A counsellor-supported ‘PTSD Coach’ intervention versus enhanced treatment as usual in a resource-constrained setting: A randomised controlled trial

Abstract

To widen treatment access for posttraumatic stress disorder (PTSD) in resource-constrained South Africa, we evaluated the feasibility and effectiveness of a counsellor-supported PTSD Coach mobile application (app) (PTSD Coach-CS) intervention on PTSD and associated sequelae in a community sample. Participants (female = 89%; black = 77%; aged 19-61) with PTSD were randomised to PTSD Coach-CS (n = 32) or enhanced Treatment-as-Usual (n = 30), and assessed with the Clinician-Administered PTSD Scale (CAPS-5), PTSD Checklist (PCL-5) and Depression, Anxiety and Stress Scale-21 items, at pre-to post-treatment and follow-up (1 and 3 months). We also collected data on user experiences of the PTSD Coach app with selfadministered surveys. We conducted an intent-to-treat analysis and linear mixed models. A significant (group × time) effect for the CAPS-5 (F 3.136 = 3.33, p = 0.02) indicated a greater reduction in PTSD symptom severity over time for the intervention group with a significant between-group effect size detected at 3-month follow-up. Significant between-group effect sizes were detected in self-reported stress symptom reduction in the intervention group at posttreatment and 3-month follow-up. Participants perceived the app as helpful and were satisfied with the app. Findings suggest PTSD Coach-CS as a suitable low-cost intervention and potential treatment alternative for adults with PTSD in a resource-constrained country. Replication in larger samples is needed to fully support effectiveness. Pan African Trial Registry: PACTR202108755066871. Impact statementMany individuals in low-middle-income countries (LMICs), such as South Africa, often experience high trauma exposure rates and associated posttraumatic stress disorder (PTSD). PTSD can have harmful effects on the individual with their daily functioning often negatively impacted. Unfortunately, many individuals with PTSD in these settings do not access the needed support and treatment due to healthcare resource constraints. These resource constraints include overburdened public health care services and difficulty accessing these services when available. More feasible intervention alternatives are needed to widen access to support and treatment in the general population. Mobile-based interventions, such as the freely available PTSD Coach mobile application (app), is one such alternative. We evaluated the effectiveness of a four-session counsellor-supported PTSD Coach app (PTSD Coach-CS) intervention in reducing PTSD, depression, anxiety, and stress symptoms in a South African adult community sample. Our findings support that a low-cost, more accessible PTSD Coach-CS intervention is a feasible intervention alternative for adults with PTSD in a resourceconstrained setting such as South Africa. It also appears that it can reduce PTSD and stress symptoms; however, more research is needed to fully support this. Importantly, our findings indicate that the original version of the app, developed for veterans in the United States, can be used in a culturally different sett...

Participants’ experiences of a counsellor-supported PTSD Coach intervention in a resource-constrained setting

“…Overall, the RCT results supported the feasibility and acceptability of both the original version of the PTSD Coach mobile app platform and the notion of involving counsellors in intervention delivery (Bröcker et al, 2024). For more information on the original RCT (e.g., counsellor training and protocol fidelity, please see Bröcker et al, 2024).…”

“…To address the aforementioned gap in the extant literature on PTSD Coach, we conducted a randomised controlled trial (RCT) to evaluate the effectiveness of a brief four-session counsellor-supported PTSD Coach mobile app (PTSD Coach-CS) intervention in South African adults with PTSD (trial registration number: PACTR202108755066871) (Bröcker et al, 2024 ). Study flyers were distributed in the community and promoted on social media.…”

“…Study flyers were distributed in the community and promoted on social media. The RCT allocated participants to PTSD Coach-CS or enhanced Treatment-as-Usual (e-TAU) on a 1:1 basis ((Bröcker et al, 2024 ). RCT participants were aged 19–61 years; female = 89%; black = 77%, owned smartphones, could provide written informed consent, and were conversant in English.…”

“…The main findings of the RCT included greater improvement in clinician-monitored PTSD and self-reported stress symptoms over time in the PTSD Coach-CS group compared to the e-TAU group (Bröcker et al, 2024 ). The intervention uptake was good, with most participants attending all four intervention sessions.…”

“…The intervention uptake was good, with most participants attending all four intervention sessions. Also, self-reported app use outside of these sessions varied from daily to five times per week (Bröcker et al, 2024 ). Generally, the PTSD Coach app was positively received, and participants rated the app as moderately to very helpful in managing PTSD symptoms.…”