Can a Smartphone App Help Reduce PTSD Symptoms?

What you need to know

• Researchers are testing a new smartphone app designed to help people with post-traumatic stress disorder (PTSD) change negative thought patterns.
• The app uses a technique called cognitive bias modification to train users to interpret ambiguous situations more positively.
• If effective, this app could provide an accessible treatment option to help reduce PTSD symptoms while people wait for in-person therapy.

A New Approach to Treating PTSD

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. People with PTSD often struggle with intrusive memories, nightmares, negative thoughts and beliefs, and heightened anxiety or fear responses. While effective treatments exist, many people face long wait times to access therapy. Researchers are now exploring whether a smartphone app could help fill this gap and provide relief for those waiting to start formal treatment.

A team of researchers in Germany has designed an app that aims to retrain how people with PTSD interpret ambiguous situations. This approach, called cognitive bias modification, is based on the idea that people with PTSD tend to interpret unclear information in an overly negative or threatening way. By repeatedly practicing more positive or neutral interpretations, the hope is that this can help shift thought patterns over time.

How the App Works

The app contains a series of audio recordings describing everyday scenarios that start out ambiguous but resolve in a positive way. For example, a scenario might begin by describing walking down a dark street at night and hearing footsteps behind you. While someone with PTSD might immediately jump to assuming danger, the scenario would continue to reveal it was just a jogger passing by.

Users are instructed to close their eyes and vividly imagine each scenario using all their senses as they listen. After each recording, they answer some questions about what they imagined. The goal is to practice envisioning and internalizing more positive outcomes in ambiguous situations.

The full program involves 9 training sessions over 3 weeks, with each session lasting about 20 minutes. Two months later, users complete a 1-week “booster” of 3 additional sessions to reinforce what they learned.

Potential Benefits of App-Based Treatment

If shown to be effective, this type of app-based treatment could have several advantages:

• Accessibility: Users can complete sessions anytime, anywhere using their smartphone.
• Low barrier to entry: No need to travel to appointments or spend time on waitlists.
• Cost-effective: Potentially much cheaper than traditional therapy.
• Scalable: Could reach many more people than limited therapy spots allow.
• Complementary: May help reduce symptoms while waiting for or between therapy sessions.

The researchers emphasize that the app is not meant to replace professional treatment. Rather, it could serve as a helpful supplement or stopgap measure.

What the Study Will Test

To determine if the app is actually beneficial, the researchers are conducting a randomized controlled trial with 130 participants who have been diagnosed with PTSD. Half will be assigned to use the app over 3 weeks, while the other half will be placed on a waitlist to serve as a control group.

The study will measure several outcomes, including:

• Changes in how participants interpret ambiguous information
• PTSD-related thoughts and beliefs
• PTSD symptom severity
• Negative mood and emotions
• User satisfaction and acceptability of the app

Participants will complete assessments before starting the program, 1 week after finishing, 2 months later, and again after the booster session. This will allow researchers to see both immediate and longer-term effects.

How Interpretation Biases Impact PTSD

To understand why this app approach might help, it’s useful to look at how interpretation biases play a role in PTSD. When we encounter an ambiguous situation - one that could be interpreted in multiple ways - our brains quickly make assumptions to fill in the gaps. For people with PTSD, this process often goes awry.

According to cognitive models of PTSD, traumatic experiences can lead people to develop excessively negative beliefs about themselves, others, and the world around them. Common beliefs might include:

• “The world is a dangerous place”
• “I can’t trust anyone”
• “I’m powerless to protect myself”
• “Something bad could happen at any moment”

These beliefs then color how people interpret new situations, creating a bias toward seeing threat and danger even when it’s not actually present. For example, hearing an unexpected noise at night might be instantly interpreted as an intruder breaking in, rather than a harmless explanation like the house settling.

Over time, this negative interpretation bias can maintain or even worsen PTSD symptoms. It keeps people in a state of hypervigilance and anxiety, reinforcing beliefs that the world is unsafe. It can also lead to avoidance of situations that trigger anxiety, preventing opportunities to learn that feared outcomes often don’t occur.

By targeting this interpretation bias directly, the app aims to help break this cycle. The goal is to make more balanced or positive interpretations feel more automatic and natural over time.

How Cognitive Bias Modification Works

Cognitive bias modification builds on principles from cognitive behavioral therapy, a leading evidence-based treatment for PTSD. Both approaches aim to shift unhelpful thought patterns. However, cognitive bias modification takes a more implicit, bottom-up approach.

Rather than explicitly challenging negative thoughts, it uses repeated practice to gradually retrain automatic mental habits. This is based on the idea that our brains are constantly making predictions and assumptions to quickly make sense of the world around us. With enough repetition, we can shift what feels most natural or likely to our brains.

The use of mental imagery is thought to enhance this process. Vividly imagining scenarios engages similar brain regions as actually experiencing them. This may help make the training feel more real and relevant, potentially leading to greater changes in thought patterns.

Previous studies testing cognitive bias modification for PTSD have shown mixed results. However, most used written sentences rather than audio scenarios. The researchers hope that using more immersive audio recordings combined with mental imagery will lead to stronger effects.

Potential Challenges and Limitations

While the app-based approach shows promise, there are some potential drawbacks to consider:

• May not be suitable for all types or severities of PTSD
• Requires consistent engagement and practice to see benefits
• Cannot address all aspects of PTSD treatment (e.g. processing traumatic memories)
• May be triggering for some without therapist guidance
• Effectiveness likely depends on user motivation and effort

Additionally, the study has some limitations. It uses a waitlist control group rather than an active control (e.g. a similar app without the bias modification component). This makes it harder to rule out placebo effects or benefits simply from engaging with a smartphone app.

The researchers also note that results may not generalize to all treatment settings, particularly inpatient care for severe PTSD. Larger studies across diverse populations will be needed to determine who this approach works best for.

Conclusions

• If effective, this app could provide an accessible, low-cost option to help reduce PTSD symptoms while waiting for therapy.
• The app aims to retrain automatic thinking habits related to interpreting ambiguous situations more positively.
• While promising, app-based treatment is not meant to replace professional therapy for PTSD.
• More research is needed to determine how well this approach works and who can benefit most from it.

Overall, this innovative study highlights the potential for leveraging smartphone technology to expand access to mental health support. As the researchers test the app’s effectiveness, it may open up new possibilities for delivering elements of cognitive therapy in more flexible, widely available formats. For those struggling with PTSD symptoms, it offers hope for a new tool to aid in recovery.