Spring Military-PTSD : development and pilot evaluation of a guided digital therapy for military veterans with post-traumatic stress disorder (PTSD)

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Background: Cognitive behavioural therapy with a trauma focus (CBT-TF) is the gold-standard treatment for military post-traumatic stress disorder (PTSD), but access is limited by high costs, therapist shortages, and the demands of in-person delivery. Guided digital CBT-TF, delivered via an app or website with therapist support, offers a scalable alternative.Objective: This study aimed to adapt Spring PTSD, an evidence-based guided digital therapy, for military veterans and conduct an initial pilot test of the adapted version.Method: A two-stage process was used. In Stage 1, veterans with lived experience of PTSD (n = 11) participated in focus groups to guide adaptations. Key themes included the need for a relatable narrator, authentic military representation, diverse visuals, and military-inspired design. Veterans also emphasised addressing emotional regulation. These insights shaped the development of Spring Military-PTSD, which incorporated techniques from Enhanced Skills Training for Affective and Interpersonal Regulation (ESTAIR). In Stage 2, treatment-seeking veterans with PTSD (n = 10) took part in a pilot study that collected qualitative and quantitative data. The primary outcome was change in PTSD severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Participants received an average of 3 h and 50 min of therapist support.Results: Eight participants completed the pilot; two dropped out. Of the completers, four no longer met diagnostic criteria for PTSD, and six showed reliable improvement on CAPS-5. Statistically significant reductions were also seen in self-reported PTSD, disturbance in self-organisation (DSO), anxiety, and depression. Qualitative feedback supported the relevance and acceptability of the intervention.Conclusions: Findings provide preliminary evidence for the efficacy and acceptability of Spring Military-PTSD. The adapted intervention shows promise as a scalable and engaging treatment for veterans with PTSD. Further research is warranted to evaluate its effectiveness and potential for broader implementation.