is not visual consistency across these images (i.e., use of landscapes, abstract images, to basic figures) and in addition, several images used may be upsetting or disempowering to some users (i.e. an angry face for managing anger or a silhouette of a head with lightning bolts inside). 

The layout is well organized and consistent throughout the app—making engaging with content easy and without barriers.  When adding customization, the flow of the app organizes this information in a way to further enhance the use of the app and ease of use within the application—to the degree the app will begin to feel familiar and provide natural reminders for those using the app.   The app will also adjust to mobile settings for those with visual and auditory disabilities or impairments. 

Overall Impression

PTSD Coach is a user-friendly app that provides high quality content and lots of options for customization and personalization. The app is backed by science, and provides progressive muscle relaxation, breathing training, and mindfulness approaches-among other CBT based tools to assist users who are experiencing symptoms of PTSD/trauma, anxiety, and depression.  Given it can be downloaded in low bandwidth areas and does not need internet to function, it has the capacity to be helpful to a wide range of adult users, who can easily become comfortable using the app and find strategies and information that may be most helpful to what a user may be experiencing or wanting to learn more about PTSD. Much of the content is also available on a website for those who do not have access to a smartphone device. 

While there is research that supports the efficacy of PTSD Coach, users most likely will need to use the app 1-2x a week for a few months to gain benefit from the app.  A benefit of the app is the user’s ability to rate how they feel prior to trying a tool and how they feel after—to gather further awareness of how helpful the content of the app is for their particular experiences of symptoms (the user may also disable the scale, which is helpful for those who may be using the app for the longer term and know what works best for them). The customization of the app, when used as a support for those who may already be engaged in psychological care, may also serve as a springboard for a discussion during an appointment or session of natural supports, words/phrases that a user may find inspirational, or types of soothing music, photos, and images.  These opportunities for discussion may also provide psychologists or other supportive clinicians or providers with additional ways of exploring and discovering with their patient/client cultural factors, needs, and traditions that are important within the patient/client’s experience of trauma and salient to their recovery.  

The Learning section is very robust and provides lots of helpful information that also can be of assistance to family members and even for those with children, which is a unique feature of this app and one I have found to be helpful for several of my clients and supervisees.   Furthermore, the app provides detailed information for those what may be considering psychological care, which seeks to reduce stigma and barriers and empower those who are trying to improve their symptoms. 

Users, given that we are within the time of COVID-19, do need to be aware of the limitations of content on this app, which have not been updated since the pandemic began (however, there is a COVID Coach also developed by the VA) and may further point client’s to coping strategies that are simply not possible currently or are unhelpful given the changes we are all experiencing due to the pandemic.  The app, while based in CBT, does not provide much of cultural considerations on the surface of the app.  As such, users and those who recommend the apps to others within the medical or mental health professions, may provide exploration of the app together with the user and discuss potential modifications to coping strategies to better adapt for client’s use and cultural considerations/factors.  PTSD Coach may be helpful in the initial phases of in-person treatment and as a support outside of session.  Clinicians may find the app helpful in reviewing and creating an accessible and readily usable safety plan with clients.  PTSD Coach needs to incorporate additional voices of POCs, those with disability or acquired disabilities, or those from marginalized or oppressed groups, especially in aspects of leisure activities and inspirational quotes, as this may also improve outreach and development of additional tools to assist users.

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