A Mobile Health Intervention to Improve Psychosocial Functioning in Veterans with Posttraumatic Stress Disorder and Depression Symptoms

About This Grant

Background: Veterans experience high rates of posttraumatic stress disorder (PTSD) and depression, which are frequently comorbid and result in difficulties with psychosocial functioning substantially greater than either disorder alone. Functioning difficulties in Veterans have not been adequately addressed by most existing psychotherapies for PTSD and depression because they often focus on symptom improvement and are highly resource-intensive, requiring the training and time of skilled providers. To address this gap, mobile health (mHealth) apps can serve as a widely accessible, standalone or adjunctive intervention to target psychosocial functioning among Veterans with comorbid PTSD and depression. This RR&D CDA-2 proposal involves the development of a self-guided mHealth intervention based on Skills Training in Affective and Interpersonal Regulation (STAIR), an evidence-based psychotherapy that explicitly targets functioning improvements and also alleviates PTSD and depression symptoms among trauma survivors. As part of the intervention, real-time assessment will be incorporated to support Veterans in monitoring their functioning, symptoms, and potential benefits from STAIR. Aim 1 is to adapt the existing STAIR Coach mobile app to make it optimal for self-guided use and to enhance it with real-time assessment (i.e., ecological momentary assessment of functioning and symptoms and passive sensing of location and communication patterns). A user-centered iterative design process will be used to obtain feedback on the intervention from Veterans with PTSD and depression (N = 15) and VA STAIR providers (N = 5). Aim 2 is to evaluate self-guided STAIR Coach with real-time assessment in a pilot randomized controlled trial (RCT), focusing on determining feasibility and acceptability and exploring outcomes of psychosocial functioning, PTSD symptoms, and depression symptoms. Veterans with PTSD and depression (N = 40) will be randomized to self-guided STAIR Coach with real-time assessment (intervention condition) or to real-time assessment only (active control condition) for 12 weeks. Aim 3 is to apply idiographic analysis to each Veteran’s real-time assessment data to inform the timing and personalization of a future just- in-time adaptive intervention (JITAI) based on STAIR. A JITAI embodies a precision medicine approach to deliver the right type of support to the right person at the right time and has the potential to flexibly target the PTSD or depression symptom most linked to functioning for a Veteran. The candidate is applying as a clinical psychologist at the National Center for PTSD Dissemination and Training Division located at VA Palo Alto. Research and training will take place in the rich institutional environment of VA Palo Alto and its academic affiliate Stanford School of Medicine, with the guidance of an accomplished mentorship team comprised of mHealth and STAIR experts. The training goals of the proposal are directly relevant to the specific aims and include gaining expertise in app intervention development, clinical trial methodology, and idiographic quantitative data analysis. Additionally, the candidate will train in overall mHealth innovation and VA professional development skills. The research and training in this CDA-2 will prepare the candidate to achieve her immediate goal of obtaining a VA Merit Review Award that involves building and testing a STAIR JITAI to maximize functioning among Veterans with PTSD and depression. The candidate’s long term goal is to become an mHealth expert in timely and personalized interventions, including JITAIs, for enhancing psychosocial functioning in the everyday lives of Veterans with PTSD and depression. Significance and Innovation: This CDA-2 will address a high priority area of mental health for VA and is consistent with national VA priorities (e.g., Whole Health), with the goal of helping Veterans with PTSD and depression function more fully in their lives, which may in turn decrease suicide risk. It will target the improvement of functioning through cutting-edge mHealth technology and advanced analytic techniques. It may ultimately help to position the VA as a national leader in incorporating innovative technologies into recovery-oriented mental health care.