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Moving Beyond Trauma and PTSD with Digital Behavioral Health Solutions

Dr. Julia Hoffman

01.03.20

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Before I became a psychologist, Post-Traumatic Stress Disorder (PTSD) was an acronym I associated with movie-based caricatures of veterans, hiding under tables, hallucinating images of wars from decades before. Years later, when I had the great privilege to work with veterans and active duty service members at the National Center for PTSD in the U.S. Department of Veterans Affairs, I got a close-up view of what the condition really was and realized that it is not like the movies at all.

In every clinical role I’ve held--with children, adolescents, and adults of all demographic groups — trauma has played a central role. While it is true that certain life circumstances make some groups more likely to experience traumatic events, in many ways, trauma is the great leveler among the behavioral health conditions. No one is completely exempt from experiencing the joys — or horrors — of life. Nearly 90 percent of Americans experience at least one traumatic event in their lives[1] which can adversely affect emotional well-being and interfere with relationships, work, and impact overall quality of life.

Traumatic events vary widely as do the reactions to them. This includes unexpected incidents like car accidents, assaults, or natural disasters, to extended or context-dependent experiences like emotional or physical abuse, military deployments, and more. No matter the event, trauma can take a huge emotional and physical toll.

I have seen a diversity in responses to potentially traumatic events. Some (more than half, according to the scientific literature) will struggle, and then ultimately feel better without treatment. Others will have chronic challenges related to the event(s). Finally, a select group will report posttraumatic growth: a positive personal transformation that is the result of the adversity. No matter the response, the result is hardly an issue of willpower or some potentially controllable factor. Emerging science continues to help us understand the myriad variables at play here, ranging from how a person felt during the traumatic event, to the resources available to them directly afterward, or even their genetic predisposition to trauma, handed down through generations.

An official diagnosis of PTSD is made when the effects of trauma are more serious and sustained. While roughly 11-20 percent of veterans (depending on their era of service) experience PTSD in their lifetime[2], it is imperative to note that PTSD does not solely affect military personnel. In fact, an estimated one in 11 U.S. adults will be diagnosed with PTSD at some point in their lives and during any given year and about eight million U.S. adults struggle with PTSD[3]. It is a painful condition, for the traumatized individual and for loved ones. The symptoms don’t look like the Hollywood rendering; instead it looks like some combination of recalling the trauma over and over, whether awake or asleep, avoiding people, places, things, thoughts, and conversations associated with the trauma, feeling emotionally numb, and being on edge which can drive irritability, sleeplessness, and other issues.

It’s important to understand not just how our diagnostic manual describes a condition but what it really looks and feels like. Everyone is different and the nature of their trauma and their personal circumstances will present itself differently. In my experience, PTSD looks like choosing a seat at a restaurant with your back against the wall to ensure potential threats are visible. It’s avoiding necessary gynecological appointments to avoid traumatization after a sexual assault. It’s the unproductivity and related self-blaming that comes from being distracted by trauma reminders. It’s avoiding sleep to escape nightmares, which ultimately leads to emotional dysregulation. It’s white knuckling it through car rides, avoiding malls, jumping at small sounds or movements, and living with the shame and hopelessness related to being unable to put old wounds aside.

People with PTSD often describe their world getting smaller and smaller. As they fastidiously avoid trauma reminders, options to engage become fewer and far between. This, in turn, feeds the foundational inaccurate beliefs that fuel the disorder itself: the world is dangerous, I am weak, I cannot keep myself safe, and other similar thoughts. The avoidance, aimed at decreasing stress, paradoxically increases. It’s no surprise that approximately 80 percent of people with PTSD meet criteria for one or more co-occurring behavioral health conditions such as substance use disorder, depression, insomnia, and various anxiety disorders[4].

Perhaps, more surprising is the relationship between PTSD and physical health conditions. The toll that PTSD takes on the body is profound, especially over the longer term. For example, PTSD is associated with significantly increased risk of cardiovascular complications[5], obesity[6], and type 2 diabetes[7]. Although the causation is unclear, approximately ten percent of people with chronic pain meet the criteria for PTSD[8]. The result of these various complexities can be measured in dollars as well. PTSD costs $18,753 per year on average of for those with Medicaid and $10,024 for those with private insurance[9].

The Good and the Bad News

Over the past three decades, incredibly effective interventions for managing the acute impact of trauma, as well as formal diagnosis of PTSD, have been developed and rigorously tested. Despite being a painful condition, it is treatable using one of a handful of gold standard interventions. However, despite the fact that trauma is common and treatable, many people do not seek care. This is often due to personal views, reluctance to seek help, available resources, or access to care.

Our Approach

Livongo for Behavioral Health by myStrength is proud to announce the addition of the new Trauma and PTSD program to our digital behavioral health solutions. Moving Beyond Trauma and PTSD is a unique program that empowers those who have experienced a wide range of traumatic events, with each Member moving through the program by exploring examples, topics, and themes that are relevant to their own specific situation. The program helps normalize and validate the Member’s thoughts, feelings and experiences---including what can be done to manage discomfort and distress---and provides actionable coping skills and insights to manage daily symptoms. The program offers a guided path to resources and activities based on clinical models, as well as stories from people who have been through similar experiences, reinforcing that there is hope and recovery is possible.

Moving Beyond Trauma and PTSD improves health literacy around trauma and introduces Members to principles, techniques, and skills based in Dialectical Behavioral Therapy, Cognitive-Behavioral Therapy, as well as Mindfulness to help manage trauma symptoms. It educates Members about evidence-based, gold standard clinical approaches to PTSD treatment and related distress including Cognitive Processing Therapy, Prolonged Exposure Therapy, Stress Inoculation Therapy, and Eye Movement Desensitization and Reprocessing (EMDR). See the program video here: https://view.vzaar.com/20789392/video.

We understand the emotional and physical effects trauma can bring to our Members, and we are here to help. Livongo for Behavioral Health by myStrength’s integrated platform is uniquely positioned to empower individuals with personalized pathways incorporating multiple programs to help manage and overcome comorbid challenges, addressing the needs of the whole person. We are thrilled to launch this ground-breaking new program and to continue to offer innovative digital health solutions with depth and breadth to build Member’s resiliency, manage stress, improve mood, sleep better, find daily inspiration and better manage all aspects of their health.


[1]Kilpatrick DG, Resnick HS, Milanak ME, Miller MW, Keyes KM, Friedman MJ. National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. J Trauma Stress. 2013;26(5):537–547. doi:10.1002/jts.21848

[2]Gradus, DSc, MPH, Jaimie L. “National Center for PTSD.” PTSD, 15 Aug. 2013,www.ptsd.va.gov/.https://www.ptsd.va.gov/understand/common/common_veterans.asp

[3]National Comorbidity Survey. (2005). NCS-R appendix tables: Table 1. Lifetime prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Table 2. Twelve-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Available at: www.hcp.med.harvard.edu/ncs/publications.php

[4]Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds.). (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York, NY, US: Guilford Press.

[5]Vaccarino V1, Goldberg J, Rooks C, Shah AJ, Veledar E, Faber TL, Votaw JR, Forsberg CW, Bremner JD. Post-traumatic stress disorder and incidence of coronary heart disease: a twin study. J Am Coll Cardiol. 2013 Sep 10;62(11):970-8. doi: 10.1016/j.jacc.2013.04.085. Epub 2013 Jun 27.

[6]Kubzansky LD, Bordelois P, Jun HJ, Roberts AL, Cerda M, Bluestone N, Koenen KC. The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry. 2014 Jan;71(1):44-51. doi: 10.1001/jamapsychiatry.2013.2798.

[7]Roberts AL, Agnew-Blais JC, Spiegelman D, et al. Posttraumatic stress disorder and incidence of type 2 diabetes mellitus in a sample of women: a 22-year longitudinal study. JAMA Psychiatry. 2015;72(3):203–210. doi:10.1001/jamapsychiatry.2014.2632

[8]Siqveland J, Hussain A, Lindstrøm JC, Ruud T, Hauff E. Prevalence of Posttraumatic Stress Disorder in Persons with Chronic Pain: A Meta-analysis. Front Psychiatry. 2017;8:164. Published 2017 Sep 14. doi:10.3389/fpsyt.2017.00164

[9]Ivanova JI, Birnbaum HG, Chen L, Duhig AM, Dayoub EJ, Kantor ES, Schiller MB, Phillips GA. Cost of post-traumatic stress disorder vs major depressive disorder among patients covered by Medicaid or private insurance. Am J Manag Care. 2011 Aug 1;17(8):e314-23.

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