Pilot Randomized, Crossover Trial of Prolonged Exposure With and Without the PE Coach Mobile Application: A Mixed-Methods Study of Patient-Centered Outcomes Among Veterans With PTSD

Prolonged exposure (PE) Coach is a mobile application designed to support the tasks of PE psychotherapy for posttraumatic stress disorder (PTSD). However, little is known about patient treatment preferences for the application nor its impact on clinically salient outcomes. Veterans with PTSD (N = 20) were randomly assigned to use PE Coach during three-session blocks of treatment (either Sessions 1-3 or 4-6). After Session 6, veterans were asked to choose whether they wanted to continue treatment with or without the app. Homework was monitored, and veterans were surveyed on their treatment experience following each three-session block. Qualitative interviews explored reasons for treatment preference. Thirteen of 14 veterans (92.8%) chose to finish treatment with PE Coach. Veterans reported improved clinical experiences during PE Coach use, including increased convenience completing homework tasks (Hedge's g = 1.37) and higher treatment satisfaction (Hedge's g = 0.63). PE Coach usability was highly rated. Adequate homework thresholds for maximizing clinical outcomes were achieved more frequently during use of PE Coach than without the app (69% vs. 50% for imaginal exposure; 88% vs. 65% for in vivo homework). Qualitative interviews highlighted ease of use and improved accessibility, privacy, and homework accountability. This pilot study suggests PE Coach may be some veterans' preferred way to participate in PE and is a promising tool to enhance acceptability, accountability, and engagement in PTSD treatment.