User:CyrusChang09/Treatments for PTSD

Digital Interventions
Digital delivery is an expansion of telemedicine that focuses on symptom monitoring and clinical services. Modern technologies allow the usage of multiple engagements of interactions, such as smartphone usage for messaging, video calls, and completing self-report measures. There are two characteristics for providers in the digital delivery format: synchronous for real-time interaction (e.g., live video and telephone call) and asynchronous for interactions that involve a delay (e.g., messages and video recordings). Mobile technologies have improved access to self-help applications; some are assisted through artificial intelligence, such as chatbots. The integration of digital delivery has various forms to provide multiple modalities, such as platforms with both synchronous and asynchronous interactions (e.g., instant messaging with a provider).

Digital Interventions are found to improve the accessibility and clinical effectiveness of mental health interventions. The utilization of digital interventions is important because of barriers to seeking treatment, such as stigma, difficulties in scheduling, waitlist, and limited mental health resources. Digital interventions address these barriers by tailoring the intervention to the individuals' needs and the cost-efficiency of implementing the treatment. Engagement with digital interventions has shown promise in randomized controlled trials. There is some concern about how these digital intervention will translate from research settings to real world settings. Some recommendations for real-world data implementation include the amount of times a digital intervention has been accessed or opened, the total number of downloads in a specific period of time, the demographics of the users, and the number of modules completed by users.

Data suggest that it may be inefficient to use evidence-based practices for all users without understanding their symptom presentation. For PTSD, some considerations for digital intervention include which individual characteristics to use to guide treatment, how to use that data to inform the progress of treatment, and how to tailor evidence-based practices to each specific users' needs. One review examined the usage of digital interventions for PTSD symptoms in the general population and found emerging evidence supporting the effectiveness of digitally delivered Cognitive Behavioral Therapy (iCBT) compared to other interventions (e.g., mindfulness, expressive writing, and cognitive tasks). The review also highlighted that it is important to explore the risks and potential adverse effects of completing a digital intervention.

Another review examined different randomized controlled trials (RCTs) exploring telehealth, Internet-based interventions, virtual reality exposure therapy, and mobile apps for PTSD. Internet-based interventions (IBIs) involve course-based computer programs that provide cognitive training, psychoeducation, and interactive exercises. The modules are designed to be completely weekly. In terms of IBIs, there were moderate effects when compared to passive control conditions and not for active controls; therefore, the benefits of using IBIs are unclear. Virtual Reality (VR) is computer generated, three-dimensional simulated environment. The common use for VR therapy is exposure therapy (VRET), allowing the therapist to control the pace of the exposure before having the individual confront real-world situations. VRET is different from standard VR experience because VRE is multisensory and increases the user's experiential engagement during treatment sessions. Virtual reality can help users feel more comfortable facing stressful situations in a virtual setting to learn new behaviors for real-life situations. A meta-analysis suggested that VRET is an effective treatment for PTSD and depression symptoms, with treatment benefits maintained for up to 6 months. However, these results were limited to male service members, which reduced the generalizability to women and other trauma populations. Mobile apps are software programs accessible on mobile devices and tablets. Mobile apps formats such as stand-alone or guided self-help had promising results for reducing PTSD symptoms; whereas depression symptoms were limited to small samples with no studies compared to evidence-based treatments for PTSD.

PTSD Coach
PTSD Coach is an application developed by the US Department of Veteran Affairs (VA) National Center for PTSD (NCPTSD) and the US Department of Defense Center for Telehealth Technology. PTSD Coach was designed for service members and veterans and as a public health resource for any individuals impacted by trauma. Many studies support the feasibility and effectiveness of PTSD Coach as a mobile health intervention for self-management care of PTSD symptoms. One study found that most users accessed the app to manage symptoms through the use of a coping tool (e.g., cognitive restructuring). It was found that PTSD Coach has been positively received by the general public, who found the app helpful in reducing momentary distress. The broad dissemination to the general public for PTSD Coach has continued to be supported with an average usage of three times across three separate days with a duration of 18 minutes of use. One study compared the mobile app version of PTSD Coach to the web-based version, PTSD Coach Online, and found lower attrition rates on the mobile app compared to the web-based version. The use of human support yielded better outcomes than self-management alone, as participants were guided through structured weekly sessions. Another study also highlighted that clinician support increases the effectiveness of PTSD Coach for mobile app engagement. Because of the increased access to smartphones, one study examined the global use of PTSD Coach in Australia, Canada, The Netherlands, Germany, Sweden, and Denmark. There is potential for PTSD Coach to address a global unmet need for care; however, there is still much work for disseminating PTSD Coach for areas where resources are nonexistent. For community trauma survivors, PTSD Coach was found to be a feasible intervention for learning about PTSD, self-management symptoms, and symptom monitoring. The examination of PTSD Coach for efficacy was not clear compared to the waitlist condition; however, the study condition using PTSD Coach had a significant reduction in symptoms, and the waitlist did not. Therefore, it is encouraged to continue to explore the efficacy of PTSD Coach for community trauma survivors.

Digital Attrition
Because digital interventions require active user engagement, it is important to understand what facilitates digital engagement versus digital intervention attrition. Many studies highlighted the impact of digital engagement on users in PTSD Coach. Some theories to highlight digital engagements are the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT). TAM is technology acceptance through an individual's perspective of ease of use, usefulness, and subjective norms. UTAUT highlighted the behavioral intention of using digital interventions through a user's effort expectancy, performance expectancy, social influence, facilitating conditions, and habit. The importance of an effective digital intervention is to examine the user's experience and flow of engaging with technology to create a balance of challenges and content. There are other factors, such as Internet anxiety, that moderated the relationship between digital intervention usage with recommendations of providing information about data security to help users feel supported.