There are currently no e-health programs that focus on comorbid AOD use disorders and PTSD. There is, however, some evidence that internet-delivered therapy, either as the sole treatment or with the support of a therapist, can be somewhat beneficial in reducing PTSD symptoms, particularly if supported by low-level clinical care [847]. Internet programs that have been shown to have moderate treatment effects have employed CBT techniques, in the form of psychoeducation, exposure (often in the form of writing about one’s trauma experience), anxiety management, and cognitive restructuring. In particular, two Australian programs – PTSD online and PTSD program – have shown particular promise [740, 854]. Notably, both programs provide links to psychoeducation on AOD use.
PTSD online is a 10-week therapist-assisted CBT program consisting of psychoeducation; anxiety management (i.e., controlled breathing and progressive muscle relaxation); cognitive behavioural strategies to identify, challenge, and change cognitive processes; imaginal (i.e., writing about the trauma) and real-life exposure; and relapse prevention. A number of small uncontrolled trials have found promising results, including significant reductions in PTSD symptoms and psychological distress, improvements in quality of life and high levels of satisfaction with treatment [740, 855, 856].
PTSD program comprises seven online lessons, a summary/homework assignment for each lesson, an online discussion forum for each lesson moderated by the therapist, regular automatic reminder and notification emails, and instant messaging to allow secure messaging with a clinician. In a small RCT, Spence and colleagues [854] found significantly greater reductions in PTSD symptom severity among individuals randomised to receive PTSD program compared to waitlist control. Individuals who received PTSD program also reported high levels of satisfaction with the treatment.
More recently, mobile apps for PTSD have begun to be developed. PTSD Coach, in particular, has demonstrated initial promise. Developed by the US Department of Veterans Affairs to help individuals who have PTSD symptoms better understand and self-manage their symptoms [857], PTSD Coach is based on evidence-based CBT principles and can be used both as a stand-alone application as well as a supportive application during therapy. It consists of psychoeducation, self-assessment, information about referral and treatment, CBT-based exercises to reduce negative trauma-related cognitions, and tools to strengthen social support and psychological resilience. An online version of the application is also available (http:// www.ptsd.va.gov/apps/PTSDCoachOnline/). A study examining user satisfaction, perceived helpfulness, and usage patterns among veterans receiving PTSD treatment found that participants were very satisfied with PTSD Coach and perceived it as being moderately to very helpful in managing their PTSD symptoms [858]. These findings offer preliminary support for the acceptability and perceived helpfulness of PTSD Coach and suggest that it has potential to be an effective self-management tool for PTSD. Although promising, future research and validation is needed.