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Symposia

Military and Veterans Psychology

Identification and Assessment of Factors Affecting Veterans' Therapeutic Engagement

2 - (SYM 75) I Felt My Therapist's Presence During Exposures: Insights on Using Active and Passive Mobile Sensing to Enhance Patient Engagement

Sunday, November 23, 2025
2:27 PM - 2:48 PM CST
Location: Strand 12 A&B, Level 2
Keywords: Veterans, Treatment, PTSD (Posttraumatic Stress Disorder)
Recommended Readings: Johnson, E. M., & Possemato, K. (2019). Correlates and predictors of mental health care utilization for veterans with PTSD: A systematic review. Psychological Trauma: Theory, Research, Practice, and Policy, 11(8), 851-860. https://doi.org/10.1037/tra0000461,   Sherrill, A. M., Wiese, C. W., Abdullah, S., & Arriaga, R. I. (2025). Teaming with Artificial Intelligence to learn and sustain psychotherapy delivery skills: Workplace, ethical, and research Implications. Journal of Technology in Behavioral Science, 1-9. https://doi.org/10.1007/s41347-025-00484-4,   Parry, K. J., Hicken, B. L., Chen, W., Leng, J., Allen, S., & Burningham, Z. (2023). Impact of moral injury and posttraumatic stress disorder on health care utilization and suicidality in rural and urban veterans. Journal of traumatic stress, 36(1), 117-128. https://doi.org/10.1002/jts.22889,   McGuire, A. P., Rodenbaugh, M., Howard, B. A. N., & Contractor, A. A. (2024). Response styles to positive affect during a positive psychology intervention for veterans with PTSD and moral injury: Preliminary results from a moral elevation intervention pilot trial. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001774,   Rauch, S. A. M., Yasinski, C. W., Post, L. M., Jovanovic, T., Norrholm, S., Sherrill, A. M., Michopoulos, V., Maples-Keller, J. L., Black, K., Zwiebach, L., Dunlop, B. W., Loucks, L., Lannert, B., Stojek, M., Watkins, L., Burton, M., Sprang, K., McSweeney, L., Ragsdale, K., & Rothbaum, B. O. (2021). An intensive outpatient program with prolonged exposure for veterans with posttraumatic stress disorder: Retention, predictors, and patterns of change. Psychological Services, 18(4), 606–618. https://doi.org/10.1037/ser0000422
Abstract Body
Avoidance is central to PTSD and manifests in numerous ways over the course of trauma-focused treatment. Prolonged exposure (PE) requires patients to repeatedly confront feared stimuli between sessions and then report their experience to a therapist. Facilitating the patient’s between-session engagement in exposures is critical and relies on gathering accurate descriptions of their engagement. Reliance on retrospective self-report is limited by its subjective nature, recall bias, patient discomfort in disclosing avoidance, and the time-consuming nature of these discussions. To address these barriers, we developed the PE Collective Sensing System (PECSS), a ubiquitous computing system designed to improve engagement in between-session exposures through objective, real-time data collection. PECSS includes a mobile app for patients and an online dashboard for clinicians, integrating both active data collection (e.g., distress ratings, qualitative notes) and passive data streams (e.g., location, movement, ambient noise, mobile app usage, duration, and heart rate) via a Fitbit and the patient’s Android device. By continuously capturing between-session exposures, PECSS allows clinicians to assess engagement in real-time, facilitating timely interventions (e.g., praise, correction of avoidance, and plans for next exposures). In this study, 20 patients and 10 therapists used PECSS within the intensive outpatient program of a veteran specialty clinic in the Southeast. Quantitative results indicated this sample had a robust treatment response including significant reductions in both PTSD symptom severity (PTSD Checklist for DSM-5; Pre-treatment M = 43.8; Post-treatment M = 17.1; Cohen’s d = 2.14) and depression symptom severity (Patient Health Questionnaire-9; P</span>re-treatment M = 13.7; Post-treatment M = 7.1; Cohen’s d = 1.74). System usability assessments demonstrated strong perceived usability and acceptability of PECSS. Qualitative data from interviews indicated that patients and therapists varied widely in how they used the system and what they viewed as important to enhance patient engagement. While the majority expressed the usefulness of objective feedback and structured monitoring, others expressed concerns about data burdens and the impact of app use on therapeutic alliance, distraction, and safety learning. We will discuss implications for the future development of passive sensing in psychotherapies that require between-session exercises, highlighting the potential usefulness of individualized sensors.