Digital Exposure Therapy to Reduce Posttraumatic Stress Disorder Symptoms After Critical Illness: A Pilot Feasibility...

Posttraumatic stress disorder (PTSD) is common after critical illness. Therapist-delivered exposure therapy is a first-line treatment, but often inaccessible due to cost, limited therapist availability, and perceived stigma. Mobile app-delivered exposure therapy may help address these barriers. Messy Memories is a novel smartphone app that guides patients through core exposure therapy techniques, including self-directed processing of prior distressing experiences. We evaluated the feasibility, acceptability, safety, and potential clinical impact of Messy Memories among critical illness survivors.

This single-arm feasibility trial was conducted from October 2023 to September 2024. Patients were recruited from U.S. academic medical centers and online platforms. Eligibility criteria included age ≥18 years, intensive care unit (ICU) admission ≥30 days prior to study enrollment, elevated ICU-related PTSD symptoms (i.e., baseline PTSD Checklist [PCL-5] score ≥10), access to an internet-equipped smartphone, and English proficiency. Patients used the Messy Memories app over 6 weeks, during which they received psychoeducation and guided processing of traumatic ICU memories through user-recorded audio exercises. Psychological symptoms, health behaviors, and implementation outcomes were assessed using validated questionnaires and qualitative feedback at 0, 3, 6, and 12 weeks.

We enrolled 25 patients (mean age 38±12 years, 56% female, 52% Black, 12% Hispanic, 56% college graduates), of whom 22 (88%) completed the 3-week assessment, 19 (76%) completed the 6-week assessment, and 20 (80%) completed the 12-week assessment. Patients logged into the app a mean of 8.20±7.74 times, and 19 (76%) patients recorded at least one memory (mean 2.58±1.95 memories/patient). Mean PCL-5 score improved from 37.8±13.8 at baseline to 21.4±16.1 at 12 weeks (p < 0.01; Cohen's d = 1.13, 95% CI 0.55-1.71). The proportion of patients meeting criteria for probable PTSD decreased from 64% at baseline to 20% after 12 weeks (p = 0.02), and 55% of patients experienced a clinically significant reduction in PCL-5 score from baseline to 12 weeks. The app was rated as highly feasible, acceptable, and appropriate. No serious adverse events occurred.

Our findings suggest that Messy Memories is feasible, acceptable, and shows promise for reducing PTSD symptoms after critical illness. Further testing is warranted to determine its efficacy in well-powered randomized trials.