Longitudinal follow-up of the randomized controlled trial of access to the trauma-focused self-management app PTSD Coach.

Apps that target posttraumatic stress are rarely evaluated and long-term examination of symptom change is rare. In a waitlist-controlled randomized controlled trial, we found that the Swedish version of the self-management app PTSD Coach confers benefits on posttraumatic stress and depressive symptoms after three months use. Here, we aimed to evaluate between-group effects on functional disability as well as within-group changes on mental health, somatic illness and functional disability after access to the Swedish PTSD Coach app during 9 months. In addition, we described negative effects, helpfulness and satisfaction with the app. Among the 179 trauma-exposed adults (92 % women) randomized to instant access or delayed access to PTSD Coach, symptoms of posttraumatic stress, depression, somatic illness and functional disability decreased and were maintained within 3 to 9 months of app access. Posttraumatic stress continued to improve during follow-up. PTSD Coach was considered slightly to moderately helpful and satisfactory and 43 % reported any negative effect related to using the app. PTSD Coach is an effective self-management intervention for trauma-related distress. Future research should investigate mechanisms of change, as well as individual characteristics that predict symptom reduction after access to PTSD Coach in order to inform clinical practice.

Correction: Efficacy, Benefits, and Harms of a Self-management App in a Swedish Trauma-Exposed Community Sample (PTSD Coach): Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/31419.].

Efficacy, Benefits, and Harms of a Self-management App in a Swedish Trauma-Exposed Community Sample (PTSD Coach): Randomized Controlled Trial.

BACKGROUND: Self-guided interventions may complement and overcome obstacles to in-person treatment options. The efficacy of app interventions targeting posttraumatic stress disorder (PTSD) is unclear, and results from previous studies on PTSD Coach-an app for managing trauma-related distress-are inconsistent. OBJECTIVE: This study investigates whether access to the Swedish version of the PTSD Coach affects posttraumatic stress, depressive, and somatic symptoms. In addition, we aim to assess the perceived helpfulness, satisfaction, negative effects, response, and remission related to PTSD Coach. METHODS: Adults who had experienced potentially traumatic events in the past 2 years were randomized (1:1) to have access to PTSD Coach (n=89) or be on the waitlist (n=90). We assessed clinical characteristics at baseline (semistructured interviews and self-rating scales) and after 3 months (self-rating scales). We analyzed the data in R software using linear mixed effects models, chi-square tests, and Fisher exact test. RESULTS: Intention-to-treat analyses indicated that access to PTSD Coach decreased posttraumatic stress and depressive symptoms but not somatic symptoms. More participants who had access to PTSD Coach responded with clinically significant improvement and fewer instances of probable PTSD after 3 months compared with waitlist controls. Overall, participants found that PTSD Coach was slightly to moderately helpful and moderately satisfactory. Half of the intervention group (36/71, 51%) reported at least one negative reaction related to using PTSD Coach (eg, disappointment with the app or its results, arousal of stress, or distressing memories). CONCLUSIONS: Using PTSD Coach may trigger symptoms among a few users; however, most of them perceived PTSD Coach as helpful and satisfactory. This study showed that having access to PTSD Coach helped improve psychological trauma-related symptoms. In addition, we have discussed implications for future research and clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922.

Daily uplifts during the COVID-19 pandemic: what is considered helpful in everyday life?

BACKGROUND: Knowledge of what is uplifting and helpful during pandemics could inform the design of sustainable pandemic recommendations in the future. We have explored individuals' views on helpful and uplifting aspects of everyday life during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Participants answered a brief, daily survey via text messages during 14 consecutive days in July-August, 2020. The survey included the question: "During the past 24 hours, is there anything that has made you feel good or helped you in your life?" We used content analysis to compile responses from 693 participants, who provided 4,490 free-text answers, which resulted in 24 categories subsumed under 7 themes. RESULTS: Positive aspects during the COVID-19 pandemic primarily related to social interactions, in real life or digitally, with family, friends and others. Other important aspects concerning work, colleagues and maintaining everyday life routines. One theme concerning vacations, going on excursions and being in nature. Leisure and recreation activities, such as hobbies and physical exercise, also emerged as important, as did health-related factors. Bodily sensations, thoughts, feelings and activities that benefited well-being were mentioned frequently. Lastly, people commented on the government strategies for containing COVID-19, and whether to comply with restrictions. CONCLUSIONS: To summarize, daily uplifts and helpful aspects of everyday life centered around social relationships. To comply with recommendations on physical distancing, people found creative ways to maintain social connections both digitally and face-to-face. Social interaction, maintenance of everyday life routines, hobbies and physical activity appeared to be important for well-being.

Ecological momentary assessment of self-rated health, daily strategies and self-management app use among trauma-exposed adults.

Background: The process whereby trauma-exposed people benefit from self-management apps to increase health is poorly understood. Objective: We investigated whether access to a self-management smartphone app for posttraumatic stress (PTSD Coach) improved momentary self-rated health (SRH) and if use of a self-management app or specific strategies related to SRH. Method: Participants were 179 adults in Sweden with trauma exposure in the past 2 years who were enrolled in a randomized trial of PTSD Coach versus waitlist. Ecological momentary assessments (EMA) were collected twice daily during 21 consecutive days from participants in both groups, with questions about momentary SRH as well as self-management app use and use of strategies (social support, distress management, monitoring of discomfort and seeking information) in the preceding 12 hours. Results: Overall, neither access to PTSD Coach nor reported use of an app in the preceding hours was related to SRH. Even so, people with access to PTSD Coach reported using more social support over time. Socializing and use of social support predicted greater SRH. Use of other strategies was associated with worse short-term SRH. Conclusions: Momentarily improved health relates to utilization of social support. However, the directionality of the day-to-day associations is unclear; uncertainty remains around the timing for assessing these relationships.

Antecedentes: El proceso por el cual las personas expuestas al trauma se benefician de las aplicaciones de autogestión para mejorar la salud es poco conocido.Objetivo: Investigamos si el acceso a una aplicación de autogestión para teléfonos inteligentes, para el estrés postraumático (PTSD Coach) mejora la salud autoevaluada del momento (SRH en su sigla en inglés) y si el uso de una aplicación de autogestión o estrategias específicas se relacionan con la SRH.Método: Los participantes fueron 179 adultos en Suecia con exposición a trauma en los últimos dos años que se inscribieron en un ensayo aleatorio de PTSD Coach versus lista de espera. Las evaluaciones ecológicas momentáneas (EMA en su sigla en inglés) se recopilaron dos veces al día durante 21 días consecutivos en los participantes de ambos grupos, con preguntas sobre SRH del momento, así como el uso de aplicaciones de autogestión y el uso de estrategias (apoyo social, manejo del estrés, monitoreo del malestar y búsqueda de información) en las 12 horas anteriores.Resultados: En general, ni el acceso a PTSD Coach ni el uso informado de una aplicación en las horas anteriores se relacionaron con la SRH. Aun así, las personas con acceso a PTSD Coach informaron que usaron más apoyo social a lo largo del tiempo. La socialización y el uso del apoyo social predijeron una mayor SRH. El uso de otras estrategias se asoció con peor SRH a corto plazo.Conclusiones: La mejoría en salud del momento se relaciona con la utilización del apoyo social. Sin embargo, la direccionalidad de las asociaciones del día a día no está clara y persiste la incertidumbre sobre el momento para evaluar estas relaciones.