U.S. Navy Battles PTSD with iPad

By Stephanie Blanchard, Digital Editor — March 22, 2013

Post Traumatic Stress Disorder (PTSD) affects almost 8% of Americans at some point in their life, according to the National Institute of Mental Health. Put that person in a warzone, and the number goes up substantially. A February 2012 Congressional Budget Office report noted that 21% of military personnel returning from Afghanistan and Iraq suffer from PTSD.

America's Heroes at Work offers resources to help enterprises address the needs of employees with PTSD. Recommended accommodations include instituting flexible work time and scheduled rest breaks.

Stop Before It Starts
Trying to prevent the disorder from occurring in the first place, the Office of Naval Research (ONR) is developing an iPad-based app to help military personnel before they are deployed. The Stress Resilience Training System (SRTS) is designed to help sailors and Marines manage their stress responses through biofeedback techniques.

Research for the project started in 2009. “We took a gamble on leveraging the research that has gone into biofeedback, looking at different ways of looking at complex brain processes combined with the notions of stress management that have been around 40+ years,” said Commander Joseph Cohn in an interview with Mobile Enterprise.  A program officer in ONR’s Warfighter Performance Department, Commander Cohn was originator of the SRTS project.

During project conception, team members studied available tablets, performing a “market survey” comparison. They concluded that the iPad was the most easily recognized platform at the time, therefore an iPad app would likely have the most possible adoption.

How It Works
Using an iPad and a heart rate monitor clipped to an earlobe, the app’s core concept is that the heart rate can be influenced and controlled. The heart rate algorithms will cast along a scale of zero to 100, called variability. Because each person responds differently to stress (novice paratroopers have more adrenaline the day of the jump, expert paratroopers the day before, for example), the app takes into account individuality.

Initially, users are introduced to the concept of heart rate variability through visual representations similar to etch-a-sketch squiggles. They then play a series of video games starting with “Basic Training,” and in the process practice how to control their heart rate through breathing and other cognitive techniques.

The hardest level game, Commander Cohn said, is one that involves a racing car. The ability to control this vehicle, without running into obstacles, is based on how well one can control the heart rate variability. When a user is stressed, the car becomes sluggish. When the user’s variability is normal, the auto runs smoothly.

In addition to the games, information and resilience techniques provided, the SRTS app has a review section which allows users to keep track of training progress.

Developed in conjunction with the Defense Advanced Research Projects Agency, the app is scheduled for field testing at the Naval Center for Combat and Operational Stress Control (NCCOSC) in San Diego starting this April. If deployed, the ONR estimates this solution will save billions of dollars in associated medical costs, officials said.

More Apps to Help
“As a whole, Service members exposed to combat experience significantly more potentially traumatic experiences early in their lifetime than many Americans experience in a lifetime,” said Dr. William Brim, Deputy Director, Center for Deployment Psychology, via email.

In response to those affected, the Department of Defense’s National Center for Telehealth and Technology and Veteran Affair's National Center for PTSD developed a mobile app, PTSD Coach. Available for iOS and Android, the app offers information about common reactions to trauma and provides tools for tracking symptoms.

Meant to be used in conjunction with psychological therapy, the app does serve as standalone educational tool. It has been downloaded more than 100,000 times since it debuted in 2011.

Mobile Enterprise asked Veteran Affairs on how the PTSD Coach app has helped veterans. Mark Ballesteros, spokesperson, responded by email:

“We have invested significant resources into program evaluation to ensure that the application provides useful tools to Veterans with PTSD. While most of the research is still underway at sites around the country, we have preliminary studies complete that indicate that the app is perceived by Veterans to be helpful with their PTSD symptoms.”

Ballesteros noted that veterans have used the application to manage acute distress and PTSD symptoms, to track changes in their condition, to better understand the most important elements of PTSD, and to communicate effectively with others.

What has the general feedback been?

“We were careful throughout the development process to ensure that Veteran voices were present in the definition of the feature set, and we have found that this has led to generally excellent ratings of usability and perceived helpfulness,” he said. “While we do not suggest that the application be used in place of face-to-face clinical care, our data does suggest that PTSD Coach has the potential to be a clinically effective self-management tool for individuals with PTSD symptoms.”

“As scientists focused on evidence-based practice we tend to ignore anecdotes in favor of true controlled trials of interventions,” Ballesteros said. “However, the anecdotal feedback from Veterans, families, and clinicians has been outstanding and, in some cases has led to measurable outcomes.”
Numerous VA clinicians, for example, have reported that veterans use the app to successfully navigate distress between sessions.“This can be especially valuable for those who are not currently undergoing PTSD treatment but whose treatment is being managed in primary care,” he explained.

In response to requests from clinicians in almost all 50 states, the VA has sent materials on how to download and use the app.

“Our colleagues at the Veterans Crisis Line have reported calls from Veterans who indicated that their ‘phone told [them] to call’ and who were subsequently provided with appointments at appropriate local facilities. This underscores one of the most important and simple elements of the app: it uses very basic information in order to nudge the user in the direction of a positive coping strategy. The Veterans Crisis Line is not a new service, but the application enables successful use of this important resource.”

In addition, veterans in other countries have also requested similar resources. In response, the PTSD Coach app has been translated into six languages and released in two other countries, with four more scheduled for the nearby future.

Other Resources
Similar in vein to the PTSD Coach, another smartphone app is the T2 Mood Tracker. Employed by military members and civilians alike, the apps lets users monitor and track a range of emotions. Developed by the Department of Defense, the app has been recently updated to let users send information to home computers and health care providers.

Another example, PE Coach, developed by the National Center for PTSD and The Center for Deployment Psychology, is a free mobile app designed for patients undergoing prolonged exposure therapy. By recording their sessions, users can continue to confront and process traumatic events, a key component of the therapy. The app also provides information and assignments that could be completed between therapy sessions.

Going Forward, Going Mobile
It is clear that with the advance of mobile technology, more and better apps will continue to be developed for a wide spectrum of physical impairments and diseases, from Autism to Parkinson’s.

CreateAbility Concepts, Inc. is currently developing iUtileyes, a smartphone and tablet application to help visually impaired individuals use devices with flat-panel displays, many of which are found in office environments. Initially funded by Department of Education grants, the project combines optical character recognition with text-to-speech software, so that instruction on how to navigate an interface can be verbally supplied to a user. The company is currently seeking funding for phase two of the project.

In addition to helping patients and enabling patient/doctor relationships, mobile technology in healthcare settings like hospitals is on the rise overall, modernizing and streamlining a once a fragmented and paper-based “business” to one where the multitude of workers and caregivers can collaborate and be more productive in real time.


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