The Effects of an Exposure-Based Mobile App on Symptoms of Posttraumatic Stress Disorder in Veterans: Pilot Randomized Controlled Trial

Carmen McLean, C Adrian Davis, Madeleine Miller, Josef Ruzek, Eric Neri, Carmen McLean, C Adrian Davis, Madeleine Miller, Josef Ruzek, Eric Neri

Abstract

Background: Barriers to accessing in-person care can prevent veterans with posttraumatic stress disorder (PTSD) from receiving trauma-focused treatments such as exposure therapy. Mobile apps may help to address unmet need for services by offering tools for users to self-manage PTSD symptoms. Renew is a mobile mental health app that focuses on exposure therapy and incorporates a social support function designed to promote user engagement.

Objective: We examined the preliminary efficacy of Renew with and without support from a research staff member compared with waitlist among 93 veterans with clinically significant PTSD symptoms. We also examined the impact of study staff support on participant engagement with the app.

Methods: In a pilot randomized controlled trial, we compared Renew with and without support from a research staff member (active use condition) with waitlist (delayed use condition) over 6 weeks. Participants were recruited through online advertisements. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PTSD symptoms at pre, post, and 6-week follow-up. Usage data were collected to assess engagement with Renew.

Results: Results indicated a small effect size (d=-0.39) favoring those in the active use conditions relative to the delayed use condition, but the between-group difference was not significant (P=.29). There were no differences on indices of app engagement between the 2 active use conditions. Exploratory analyses found that the number of support persons users added to the app, but not the number of support messages received, was positively correlated with app engagement.

Conclusions: Findings suggest Renew may hold promise as a self-management tool to reduce PTSD symptoms in veterans. Involving friends and family in mobile mental health apps may help bolster engagement with no additional cost to public health systems.

Trial registration: ClinicalTrials.gov NCT04155736; https://ichgcp.net/clinical-trials-registry/NCT04155736.

Keywords: cognitive behavioral therapy; exposure therapy; mHealth; mobile apps; posttraumatic stress disorder; self-management; veteran’s health.

Conflict of interest statement

Conflicts of Interest: None declared.

©Carmen McLean, C Adrian Davis, Madeleine Miller, Josef Ruzek, Eric Neri. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 04.11.2022.

Figures

Figure 1
Figure 1
Sample screenshot of the Renew app home screen. The home screen displays the 6 primary components of the app. During onboarding, the “Begin” button takes users to a short, animated video that outlines the features of Renew and the rationale behind exposure as an approach to managing posttraumatic stress.
Figure 2
Figure 2
Sample screenshots of the Renew app—support. The image on the left displays some of the explanation of the support feature in Renew. The image on the right displays an example of the messages a user might see from one of their support team members in response to usage notifications.
Figure 3
Figure 3
Sample screenshot of the Renew app—process. This image shows the writing prompts available to users. Prompts are unlocked as the user progresses in the program.
Figure 4
Figure 4
Sample screenshot of the Renew app—process. This image shows a portion of the instructions shown to users after clicking on the writing prompt sections.
Figure 5
Figure 5
Sample screenshot of the Renew app—approach. This image shows some of the instructions shown to users in the approach section of the app.
Figure 6
Figure 6
Sample screenshot of the Renew app—approach. This image displays the screen shown to users who have initiated an approach activity. The activity is timed, and they have access to a list of tips as well as the content in the motivation section.
Figure 7
Figure 7
CONSORT (Consolidated Standards of Reporting Trials) participant flow diagram.
Figure 8
Figure 8
PCL-5 score comparison—active use versus delayed use. PCL-5: Posttraumatic Stress Disorder Checklist for DSM-5.

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