The “PE coach” smartphone application: An innovative approach to improving implementation, fidelity, and homework adherence during prolonged exposure.

Abstract

Prolonged exposure (PE) is an empirically supported treatment that is being disseminated broadly to providers in the Department of Veterans Affairs and Department of Defense. Innovative methods are needed to support the implementation, dissemination, and patient and provider adherence to PE. The PE Coach is a smartphone application (app) designed to mitigate barriers to PE implementation. PE Coach is installed on the patient's phone and includes a range of capabilities for use during the PE session and after each session to support the treatment. Functions include the ability to audio record treatment sessions onto the patient's device, to construct the in vivo hierarchy on the device, to record completed homework exercises, to review homework adherence, and to track symptom severity over time. The app also allows sessions and homework to be scheduled directly in the app, populating the device calendar with patient reminder notifications. In the final session, a visual display of symptom improvement and habituation to items on the in vivo hierarchy is presented. These capabilities may significantly improve convenience, provider implementation and adherence, and patient compliance with treatment. Future research is needed to test whether PE Coach is useful and effective.

Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology

“…Several apps relevant to CBT homework have been developed for adults, all providing full homework support: PE Coach [59,60], PsychAssist [61], and a general therapy support system [62]. All 3 systems contain psychoeducation and homework assignments for each component of treatment.…”

Evidence-based Treatments for Military-related Posttraumatic Stress Disorder in a Veterans Affairs Setting

“…The hope is that these devices will increase treatment compliance, adherence, and convenience. 71 One study completed by Kuhn and colleagues 72 examined the use of the PTSD Coach. Results demonstrated that the Veterans who participated in the study were moderately to extremely satisfied with the app and found the content to be moderately to very helpful in managing symptoms.…”

Trauma psicológico en la atención primaria: orientaciones de manejo

“…Se trata de una estrategia de ayuda humanitaria inespecífica que se considera de elección por su bajo riesgo de iatrogenia, por su simpleza (no necesita ser profesional de la salud mental quien la aplique) y porque promueve varios factores "informados en la evidencia" que de acuerdo a varios expertos favorecerían la resiliencia (seguridad, calma, autoeficacia, conexión y esperanza) 37 . Es una técnica poco estructurada, adaptada al paciente y su cultura, pero que en la práctica, y con fines operativos, la resumiremos en cinco acciones: a) ofrecer un tiempo razonable de escucha activa (10-20 min), que puede ser definida como "poner toda la atención de uno en la otra persona y comunicarle que estamos interesados y preocupados" a través de un lenguaje corporal atento, un seguimiento adecuado de lo que el paciente dice y conductas reflejo 38 , como copiar o repetir las posturas, gestos o palabras que la persona utiliza; b) ofrecer ayuda concreta para lograr la calma, lo que puede efectuarse con técnicas de reentrenamiento de la respiración 39 apoyadas incluso por aplicaciones móviles 40,41 , contracturas musculares progresivas de Jacobson 42,43 u otras técnicas de relajación (Tabla 3); c) ofrecer apoyo en sistematización y priorización de necesidades inmediatas como contacto con familiares, información, protección financiera, asistencia legal, abrigo, etc. ; d) ofrecer apoyo para satisfacer las necesidades prioritarias, activando las redes de apoyo y de seguridad social disponibles; y e) ofrecer psicoeducación respecto a las reacciones normales frente al trauma, cómo ayudarse y ayudar a otros, cuáles son los signos de alarma y dónde buscar ayuda.…”