A clinician-monitored ‘PTSD Coach’ intervention: findings from two pilot feasibility and acceptability studies in a resource-constrained setting

Background: The high prevalence of trauma exposure and consequent post-traumatic stress disorder (PTSD) is well documented in low- and middle-income countries, and most individuals with PTSD have limited access to treatment in these settings. Freely available internet-based interventions, such as PTSD Coach (web-based and mobile application), can help to address this gap and improve access to and efficiency of care. Objective: We conducted two pilot studies to evaluate the feasibility, acceptability, and preliminary effectiveness of PTSD Coach in a South African resource-constrained context. Method: Pilot 1: Participants with PTSD (n = 10) were randomized to counsellor-supported PTSD Coach Online (PCO) or enhanced treatment as usual. Pilot 2: Participants (n = 10) were randomized to counsellor-supported PTSD Coach Mobile App or self-managed PTSD Coach Mobile App. Feasibility and acceptability were assessed by comparing attrition rates (loss to follow-up), reviewing participant and counsellor feedback contained in fieldnotes, and analysing data on the ‘Perceived helpfulness of the PTSD Coach App’ (Pilot 2). PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5), changes between treatment and control groups were compared, the reliable change index (RCI) was calculated, and clinically significant changes were determined. Results: Three participants in Pilot 1 and two participants in Pilot 2 were lost to follow-up. Fieldnotes indicated that PTSD Coach Mobile App addressed identified computer literacy challenges in Pilot 1 (PCO); and a shorter duration of intervention (from 8 to 4 weeks) was associated with less attrition. The RCI indicated that four participants in Pilot 1 and eight participants in Pilot 2 experienced significant improvement in PTSD symptom severity. Conclusions: The preliminary results suggest that both platforms can alleviate PTSD symptoms, and that the involvement of volunteer counsellors is beneficial. The use of PTSD Coach Mobile App may be more feasible than the online version (PCO) in our setting. HIGHLIGHTSResearch on supported PTSD Coach interventions is limited in resource-constrained settings.Both volunteer counsellor-supported PTSD Coach Online and the PTSD Coach Mobile App showed preliminary reliable and clinically significant changes.The use of PTSD Coach Mobile App seems more feasible than the volunteer counsellor-supported PTSD Coach Online. Research on supported PTSD Coach interventions is limited in resource-constrained settings. Both volunteer counsellor-supported PTSD Coach Online and the PTSD Coach Mobile App showed preliminary reliable and clinically significant changes. The use of PTSD Coach Mobile App seems more feasible than the volunteer counsellor-supported PTSD Coach Online.

背景：创伤暴露的高发生率及其导致的创伤后应激障碍（PTSD）在低收入及中等收入国家中已有充分记录，而大多数患有PTSD的个人在这些环境中难以获得治疗。如PTSD教练（基于网络的移动应用程序）等免费互联网干预措施，有助于弥补这一差距，并提高护理的获得性和效率。目标：我们进行了两项试点研究，以评估PTSD教练在南非资源受限环境中的可行性、可接受性和初步有效性。方法：试点1：将10名患有PTSD的参与者随机分配到心理咨询支持的PTSD教练在线（PCO）或加强版的常规治疗。试点2：将10名参与者随机分配到心理咨询支持的PTSD教练移动应用程序或自我管理的PTSD教练移动应用程序。通过比较脱落率（失访）、查阅包含在实地笔记中的参与者和心理咨询师反馈，以及分析‘PTSD教练应用程序感知有用性’（试点2）数据来评估可行性和可接受性。使用临床医生实施的PTSD量表（CAPS-5）评估PTSD症状严重程度，比较治疗组和对照组之间的变化，计算可靠变化指数（RCI），并确定临床上有意义的变化。结果：试点1中有3名参与者，试点2中有2名参与者失访。实地笔记表明，PTSD教练移动应用程序解决了试点1（PCO）中识别出的计算机素养挑战；干预持续时间缩短（从8周缩短至4周）与较低的脱落率相关。RCI表明，试点1中有4名参与者，试点2中有8名参与者PTSD症状严重程度显著改善。结论：初步结果表明，两种平台均可缓解PTSD症状，且志愿心理咨询师的参与有益。在我们的环境中，使用PTSD教练移动应用程序可能比在线版本（PCO）更具可行性。研究显示，在资源受限的环境中，对支持型PTSD教练干预的研究有限。志愿心理咨询支持的PTSD教练在线和PTSD教练移动应用程序均显示出初步的可靠性和临床上的有意义变化。与志愿心理咨询支持的PTSD教练在线相比，PTSD教练移动应用程序的使用似乎更具可行性。研究显示，在资源受限的环境中，对支持型PTSD教练干预的研究有限。志愿心理咨询支持的PTSD教练在线和PTSD教练移动应用程序均显示出初步的可靠性和临床上的有意义变化。与志愿心理咨询支持的PTSD教练在线相比，PTSD教练移动应用程序的使用似乎更具可行性。