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Using the PTSD Coach App in Primary Care

Post-traumatic stress disorder (PTSD) is common in Veterans seen in VA primary care. However, evidence-based PTSD interventions appropriate for this setting are lacking. Therefore, primary care practitioners typically refer Veterans to specialty mental health care so they can receive evidence-based treatments. Unfortunately, many Veterans decline such referrals or fail to follow through on them, resulting in a care gap for these Veterans. Digital health technology could help address this unmet need. In 2011, VA’s National Center for PTSD (NCPTSD) developed PTSD Coach, a self-management mobile app with content informed by evidence-based psychotherapies that offers psycho-education, symptom monitoring, coping skills, and links to social support and professional resources.1 Since then, the PTSD Coach app has been downloaded 425,000 plus times in over 100 countries and has shown encouraging results in several studies.2 Recognizing that added clinician support to such self-management programs can increase their utilization and effectiveness, we developed Clinician-Supported PTSD Coach (CS PTSD Coach). Tailored to the primary care setting, this intervention combines the PTSD Coach app with four 30-minute sessions (in-person or by phone) of clinician support delivered over eight weeks.3 Pilot data suggest that CS PTSD Coach leads to improvement in PTSD symptoms and increased acceptance of mental health care.4 Given this promise, our team of researchers from the VA Palo Alto’s NCPTSD and HSR&D Center for Innovation to Implementation (Ci2i), along with VISN 2’s Center for Integrated Healthcare, are conducting an HSR&D-funded, multi-site randomized controlled trial investigating the impact of CS PTSD Coach on PTSD severity and engagement in mental health care. To date, 113 participants have been randomized to either CS PTSD Coach or treatment as usual (i.e., primary care mental health integrated care). While outcomes are not yet available, this project has the potential to improve the quality of care for Veterans with PTSD presenting in VA primary care by establishing the effectiveness of an innovative and highly scalable PTSD intervention.

  1. Kuhn E, et al. “A Preliminary Evaluation of PTSD Coach, a Smartphone app for Posttraumatic Stress Symptoms,” Military Medicine 2014; 179:12-8.
  2. Gould CE, et al. “Veterans Affairs and Department of Defense Mental Health Apps: A Systematic Review of the Available Evidence,” Psychological Services 2018. Advance online publication. http://dx.doi.org/10.1037/ser0000289
  3. Possemato K, et al. “Clinician-supported PTSD Coach: Provider and Patient Input on Acceptability and Barriers and Facilitators to Implementation,”Translational Behavioral Medicine: Practice, Policy, Research 2017; 7:116-26.
  4. Possemato K, et al. "Using PTSD Coach in Primary Care with and without Clinician Support: A Pilot Randomized Controlled Trial," General Hospital Psychiatry 2016; 38: 94-8.

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