Trauma-focused digital support, momentary psychological states, and long-term symptoms : Randomized controlled trial and ecological momentary assessment

Abstract: Perceived health, symptoms, and emotional states may fluctuate in response to coping efforts and support. The short- and long-term effects, benefits, and harms of trauma-focused self-management apps should be investigated. This thesis explored digital and face-to-face social activities in relation to same-day emotional states and health during the COVID-19 pandemic. Furthermore, the implications of using specific coping strategies for health and the effects of the unguided self-management app PTSD Coach for trauma-related complications were investigated. In Study I, 697 adults in Sweden responded to daily surveys (ecological momentary assessments) once a day during 14 consecutive days during the COVID-19 pandemic. In Studies II–IV, 179 trauma-exposed adults responded to 2 daily surveys during 21 consecutive days, and 4 retrospective surveys from 0 to 9 months later. Access to PTSD Coach or inactive waitlist was randomized (1:1) at baseline and restricted until 3 months later. Effects were analyzed with mixed-effects models that accounted for simultaneous within- and between-person effects (Studies I–II) or intention-to-treat models with imputed data of controlled effects (Study III) and within-group longitudinal changes (Study IV). Socializing face-to-face during the COVID-19 pandemic coincided with same-day lesser loneliness, greater sense of belonging, and better health. More digital social interaction than usual only related to same-day sense of belonging among people aged ≥ 70 years. Greater utilization than usual of perceived social support related to better same-day health among trauma-exposed adults. Access to PTSD Coach ameliorated posttraumatic stress, depressive symptoms, and functional disability compared with waitlist controls and related to within-group reductions in somatic symptoms. Posttraumatic stress continued to decrease during the uncontrolled follow-up. Unguided access to PTSD Coach was considered slightly to moderately helpful. Access to PTSD Coach did not relate to deteriorated posttraumatic stress. Approximately half of the participants reported no negative effects, while ≤ 13% reported potential trauma-related reactions such as distressing memories related to using PTSD Coach. Face-to-face social interactions and perceived social support appear favorable for health. PTSD Coach is a slightly helpful trauma-focused self-management tool that may improve symptoms but also elicit negative effects. Future research could explore mechanisms of change and temporal, causal relationships between coping and health in order to optimize app interventions and resilience during crises.