Post-Traumatic Stress Disorder (PTSD) Symptoms in Patients with Acute Myeloid Leukemia (AML)

Background: Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy face a life-threatening illness, experience a prolonged, isolating hospitalization, and endure substantial physical and psychological symptoms. Some patients with AML experience traumatic stress as a result of their diagnosis and illness course. As traumatic stress reactions can negatively impact patients' QOL, mood, and clinical outcomes, it is essential to understand the extent of this trauma, its clinical manifestations, and risk factors to inform targeted management strategies. Post-traumatic stress disorder (PTSD), characterized by experiencing a traumatic event, is a common stress related disorder in cancer populations. Despite the potential link between AML and PTSD, data are limited regarding risk and risk factors of PTSD symptoms in this population. Methods: We conducted a secondary analysis of 160 patients with high-risk AML hospitalized to receive intensive chemotherapy. We used the Post-Traumatic Stress Disorder Checklist-Civilian Version to assess PTSD symptoms at one month after diagnosis of AML. We used the Brief COPE, and Functional Assessment of Cancer Therapy-Leukemia at baseline and week-2 during hospitalization to assess coping and quality of life (QOL), respectively. We then used multivariate regression models to assess the relationship between PTSD symptoms at one month and patient baseline sociodemographic factors, coping, and QOL. Results: Twenty-eight percent of patients reported clinically significant PTSD symptoms, describing high rates of intrusion (92%), avoidance (100%), and hypervigilance (97%). Among those who did not have clinically significant PTSD symptoms, 27%, 26%, and 23% of patients reported clinically significant intrusion, avoidance, and hypervigilance symptoms, respectively. In adjusted analyses, higher baseline QOL (B= -.22, p= <.001) and less decline in QOL during hospitalization (B= -.17, p=.018) were associated with fewer PTSD symptoms. The use of approach-oriented coping (B= -.72; p= .018) was also associated with fewer PTSD symptoms, while the use of avoidant coping was not significantly associated with PTSD symptoms. Conclusion: A substantial proportion of patients with AML report clinically significant PTSD symptoms at one month after initiating intensive chemotherapy. These findings highlight the need to routinely screen, assess, and manage PTSD symptoms in all patients with AML. Patients' baseline QOL, coping strategies, and extent of QOL decline during hospitalization are important risk factors for PTSD symptoms, underscoring potential intervention targets in future studies to reduce the impact of PTSD in this population. Disclosures LeBlanc: Heron: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Otsuka: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Medtronic: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Welvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; American Cancer Society: Research Funding; BMS: Research Funding; Duke University: Research Funding; NINR/NIH: Research Funding; Jazz Pharmaceuticals: Research Funding; UpToDate: Patents & Royalties; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Consultancy, Honoraria, Research Funding, Speakers Bureau; CareVive: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Daiichi Sankyo: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Flatiron: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Helsinn: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Hobbs:Merck: Research Funding; Incyte: Research Funding; Celgene/BMS: Honoraria; Novartis: Honoraria; Jazz: Honoraria; Bayer: Research Funding; Constellation: Honoraria, Research Funding. Brunner:Novartis: Research Funding; AstraZeneca: Research Funding; Forty-Seven Inc: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Takeda: Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding. Luger:Daiichi-Sankyo: Honoraria; Pfizer: Honoraria; Bristol-Myers Squibb: Honoraria; Acceleron: Honoraria; Agios: Honoraria; Loxo Oncology: Honoraria; Onconova: Research Funding; Kura: Research Funding; Hoffman La Roche: Research Funding; Ariad: Research Funding; Biosight: Research Funding. Bhatnagar:KITE: Membership on an entity's Board of Directors or advisory committees; KaryoPharm Therapuetics: Research Funding; Cell Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees.

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Genes and hormones of the hypothalamic–pituitary–adrenal axis in post-traumatic stress disorder. What is their role in symptom expression and treatment response?

Journal of Neural Transmission ◽

10.1007/s00702-021-02330-2 ◽

2021 ◽

Author(s):

Susanne Fischer ◽

Tabea Schumacher ◽

Christine Knaevelsrud ◽

Ulrike Ehlert ◽

Sarah Schumacher

Keyword(s):

Hpa Axis ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Alternative Treatments ◽

Hypothalamic Pituitary Adrenal ◽

Post Traumatic

Abstract Background Less than half of all individuals with post-traumatic stress disorder (PTSD) remit spontaneously and a large proportion of those seeking treatment do not respond sufficiently. This suggests that there may be subgroups of individuals who are in need of augmentative or alternative treatments. One of the most frequent pathophysiological findings in PTSD is alterations in the hypothalamic–pituitary–adrenal (HPA) axis, including enhanced negative feedback sensitivity and attenuated peripheral cortisol. Given the role of the HPA axis in cognition, this pattern may contribute to PTSD symptoms and interfere with key processes of standard first-line treatments, such as trauma-focused cognitive behavioural therapy (TF-CBT). Methods This review provides a comprehensive summary of the current state of research regarding the role of HPA axis functioning in PTSD symptoms and treatment. Results Overall, there is preliminary evidence that hypocortisolaemia contributes to symptom manifestation in PTSD; that it predicts non-responses to TF-CBT; and that it is subject to change in parallel with positive treatment trajectories. Moreover, there is evidence that genetic and epigenetic alterations within the genes NR3C1 and FKBP5 are associated with this hypocortisolaemic pattern and that some of these alterations change as symptoms improve over the course of treatment. Conclusions Future research priorities include investigations into the role of the HPA axis in day-to-day symptom variation, the time scale in which biological changes in response to treatment occur, and the effects of sex. Furthermore, before conceiving augmentative or alternative treatments that target the described mechanisms, multilevel studies are warranted.

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Pharmacotherapy for post-traumatic stress disorder: Systematic review and meta-analysis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.148551 ◽

2015 ◽

Vol 206 (2) ◽

pp. 93-100 ◽

Cited By ~ 156

Author(s):

Mathew Hoskins ◽

Jennifer Pearce ◽

Andrew Bethell ◽

Liliya Dankova ◽

Corrado Barbui ◽

...

Keyword(s):

Systematic Review ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Selective Serotonin Reuptake Inhibitors ◽

Stress Disorder ◽

Positive Impact ◽

Meta Analysis ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic

BackgroundPharmacological treatment is widely used for post-traumatic stress disorder (PTSD) despite questions over its efficacy.AimsTo determine the efficacy of all types of pharmacotherapy, as monotherapy, in reducing symptoms of PTSD, and to assess acceptability.MethodA systematic review and meta-analysis of randomised controlled trials was undertaken; 51 studies were included.ResultsSelective serotonin reuptake inhibitors were found to be statistically superior to placebo in reduction of PTSD symptoms but the effect size was small (standardised mean difference −0.23, 95% CI −0.33 to −0.12). For individual pharmacological agents compared with placebo in two or more trials, we found small statistically significant evidence of efficacy for fluoxetine, paroxetine and venlafaxine.ConclusionsSome drugs have a small positive impact on PTSD symptoms and are acceptable. Fluoxetine, paroxetine and venlafaxine may be considered as potential treatments for the disorder. For most drugs there is inadequate evidence regarding efficacy for PTSD, pointing to the need for more research in this area.

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"Efficacy of Cognitive Behavioral Therapy in Post-traumatic Stress Disorder Among Spinal Cord Injury Patients: A Randomized Controlled Pilot Study"

Journal of Evidence-Based Psychotherapies ◽

10.24193/jebp.2021.2.16 ◽

2021 ◽

Vol 21 (2) ◽

pp. 143-162

Author(s):

Anwar Khan ◽

Faseeh Ullah ◽

Omer Abid ◽

Khizra Hafeez Awan

Keyword(s):

Spinal Cord ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Behavioral Therapy ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Randomized Controlled ◽

Cord Injury ◽

Post Traumatic

"Post-Traumatic Stress Disorder (PTSD) develops after exposure to or witnessing traumatic events. PTSD is very common among the Spinal Cord Injury (SCI) patients. PTSD can be successfully treated with the Cognitive Behavioral Therapy (CBT). However, CBT is mostly used in the western countries, so its efficacy in the eastern culture is still not fully known. Keeping this in view, the current study has determined the efficacy of CBT in the treatment of PTSD among the SCI patients in Pakistan. Using a Randomized Controlled Pilot Study design, data were collected through the Clinician-Administered PTSD Scale for DSM-5 from thirty patients admitted to the Paraplegic Center. Trauma-focused CBT(TF-CBT) protocol was applied through fourteen sessions. Data were analyzed by descriptive and multivariate statistics. Findings show that the level of PTSD symptoms gradually decreased from high at baseline (CAPS-5 Mean Scores μ= 3.6) to low during follow-up stage (CAPS-5 Mean Scores μ= 0.89). Results obtained from the present study on the efficacy of CBT are in concurrence with the research findings in other countries. This study supports the efficiency CBT intervention among Pakistani patients who had developed PTSD symptoms after suffering from SCI. Therefore, CBT can be widely used in the management of PTSD in Pakistan."

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Perceived stress and post-traumatic stress disorder symptoms among intensive care unit staff caring for severely ill coronavirus disease 2019 patients during the pandemic: a national study

Annals of General Psychiatry ◽

10.1186/s12991-021-00363-1 ◽

2021 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Nisha Kader ◽

Bushra Elhusein ◽

Nirvana Swamy Kudlur Chandrappa ◽

Abdulqadir J. Nashwan ◽

Prem Chandra ◽

...

Keyword(s):

Mental Health ◽

Intensive Care Unit ◽

Perceived Stress ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Well Being ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic

Abstract Background Intensive care unit (ICU) staff have faced unprecedented challenges during the coronavirus disease 2019 (COVID-19) pandemic, which could significantly affect their mental health and well-being. The present study aimed to investigate perceived stress and post-traumatic stress disorder (PTSD) symptoms reported by ICU staff working directly with COVID-19 patients. Methods The Perceived Stress Scale was used to assess perceived stress, the PTSD Diagnostic Scale for the Diagnostic and Statistical Manual of Mental Disorders (5th edition) was used to determine PTSD symptoms, and a sociodemographic questionnaire was used to record different sociodemographic variables. Results Altogether, 124 participants (57.2% of whom were men) were included in the analysis. The majority of participants perceived working in the ICU with COVID-19 patients as moderately to severely stressful. Moreover, 71.4% of doctors and 74.4% of nurses experienced moderate-to-severe perceived stress. The staff with previous ICU experience were less likely to have a probable diagnosis of PTSD than those without previous ICU experience. Conclusions Assessing perceived stress levels and PTSD among ICU staff may enhance our understanding of COVID-19-induced mental health challenges. Specific strategies to enhance ICU staff’s mental well-being during the COVID-19 pandemic should be employed and monitored regularly. Interventions aimed at alleviating sources of anxiety in a high-stress environment may reduce the likelihood of developing PTSD.

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GEROFIT: IMPACT ON PTSD SYMPTOMS AMONG PARTICIPATING VETERANS WITH SELF-REPORTED PTSD

Innovation in Aging ◽

10.1093/geroni/igz038.133 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S34-S34

Author(s):

Cathy Lee ◽

Rebecca Melrose ◽

Erin Blanchard ◽

Stacy Wilkins ◽

Steven Castle ◽

...

Keyword(s):

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Exercise Program ◽

Self Report ◽

Symptom Improvement ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic ◽

Negative Feelings

Abstract Post-traumatic stress disorder (PTSD) increases risk of medical comorbidities in aging. The Gerofit Program is an exercise program for older Veterans that shows efficacy for physical health. We sought to determine its impact on PTSD. Veterans in Gerofit completed a self-report questionnaire at 3 and 6 months assessing effect of Gerofit on: PTSD symptoms generally, disturbing dreams, avoidance, negative feelings, and irritability. Two hundred twenty-nine Veterans completed the questionnaire. Of these, 56 (24.5%) reported PTSD. None reported worsened PTSD following Gerofit participation. At 3 months, >50% of Veterans reported symptom improvement and this was maintained over 6 months for all items (p>0.05 paired t-test). There was an increase between 3 and 6 months in the percentage who reported “improved a lot” for overall symptoms (16.7% to 22.2%), negative feelings (5.6% to 11.1%) and irritability (0% to 11.1%). Gerofit may offer an effective intervention to improve PTSD symptoms in older Veterans.

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Prior disclosure and emotional expression: Interactive effects on post-traumatic stress disorder symptoms

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217417749790 ◽

2017 ◽

Vol 53 (3) ◽

pp. 189-196 ◽

Cited By ~ 1

Author(s):

Yung Y Chen ◽

Min C Kao

Keyword(s):

Emotional Expression ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Trauma Processing ◽

Post Traumatic ◽

Religious Trauma

Background Previous research has revealed mixed findings with regard to the effects of disclosure on trauma recovery. More recently, studies on psychological trauma have found associations among religion, meaning, and health. This study investigated prior disclosure as a moderator for the association between religious emotional expression and adaptive trauma processing, as measured by post-traumatic stress disorder (PTSD) symptoms. Methods Using Pennebaker’s written emotional expression paradigm, 105 participants were assigned to either a conventional trauma-writing condition or religious trauma-writing condition. PTSD symptoms were assessed at baseline and again at one-month post writing. Results A two-way interaction was found between prior disclosure and writing condition on PTSD symptoms at follow-up. For the religious trauma-writing condition only, there was a significant difference between low versus high disclosure participants in PTSD symptoms at follow-up, such that low prior disclosure participants registered fewer PTSD symptoms than high prior disclosure participants, while prior disclosure did not have such effect in the conventional trauma-writing condition. Limitations: This two-way interaction may be further qualified by other important psychosocial variables, such as differences in personality, coping style, social support, or use of prayer as a form of disclosure, which were not assessed in this study. Conclusion Religious emotional expression may encourage adaptive trauma processing, especially for individuals with low prior disclosure. These findings encourage further investigation of the conditions under which disclosure and religion may be a beneficial factor in trauma adaptation and treatment.

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Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: randomised clinical trial

The British Journal of Psychiatry ◽

10.1192/bjp.2020.158 ◽

2020 ◽

Vol 217 (5) ◽

pp. 609-615

Author(s):

Katrina L. Boterhoven de Haan ◽

Christopher W. Lee ◽

Eva Fassbinder ◽

Saskia M. van Es ◽

Simone Menninga ◽

...

Keyword(s):

Childhood Trauma ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Randomised Clinical Trial ◽

Drop Out ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic ◽

Imagery Rescripting

BackgroundInvestigation of treatments that effectively treat adults with post-traumatic stress disorder from childhood experiences (Ch-PTSD) and are well tolerated by patients is needed to improve outcomes for this population.AimsThe purpose of this study was to compare the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR), for treating Ch-PTSD.MethodWe conducted an international, multicentre, randomised clinical trial, recruiting adults with Ch-PTSD from childhood trauma before 16 years of age. Participants were randomised to treatment condition and assessed by blind raters at multiple time points. Participants received up to 12 90-min sessions of either ImRs or EMDR, biweekly.ResultsA total of 155 participants were included in the final intent-to-treat analysis. Drop-out rates were low, at 7.7%. A generalised linear mixed model of repeated measures showed that observer-rated post-traumatic stress disorder (PTSD) symptoms significantly decreased for both ImRs (d = 1.72) and EMDR (d = 1.73) at the 8-week post-treatment assessment. Similar results were seen with secondary outcome measures and self-reported PTSD symptoms. There were no significant differences between the two treatments on any standardised measure at post-treatment and follow-up.ConclusionsImRs and EMDR treatments were found to be effective in treating PTSD symptoms arising from childhood trauma, and in reducing other symptoms such as depression, dissociation and trauma-related cognitions. The low drop-out rates suggest that the treatments were well tolerated by participants. The results from this study provide evidence for the use of trauma-focused treatments for Ch-PTSD.

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Post-traumatic stress reactions and doctor-certified sick leave after a workplace terrorist attack: Norwegian cohort study

BMJ Open ◽

10.1136/bmjopen-2019-032693 ◽

2020 ◽

Vol 10 (2) ◽

pp. e032693 ◽

Cited By ~ 2

Author(s):

Maria Teresa Grønning Dale ◽

Alexander Nissen ◽

Mona Berthelsen ◽

Trond Heir

Keyword(s):

Sick Leave ◽

Work Environment ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Terrorist Attack ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Psychosocial Work ◽

Post Traumatic

ObjectiveTo explore the association between the psychosocial work environment and the risk of sick leave among governmental employees with symptom-defined post-traumatic stress disorder (PTSD) after a workplace bomb attack.DesignA prospective study on employees who met the symptom criteria for PTSD. Questionnaire data on the psychosocial work environment 10 months after the terrorist attack was linked to registry data on doctor-certified sick leave in the period 12–22 months after the attack.SettingThe bombing of the government ministries in Oslo, Norway, 22 July 2011.ParticipantsThe study sample consists of 94 Norwegian governmental employees, all with symptom-defined PTSD from the Norwegian version of the PTSD checklist (Post-traumatic Stress Disorder Checklist-Specific) measured 10 months after the attack.ResultsAfter adjustment for sex and severity of PTSD symptoms, predictability at work reduced the odds of sick leave (adjusted OR=0.62, 95% CI 0.40 to 0.98). Sense of control over decisions at work was associated with fewer absence days for employees with sick leave (adjusted rate ratio=0.61, 95% CI 0.38 to 0.98).ConclusionsEmployees with PTSD after workplace terrorism would benefit from control over their workplace conditions and increased predictability to reduce the risk of sick leave. The findings suggest that the work environment can facilitate employees’ work ability after stressful events, independent of severity of PTSD symptoms.

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Electroencephalography-based neurofeedback as treatment for post-traumatic stress disorder: A systematic review and meta-analysis

European Psychiatry ◽

10.1192/j.eurpsy.2019.7 ◽

2020 ◽

Vol 63 (1) ◽

Cited By ~ 5

Author(s):

Steinn Steingrimsson ◽

Gorana Bilonic ◽

Ann-Catrin Ekelund ◽

Tomas Larson ◽

Ida Stadig ◽

...

Keyword(s):

Systematic Review ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Meta Analysis ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Suicidal Thoughts ◽

Assessment Development ◽

Post Traumatic

Abstract Background. Post-traumatic stress disorder (PTSD) is debilitating for patients and society. There are a number of treatment methods albeit not all patients respond to these and an interesting method using electroencephalography-based neurofeedback (EEG-NF) has become more prominent in recent years. This systematic review aimed to assess whether EEG-NF, compared with sham NF, other treatment, or no treatment, is effective for PTSD. Primary outcomes were self-harm, PTSD symptoms, level of functioning and health-related quality of life. Methods. Systematic literature searches for randomized controlled trials (RCTs) were conducted in six databases. Random effects meta-analysis was performed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. Results. Four RCTs were included (123 participants). Suicidal thoughts were significantly reduced after EEG-NF compared with a waiting list in a small study. PTSD symptoms were assessed in all studies with different instruments. Results were consistently in favor of EEG-NF with large effect sizes (standardized mean difference −2.30 (95% confidence interval: −4.37 to −0.24). One study reported significantly improved level of executive functioning and one study a reduction in use of psychotropic medication. Complications were scarcely reported. Certainty of evidence was assessed as very low for the four assessed outcomes. Conclusions. Based on four RCTs, with several study limitations and imprecision, it is uncertain whether EEG-NF reduces suicidal thoughts, PTSD symptoms, medication use, or improves function. Although all studies showed promising results, further studies are needed to increase the certainty of evidence.

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Efficacy of mobile application interventions for the treatment of post-traumatic stress disorder: A systematic review

Digital Health ◽

10.1177/2055207619842986 ◽

2019 ◽

Vol 5 ◽

pp. 205520761984298 ◽

Cited By ~ 8

Author(s):

Alice Wickersham ◽

Petros Minas Petrides ◽

Victoria Williamson ◽

Daniel Leightley

Keyword(s):

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Mobile Apps ◽

Healthcare Services ◽

Mobile App ◽

Small Sample ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic

Background Many adults with post-traumatic stress disorder (PTSD) are unable to access healthcare services for treatment due to logistical, social, and attitudinal barriers. Interventions delivered via mobile applications (apps) may help overcome these barriers. Objective The aim of this study is to systematically evaluate the most recent evidence from trials investigating the efficacy of mobile apps for treating PTSD. Methods PubMed, Web of Science, Embase, PsycINFO, and Medline were searched in February 2018. Randomised controlled trials (RCTs) were included if they quantitatively evaluated the efficacy of a mobile app for treating PTSD as part of the primary aim. Findings were presented in a narrative synthesis. Results In the five identified RCTs, the use of app-based interventions appeared to be associated with reductions in PTSD symptoms. However, the strength of evidence for this association appeared to be inconsistent, and there was little evidence that those using the apps experienced greater reductions in PTSD symptoms than those in control conditions. Nonetheless, there was some evidence that app-based interventions are both a feasible and acceptable treatment pathway option. Conclusions Included studies were often limited by small sample sizes, brief intervention, and follow-up periods, and self-reported measures of PTSD. Evidence for the efficacy of mobile interventions for treating PTSD was inconclusive, but promising. Healthcare professionals should exercise caution in recommending app-based interventions until the potentially adverse effects of app use are better understood and larger-scale studies have taken place.

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