Smart Phones, Service Members & PTSD Treatments

The computer age has dramatically impacted the practice of medicine.  No matter what specialty of health care you look to, technology has enabled new tools to support the work of providers and facilitate the healing of patients -- behavioral health is no exception.

Mobile computing platforms, such as smart phones and tablet computers, provide capabilities that can provide constant, "hip pocket" access to a range of potentially helpful tools.

Here at The Department of Defense (DoD), National Center for Telehealth and Technology (T2),  we collaborated with the Center for Deployment Psychology (CDP), and the Department of Veterans Affairs (VA) National Center for PTSD to develop the PE Coach smartphone app.  This new smartphone  application, or app,  was recently released to support the face-to-face psychotherapy of service members or veterans engaged in treatment for posttraumatic stress disorder (PTSD).

When a patient is diagnosed with PTSD, behavioral health providers have several effective treatments from which to choose.  One of those treatments, prolonged exposure (PE), asks patients to revisit the memory of the traumatic event in their imagination.

These sessions are audio recorded and the patient listens to the recording each day.  Between PE treatment sessions, patients also confront safe but distressing situations, places, and circumstances that either remind them of the trauma or feel unsafe.

The patient writes on a worksheet when exposure homework is conducted and the level of distress experienced.  With repeated exposures, service members and veterans emotionally process their trauma memories and experience a reduction in anxiety.

PE Coach is designed to be installed on the patient’s phone for use during each PE session and after each session to support the patient’s between session tasks.  Using PE Coach, the PE therapy session can be audio recorded directly on the patient’s device, eliminating the need for digital audio recording software, microphones, and time consuming CD burning.  Education that is typically provided to the patient as written handouts during PE can be reviewed in PE Coach as audio-visual movie clips.

A list of distressing situations they will confront during therapy is stored in PE Coach, allowing the patient to add new situations as they are identified.

Between sessions, the service member or veteran can access this list and record exposure homework right in the app.  The provider can review completed homework at the next session based upon how the app was used by the patient.  This kind of reliable information about homework adherence is traditionally not available.  Accordingly, PE Coach provides new tools to help the provider identify barriers to the treatment goals and help the patient generate solutions to any problems.

PTSD symptoms can be tracked in the app over time with a graphic display to help the service member or veteran celebrate their successes in treatment.

The tools in PE Coach may make it easier for behavioral health providers to start using PE after being trained, support them in faithfully delivering the treatment as it was designed, and help patients to fully participate in PE treatment to help them meet their treatment goals.  This promising new app is one of the first to support the delivery of an effective PTSD psychotherapy.

About the Author

Dr. Greg Reger is a licensed clinical psychologist who completed his Ph.D. at Fuller Theological Seminary. He is currently leading T2’s testing of Virtual Reality and Prolonged Exposure therapies for PTSD. Prior to joining T2, Dr. Reger worked for the Center for Deployment Psychology (CDP), served at Walter Reed Army Medical Center, and deployed to Iraq in 2005-2006.