Assistive technology toolkit for veterans with PTSD

The commonality of post-traumatic stress disorder (PTSD) in veterans ranges by service era and type of service. Roughly 12-30 percent of veterans from active operations experience PTSD in their lifetime. Additional stressors that can contribute to PTSD and mental health problems after service may also include your active duty and responsibilities, politics, the type of opposition you face and where the war is located.

Some veterans may also experience PTSD from military sexual trauma (MST). It is estimated that 55 out of 100 women and 38 out of 100 men experience sexual harassment while in the military.

PTSD is diagnosed when symptoms last for more than a month, cause significant distress and interfere with a person’s ability for daily functioning. Symptoms range in severity on a case-by-case basis and may occur shortly after their PTSD-inducing experience, or years later. Symptoms include:

• Intrusive thoughts, memories, distressing dreams or flashbacks of the event.
• Avoidance of people, places, activities, objects and situations that remind the individual of, or trigger, distressing memories. Veterans with PTSD may also resist and avoid discussing the event, or any feelings they may have about it.
• Alterations in cognition and mood. This may include loss of memory and negative thoughts and feelings or distorted beliefs about oneself or others. Feelings may also include blame, fear, horror, anger, guilt, detachment or shame. Veterans with PTSD may also lose interest in activities they previously enjoyed or may experience a feeling of inability to experience positive emotions such as happiness or satisfaction.
• Alterations in arousal and reactivity may include being irritable, having angry outbursts, reckless or self-destructive behavior, being overly suspicious or watchful of one’s surroundings. It may also include being easily startled or having issues with concentration or sleep.

Furthermore, veterans who experience PTSD may also experience related conditions such as depression, memory issues, substance abuse and other physical and mental health problems. 

For some, PTSD symptoms may subside over time, while others may need treatment. Common traditional treatments for PTSD include:

• Cognitive processing and talk therapy
• Prolonged exposure therapy
• Stress inoculation therapy
• Group therapy
• Medication
• Alternative therapies such as acupuncture and animal-assisted therapy

Recent studies on PTSD care and treatment include the role of digital technology in PTSD treatments. Digital technology-based applications can provide more accessible treatment for veterans with PTSD and may include virtual telehealth, internet-based intervention, mobile apps, wearable technology, virtual experience with AR and games as well as other digital media. 

This resource guide will examine different digital therapy tools and provide resources that can be used by veterans with PTSD alongside treatment.

Studies on the advancement of mobile health apps and their use for the treatment of PTSD show that mobile apps can provide access to treatment that typically or otherwise must overcome geographic, temporal, financial and cultural barriers. The research into the efficacy of mobile health apps for PTSD is ongoing. Keeping this in mind, the study finds the following benefits to using mobile health apps:

• Improves access to care
• Makes it easier for patients to access information about their diagnosis and treatment
• Provides a discreet environment to assist in a veteran’s ability to manage their disorder
• Improves access to treatment for individuals at any time 
• Helps veterans engage in social connections with other trauma survivors for additional treatment support 

The study also noted that apps are regularly available for smartphone use, for both Android and iOS, making the treatment highly accessible without having to breach a digital divide. Many cell phone and service providers also offer specific military discounts that can make mobile devices and interconnectivity even more accessible.  Apps for mental health can also focus on anxiety management, other mental disorders and general mindfulness during the treatment and recovery phase of PTSD.

Consider the following apps for veterans with PTSD that are recommended by the U.S. Department of Veteran Affairs:

• PTSD Coach: Assists veterans by providing information about symptoms that occur after trauma, as well as features for managing a diverse range of symptoms. The app can be personalized and provides tools for screening and tracking symptoms and for handling stress. 
• Beyond MST: Developed specifically to support survivors of military sexual trauma, Beyond MST provides information on common challenges stemming from military sexual trauma. The app also provides tools to cope with problems and reduce stress. Veterans who use the app can also track progress towards recovery goals, and find additional support.
• CPT Coach: Supports cognitive processing therapy (CPT) to decrease feelings of stress induced by trauma. The app provides education and information about CPT, symptom tracking, homework assignments to support treatment and therapy, as well as additional tools.
• PE Coach: Can be used in tandem with prolonged exposure (PE) treatment from a therapist as a treatment companion. The app provides essential and additional information about common reactions to trauma, can record therapy sessions to keep off the file, provides reminders for additional tasks, symptom tracking as well as breathing retraining guidance.
• Stair Coach: Supplements in-person therapy using skills training in affective and interpersonal regulation (STAIR). The app addresses two common issues faced by veterans with PTSD: mood changes and social challenges. The features of the app include detailed information about STAIR, interactive tools for emotional and behavior management, links to support and customizable reminders.

Wearable technology can have health benefits, including the support and treatment of mental health. Wearable tech and portable devices can detect disorders early on, and can even use sensors to indicate when a person is experiencing a trauma-induced symptom. This data can be collected for healthcare providers to assist in treatments and therapy by giving the doctor information about the individual’s PTSD experience when it happens. 

There are many types of wearable tech that can be used to track symptoms and maintain physical health during treatment. These may include:

• Connected smartwatches that can maintain handless communication with healthcare providers.
• Fitness trackers can collect and monitor data from physical symptoms and activities.
• Smart eyewear and brain glasses that modify the frequency and direction of light on the retina to improve comfort, tolerance of environmental changes and decrease hypersensitivity to a sensory stimulus.
• Wearable cameras that can record stimulus and experiences of veterans with PTSD to incorporate new methods into treatment.
• Implantable tech that can monitor body temperature, heart rate, and blood oxygen levels.
• Nightwear connects to Apple products and senses and monitors body movement and heart rate during sleep.
• Emerging wearable tech that can also record fluctuations and symptoms in the body or provide additional comfort and support that may include:
  • Smart jewelry
  • Smart clothing
  • Wireless earbuds

Studies show theoretical and empirical evidence that music therapy for PTSD can have benefits and address symptoms for those that experience post-traumatic stress disorder. Music therapy can impact social, cognitive and neurobiological mechanisms and increase a person’s emotion regulation, ability to feel pleasure and happiness, reduce anxiety and increase feelings of cooperation and community building.

These benefits can help foster resilience, and engage individuals who struggle with the stigma associated with seeking out professional help. Veterans with PTSD can seek services from a music therapist or music therapy program and can make music, write lyrics or listen to music to address or soothe trauma and increase feelings of quality of life. 

There are many ways that veterans can use digital devices and audio accessories to aid in the process of music therapy. This may include:

• Headphones to listen to music at any time, as well as headphones with speakers to record vocals and lyrics 
• Veterans can also stream music to their phones or other handheld devices
• Download music-making apps for handheld devices
• Use handheld synthesizers and pocket operators as instruments
• Record music and audio that they make onto their smartphone

The Zur Institute, which offers accredited educational classes for mental health professionals, notes that cinematic therapy can support therapy and mental health by:

• Eliciting deep feelings and allowing for reflection
• Assist in new ways of thinking, feeling, pursuing and understanding one’s own life
• Lessen defenses and holding back feelings from over-intellectualizing
• Enhance perspective and increase insight and empathy

In a yearlong trial at the Medical University, a cancer center in Vienna, Austria, researchers specifically chose and curated a Disney movie selection for women undergoing chemotherapy. The research found that for women, in particular, watching Disney movies reduced stress, tension, and feelings of fatigue. 

Cinematic therapy may be used at the suggestion and curation of a therapist, but can also be used independently to ease stress and anxiety or serve as a distraction. With the streaming capabilities of modern devices, veterans can access various platforms that offer films, sports, and other entertainment options that offer not only video streaming but music and games.

However, if veterans are using cinema and streaming as a coping mechanism, they also need to be aware that some movies may include content that can trigger PTSD. Veterans can use apps that indicate and offer trigger warnings to ensure that the movies they watch do not induce stress, flashbacks or other symptoms of PTSD.

Some streaming services as well as connectivity networks, offer military and veteran discounts, making streaming movies from digital devices financially and easily accessible on digital devices for active military personnel and veterans.

Research that studied video gameplay and mental health recovery for veterans found that video games can be beneficial to mental health and recovery. Participants in the study reported that gaming not only helped to manage their mood and stress, but also assisted in other aspects of recovery. These include adaptive coping from distraction, feelings of control and symptom substitution. 

Gaming also contributed to positive psychological traits, like confidence, insight and role functioning, which foster feelings of meaning and purpose. Playing games supported these feelings by increasing confidence, feelings of insight and providing role functioning. Furthermore, gaming and using gaming accessories can support socialization when gaming and increase feelings of participation, support and social activities where gamers can connect, talk and lead others in gameplay. 

The report did include responses from participants who said that excessive gaming can lead to feelings of addiction or other life problems, but that these issues were minimal in comparison to the advantages gained through playing video games.

The numerous reports of PTSD from military personnel and veterans from Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn created an important and remarkable challenge for behavioral healthcare. This challenge initiated studies on clinical virtual reality tools for the prevention, assessment and treatment of PTSD in veterans. 

The study found promising results; 80 percent of the treatment completers showed statistical and clinically meaningful reductions in PTSD, anxiety and depression. The improvements were maintained through a post-treatment follow-up three months later. This shows promise for the ways that VR technology could change healthcare.

The use of VR to assist PTSD healing in vets supports trauma-focused healing by allowing veterans to relive, confront and reprocess their trauma safely. Virtual reality therapies immerse the participant in a virtual environment. This immersion can change how the brain processes the body and support mental health treatments with exposure therapy. 

In traditional therapy, a mental health professional might ask a patient to close their eyes and recall or imagine the stimulus that triggers a PTSD reaction. With virtual therapy, participants can relive the experience as part of their treatment. Treatment with virtual reality should be designed and accompanied by a mental health professional and will include the use of appropriate VR products and devices, as well as connectivity requirements to ensure that treatment is not disrupted during application. 

Other applications for using virtual reality for the treatment of symptoms may include utilizing VR technology to explore, engage with interesting or soothing environments that can alleviate other symptoms of stress, or support positive experiences and feelings.

In addition to technological advancements that support healing for veterans, there are also dedicated organizations and resources that provide assistance. Consider the following additional veteran-specific PTSD resources:

• Wounded Warrior Project is an organization that recognizes the individual needs and challenges of veterans. They offer a variety of sources that are supporter funded and free for veterans, including community and social support, mental wellness support, physical wellness, career counseling, and independence programs.
• The U.S. Department of Veteran Affairs has a National Center for PTSD. This program offers education and support for veterans experiencing PTSD as well as support for friends and families.
• PTSD Foundation of America provides a combat trauma helpline specific to veterans. To contact the helpline call: 877.717.7873. The organization also offers information for those with PTSD, as well as aid in finding support groups and local chapters. 
• Military OneSource provides a 24/7 call number that connects veterans with contracted mental health counselors at any time. They can also provide and guide veterans in finding supplementary support and resources.
• Militarybenefits.info offers information and resources for veterans who experience PTSD, alongside other valuable resources for military discounts, VA benefits, housing and homeownership, money and financing, as well as jobs and education support.