The PTSD help app in a Danish PTSD population: research protocol of a randomized controlled feasibility trial

Frederik Bernt Scharff, Marianne Engelbrecht Lau, Lisa Helena Grønberg Riisager, Stine Bjerrum Møller, Mehrak Lykkeberg Salimi, Matthias Gondan, Sofie Folke, Frederik Bernt Scharff, Marianne Engelbrecht Lau, Lisa Helena Grønberg Riisager, Stine Bjerrum Møller, Mehrak Lykkeberg Salimi, Matthias Gondan, Sofie Folke

Abstract

Background: Due to an increase in PTSD patients seeking help in the Danish mental health sector and the addition of Complex PTSD to the ICD-11, there is a need to increase efficiency of existing treatments for PTSD. mHealth interventions have been shown to reduce PTSD symptoms. Therefore, the implementation of a mHealth intervention designed for psychiatric PTSD patients as a therapy add-on may improve treatment outcome. No study to date has explored the effects of mHealth interventions for PTSD in the Danish mental health sector, the feasibility and effect of this type of intervention needs testing.

Methods: The study is an investigator-initiated randomized controlled feasibility trial investigating the clinical mHealth tool PTSD help combined with care as usual (CAU) compared to CAU for adults with PTSD. Seventy patients will be recruited and receive either the mHealth intervention combined with CAU or CAU alone. The primary feasibility outcome is the proportion of eligible patients that participate in the study until the end assessment. Secondary outcome data consists of the fraction of compliant patients in the experimental group and exploratory data on PTSD help on PTSD symptom severity, level of psychological distress, sleep quality, dissociation symptoms, therapy readiness, quality of life, disability levels, and recovery.

Discussion: This study may help increase our knowledge of possible benefits of, as well as potential barriers to, the implementation of mHealth tools in the psychiatric sector. It may also provide a cost-efficient means to increase therapy outcomes and decrease the duration of suffering for PTSD patients in the psychiatric sector.

Trial registration: The trial is registered at ClinicalTrials.gov (ID: NCT03862703) https://ichgcp.net/clinical-trials-registry/NCT03862703 on the 27 of February 2019 and has been approved by the Danish Data Protection Agency (journal number: VD-2018-200 ISuite number 6443). Referring to the committee law §2, the National Committee on Health Research Ethics (DNVK) [H-18024180] decided that the study could proceed without approval as the use of PTSD help did not constitute a health science intervention according to Danish health science legislation.

Keywords: Feasibility; PTSD; mHealth.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

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Consort diagram

References

    1. Atwoli L, Stein DJ, Koenen KC, McLaughlin KA. Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences. Curr Opin Psychiatr. 2015;28:307.
    1. Bech P. Measuring the dimension of psychological general well-being by the WHO-5. Quality of Life Newsletter. 2004:15–6.
    1. Bech P, Austin SF, Lau ME. Patient reported outcome measures (PROMs): examination of the psychometric properties of two measures for burden of symptoms and quality of life in patients with depression or anxiety. Nordic J Psychiatr. 2018;72:251–258.
    1. Becker S, Miron-Shatz T, Schumacher N, Krocza J, Diamantidis C, Albrecht UV. mHealth 2.0: experiences, possibilities, and perspectives. JMIR mHealth and uHealth, 2. 2014.
    1. Ben-Zeev D, Schueller SM, Begale M, Duffecy J, Kane JM, Mohr DC. Strategies for mHealth research: lessons from 3 mobile intervention studies. Adm Policy Ment Health Ment Health Serv Res. 2015;42:157–167.
    1. Billingham SA, Whitehead AL, Julious SA. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom clinical research network database. BMC Med Res Methodol. 2013;13:104.
    1. Brewin CR, Cloitre M n, Hyland P, Shevlin M, Maercker A, Bryant RA, et al. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev. 2017;58:1–15.
    1. Briere J, Scott C. Complex trauma in adolescents and adults: effects and treatment. Psychiatr Clin. 2015;38(3):515–527.
    1. Broglia E, Millings A, Barkham M. Comparing counselling alone versus counselling supplemented with guided use of a well-being app for university students experiencing anxiety or depression (CASELOAD): protocol for a feasibility trial. Pilot Feasibil Studies. 2017;3(1):3.
    1. Broglia E, Millings A, Barkham M. Counseling with guided use of a Mobile well-being app for students experiencing anxiety or depression: clinical outcomes of a feasibility trial embedded in a student counseling service. JMIR mHealth uHealth. 2019;7(8):e14318.
    1. Brownlow JA, Harb GC, Ross RJ. Treatment of sleep disturbances in post-traumatic stress disorder: a review of the literature. Curr Psychiatr Reports. 2015;17(6):41.
    1. Carlson EB, Waelde LC, Palmieri PA, Macia KS, Smith SR, McDade-Montez E. Development and validation of the dissociative symptoms scale. Generic: Assessment. Advance online publication. Ref Type; 2016.
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158:200–207.
    1. Chan, S., Torous, J. B., Hinton, L., & Yellowlees, P. M. (2016). Psychiatric apps: Patient self-assessment, communication, and potential treatment interventions. In e-Mental Health (pp. 217-229). Springer.
    1. Chan SR, Torous J, Hinton L, Yellowlees P. Mobile tele-mental health: increasing applications and a move to hybrid models of care. Healthcare (Basel) 2014;2:220–233.
    1. Christensen H, Reynolds J, Griffiths KM. The use of e-health applications for anxiety and depression in young people: challenges and solutions. Early Interv Psychiatry. 2011;5(Suppl 1):58–62.
    1. Cloitre M, Courtois CA, Charuvastra A, Carapezza R, Stolbach BC, Green BL. Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. J Trauma Stress. 2011;24:615–627.
    1. Cloitre M, Garvert DW, Brewin CR, Bryant RA, Maercker A. Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. Eur J Psychotraumatol. 2013;4:20706.
    1. Cloitre, M., Roberts, N. P., Bisson, J. I., & Brewin, C. R. (2017). The International Trauma Questionnaire (ITQ). Unpublished measure.
    1. Cloitre M, Stovall-McClough KC, Nooner K, Zorbas P, Cherry S, Jackson CL, et al. Treatment for PTSD related to childhood abuse: a randomized controlled trial. Am J Psychiatry. 2010;167:915–924.
    1. Clough BA, Casey LM. The smart therapist: a look to the future of smartphones and mHealth Technologies in Psychotherapy. Prof Psychol Res Pract. 2015;46:147–153.
    1. Danske Regioner. (2017). Care-package for PTSD. Retrieved from .
    1. Donker T, Petrie K, Proudfoot J, Clarke J, Birch MR, Christensen H. Smartphones for smarter delivery of mental health programs: a systematic review. J Med Internet Res. 2013;15:e247.
    1. Erbes CR, Stinson R, Kuhn E, Polusny M, Urban J, Hoffman J, et al. Access, utilization, and interest in mHealth applications among veterans receiving outpatient care for PTSD. Mil Med. 2014;179:1218–1222.
    1. Espie CA, Kyle SD, Hames P, Gardani M, Fleming L, Cape J. The sleep condition indicator: a clinical screening tool to evaluate insomnia disorder. BMJ Open. 2014;4:e004183.
    1. Fenger M, Lindschou J, Gluud C, Winkel P, Jørgensen L, Kruse-Blinkenberg S, et al. Internet-based self-help therapy with FearFighterΓäó versus no intervention for anxiety disorders in adults: study protocol for a randomised controlled trial. Trials. 2016;17:525.
    1. Firth J, Torous J, Nicholas J, Carney R, Rosenbaum S, Sarris J. Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. J Affect Disord. 2017;218:15–22.
    1. Foa EB, Davidson JR, Frances AE, Culpepper LE, Ross RE, Ross DE. The expert consensus guideline series: treatment of posttraumatic stress disorder. 1999.
    1. Foa EB, Rothbaum BO. Behavioural psychotherapy for post-traumatic stress disorder. Int Rev Psychiatry. 1989;1(3):219–226.
    1. Gallegos AM, Crean HF, Pigeon WR, Heffner KL. Meditation and yoga for posttraumatic stress disorder: a meta-analytic review of randomized controlled trials. Clin Psychol Rev. 2017;58:115–124.
    1. Green BL. Trauma history questionnaire. Measurement of stress, self-report trauma, and adaptation. 1996:366–9.
    1. Karatzias T, Shevlin M, Fyvie C, Hyland P, Efthymiadou E, Wilson D, et al. Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ) J Affect Disord. 2017;207:181–187.
    1. Kuhn E, Greene C, Hoffman J, Nguyen T, Wald L, Schmidt J, et al. Preliminary evaluation of PTSD coach, a smartphone app for post-traumatic stress symptoms. Mil Med. 2014;179:12–18.
    1. Kuhn E, Kanuri N, Hoffman JE, Garvert DW, Ruzek JI, Taylor CB. A randomized controlled trial of a smartphone app for posttraumatic stress disorder symptoms. J Consult Clin Psychol. 2017;85:267–273.
    1. Kyriaki GG, George K. Mental health apps: innovations, risks and ethical considerations. E-Health Telecommunication Systems and Networks. 2014;3:19–23.
    1. Lang AJ, Strauss JL, Bomyea J, Bormann JE, Hickman SD, Good RC, et al. The theoretical and empirical basis for meditation as an intervention for PTSD. Behav Modif. 2012;36(6):759–786.
    1. Leon AC, Olfson M, Portera L, Farber L, Sheehan DV. Assessing psychiatric impairment in primary care with the Sheehan disability scale. Int J Psychiatry Med. 1997;27:93–105.
    1. Lindhiem O, Bennett CB, Rosen D, Silk J. Mobile technology boosts the effectiveness of psychotherapy and behavioral interventions. Behav Modif. 2015;39:785–804.
    1. Lui JHL, Marcus DK, Barry CT. Evidence-based apps? A review of mental health Mobile applications in a psychotherapy context. Prof Psychol Res Pract. 2017;48:199–210.
    1. Luxton DD, Mccann RA, Bush NE, Mishkind MC, Reger GM. mHealth for mental health: integrating smartphone Technology in Behavioral Healthcare. Prof Psychol Res Pract. 2011;42:505–512.
    1. Mander J, Wittorf A, Teufel M, Schlarb A, Hautzinger M, Zipfel S, et al. Patients with depression, somatoform disorders, and eating disorders on the stages of change: validation of a short version of the URICA. Psychotherapy. 2012;49:519.
    1. McConnaughy EA, Prochaska JO, Velicer WF. Stages of change in psychotherapy: measurement and sample profiles. Psychotherapy: Theory, Research & Practice. 1983;20:368.
    1. Menon V, Rajan TM, Sarkar S. Psychotherapeutic applications of mobile phone-based technologies: a systematic review of current research and trends. Indian J Psychol Med. 2017;39:4.
    1. Miner, A., Kuhn, E., Hoffman, J. E., Owen, J. E., Ruzek, J. I., & Taylor, C. B. (2016). Feasibility, Acceptability, and Potential Efficacy of the PTSD Coach App: A Pilot Randomized Controlled Trial With Community Trauma Survivors. Psychological Trauma: Theory, Research, Practice, and Policy.
    1. Possemato K, Kuhn E, Johnson E, Hoffman JE, Owen JE, Kanuri N, et al. Using PTSD coach in primary care with and without clinician support: a pilot randomized controlled trial. Gen Hosp Psychiatry. 2016;38:94–98.
    1. Prentice JL, Dobson KS. A review of the risks and benefits associated with Mobile phone applications for psychological interventions. Canadian Psychology/Psychologie canadienne. 2014;55:282–290.
    1. Reger GM, Skopp NA, Edwards-Stewart A, Lemus EL. Comparison of prolonged exposure (PE) coach to treatment as usual: a case series with two active duty soldiers. Mil Psychol. 2015;27:287–296.
    1. Richards, P., Simpson, S., Bastiampillai, T., Pietrabissa, G., & Castelnuovo, G. (2016). The impact of technology on therapeutic alliance and engagement in psychotherapy: The therapist’s perspective: The impact of technology on therapeutic alliance and engagement in psychotherapy. Clinical Psychologist.
    1. Rozental A, Andersson G, Boettcher J, Ebert DD, Cuijpers P, Knaevelsrud C, et al. Consensus statement on defining and measuring negative effects of internet interventions. Internet Interv. 2014;1:12–19.
    1. Sheenan DV, Lecrubier Y, Sheenan KH, Amorim P, Janavs J, Weiller E, et al. The MINI-international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33.
    1. Siebern AT, Manber R. New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychol Res Behav Manag. 2011;4:21.
    1. Teare MD, Dimairo M, Shephard N, Hayman A, Whitehead A, Walters SJ. Sample size requirements to estimate key design parameters from external pilot randomised controlled trials: a simulation study. Trials. 2014;15:264.
    1. Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The ptsd checklist for dsm-5 (pcl-5). Scale available from the National Center for PTSD at .
    1. Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016;25:1057–1073.

Source: PubMed

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