mHealth in the Wild: Using Novel Data to Examine the Reach, Use, and Impact of PTSD Coach.

BACKGROUND: A majority of Americans (58%) now use smartphones, making it possible for mobile mental health apps to reach large numbers of those who are living with untreated, or under-treated, mental health symptoms. Although early trials suggest positive effects for mobile health (mHealth) interventions, little is known about the potential public health impact of mobile mental health apps. OBJECTIVE: The purpose of this study was to characterize reach, use, and impact of "PTSD Coach", a free, broadly disseminated mental health app for managing posttraumatic stress disorder (PTSD) symptoms. METHODS: Using a mixed-methods approach, aggregate mobile analytics data from 153,834 downloads of PTSD Coach were analyzed in conjunction with 156 user reviews. RESULTS: Over 60% of users engaged with PTSD Coach on multiple occasions (mean=6.3 sessions). User reviews reflected gratitude for the availability of the app and being able to use the app specifically during moments of need. PTSD Coach users reported relatively high levels of trauma symptoms (mean PTSD Checklist Score=57.2, SD=15.7). For users who chose to use a symptom management tool, distress declined significantly for both first-time users (mean=1.6 points, SD=2.6 on the 10-point distress thermometer) and return-visit users (mean=2.0, SD=2.3). Analysis of app session data identified common points of attrition, with only 80% of first-time users reaching the app's home screen and 37% accessing one of the app's primary content areas. CONCLUSIONS: These findings suggest that PTSD Coach has achieved substantial and sustained reach in the population, is being used as intended, and has been favorably received. PTSD Coach is a unique platform for the delivery of mobile mental health education and treatment, and continuing evaluation and improvement of the app could further strengthen its public health impact.

A multilevel examination of interpartner intimate partner violence and psychological aggression reporting concordance.

Low concordance of reports across partners has consistently been observed when partners report the frequency of intimate partner violence (IPV) and psychological aggression (PA) in their relationship. Researchers have been unsuccessful in the quest to discover systematic biases across reporters, perhaps due to examining constructs that are not the source of bias (e.g., gender, victim/perpetrator status) or examining potentially fruitful constructs using underpowered statistics or erroneous conceptualizations (e.g., examining variables at a dyadic, rather than an individual, level). We used multilevel modeling with two samples (Ns = 88 and 164 couples) to examine husbands' and wives' relationship satisfaction as individual-level correlates of husband- and wife-perpetrated IPV and PA reporting concordance. Consistent with prior literature, low to moderate levels of agreement were observed, and gender and victim/perpetrator status were not consistently associated with reporting concordance. In contrast, for both husbands and wives, relationship satisfaction was associated with reporting concordance such that high relationship satisfaction was related to reporting less of one's partner's PA than the partner reported, whereas low relationship satisfaction was related to reporting more of one's partner's PA than the partner reported. A similar pattern of results emerged for the reporting of IPV, but results did not cross validate between samples. These findings suggest that relationship satisfaction may lead to either reluctance, or increased willingness, to attribute negative relationship events to partner behavior, potentially due to partner blame and relationship schemas. In addition, the influence of individual-level factors may be occluded when aggregated across partners to examine correlates of interpartner reporting concordance.

Parenting schemas and the process of change.

Parents' childrearing behaviors are guided by schemas of the caregiving role, their functioning in that role, what children need in general, and what their own children are like in particular. Sometimes, however, parenting schemas can be maladaptive because they are too rigid or simple, involve inappropriate content, or are dominated by negative affect. In this article, we describe parenting schemas and provide an overview of empirical work documenting the characteristics of maladaptive parenting schemas. We review how intervention practices common to multiple therapeutic approaches (cognitive-behavior therapy, family therapy, parent training, attachment-based interventions, and psychoanalytic parent-infant psychotherapy) attempt to modify schemas to promote more optimal functioning among parents. We highlight how research in cognitive science may explain, in part, treatment effectiveness.