Mobile applications, or apps, for smartphones and digital devices like tablets, are designed to help veterans between therapist appointments — any time they feel symptoms of PTSD coming on.
Developed by the VA Palo Alto Health Care System, the app first asks for information about the veteran's friends, loved ones and any health professionals who can help when the vet feels distressed. App users can add pictures they find comforting or funny as well as songs they find relaxing or put them in a good mood.
People using the app for the first time select from a menu of information to determine if they have symptoms of PTSD.
Many veterans are not aware they have PTSD, a condition that can cause intense distress when something triggers memories of a combat trauma.
Educational questions such as "Are you very angry most of the time?" and "Have you been feeling anxious or had distressing thoughts almost all the time?" help people acknowledge they might have a problem, said Dr. Julia E. Hoffman, a VA clinical psychologist and mobile-apps lead at the Menlo Park campus.
If the user answers "yes" to having thoughts about suicide, hurting or killing someone else, he or she is directed to seek emergency help and is given the phone contact for the Veterans Crisis Line.
An assessment feature asks 17 questions related to symptoms. For example, "In the past month, how much have you been bothered by repeated disturbing dreams of the stressful experience?" and "In the past month, how much have you been bothered by suddenly acting or feeling as if the stressful experience were happening again?"
A touch of the screen allows the app user to check off the degree of their experience from "not at all" to "extremely."
After answering the questions, the application evaluates if the person is having difficulties that are mild and are not given to a PTSD diagnosis, or if he or she has PTSD. The person can schedule the assessments once per month and track his or her progress.
One of the app's main functions is to help veterans manage their symptoms as they are occurring. The vet can use the app to identify what he or she is experiencing, such as feeling disconnected from people, feeling sad or hopeless, disconnected from reality or angry. Touching "Reminded of the trauma," links to distress "thermometer" on which the veteran can rate the level of his or her distress, from a zero to 10.
The application then leads to a series of exercises and suggestions to help relieve the anxiety, such as muscle-relaxation exercises or a suggestion to listen to music.
The relaxation exercise has audio: "Take a deep breath and feel clean air going into your belly, and then exhale with a sigh; and again, take a deep breath and feel clean air going down into your throat," the audio instructs.
A second exercise displays the image of a many-rooted tree in a forest: "Focus all of your attention in the smells in your environment," it notes.
If the user indicates a level 10 on the scale for distress, the application concludes that the person is in crisis and suggests talking to someone immediately. The person can connect to someone through 911 or the Veterans Crisis Line — or reject that option and choose a tool.
Hoffman said more than 50,000 people have downloaded the application, PTSD Coach, in 62 countries. It has received a series of awards.
Hoffman's team has also developed PE Coach, a companion for prolonged-exposure therapy (PE), one of the most effective treatments for PTSD that is used widely throughout VA and Department of Defense.
PE Coach provides features and self-assessment that are regularly used in face-to-face prolonged-exposure therapy. It uses some of the same relaxation tools to alleviate stress.
Prolonged-exposure therapy exposes a PTSD sufferer to repeated situations that trigger the emotions associated with trauma. Over time and with counseling, the intense feelings caused by PTSD are reduced and become manageable.
Other pending applications include general mindfulness, disaster response, and cognitive behavioral therapy for insomnia, and a PTSD Coach for families. All will be available for free this year, Hoffman said.
But she noted the applications are not intended to replace psychotherapy.
"The most important pieces of therapy require experience and insight from the clinician, and would be very challenging to replicate," she said.