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pdfDepartment of Veterans Affairs
PTSD Coach App
Survey
Date:
OMB 2900-0770
VA Form 10-0496
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number. We anticipate that the time expended by all individuals who complete this survey will average 15 minutes. This includes
the time it will take to read instructions, gather the necessary facts and fill out the form. Customer satisfaction surveys are used to
gauge customer perceptions of VA services as well as customer expectations and desires. The results of this survey will lead to
improvement in the quality of service delivery by helping to shape the direction and focus of specific programs or services.
Completion of this form is voluntary and failure to respond will have no impact on benefits to which you may be entitled.
b.
3b. How helpful was the information
in the “Learn About Professional Care”
page?
Not at
all
Helpful
Slightly
Helpful
0
1
LI
LI
4. How often did you go to the “Self Assessment” page?
4c. Did you set a schedule to
regularly take the assessment?
2
3
4
Li
LI
LI
7-9
times
>10
times
LI
LI
LI
LI
LI No
Slightly
Helpful
0
1
LI
LI
5. How often did you go to the “Manage” page of the
app?
Extremely
Helpful
4-6
times
Not at
all
Helpful
LI Yes
Very
Helpful
1-3
times
LI Yes
4a. Did you take an assessment over the
weekend?
4b. How helpful was “taking an
assessment”?
Moderately
Helpful
Moderately
Helpful
Very
Helpful
Extremely
Helpful
2
3
4
LI
LI
LI
LI No
1-3
times
4-6
times
7-9
times
LI
LI
LI
>10
times
LI
5a. The following symptoms are listed on the “Manage Symptoms” page. Which one did you go to most
often?
LI
Reminded of the Trauma
LI
Avoiding Triggers
LI
Disconnected from People
LI
Disconnected from Reality
LI
Sad/Hopeless
LI
Worried/Anxious
LI
Angry
LI
Unable to Sleep
5b. The following symptoms are listed on the “Manage Symptoms” page. Which one did you go to least
often?
LI
Reminded of the Trauma
LI
Avoiding Triggers
LI
Disconnected from People
LI
Disconnected from Reality
LI
Sad/Hopeless
LI
Worried/Anxious
LI
Angry
LI
Unable to Sleep
5c. A wide range of tools were offered to help manage your stress, which one did you use most often?
LI
Relaxation Exercise
LI
Sleep Hygiene Tips
LI
RID
LI
Schedule Pleasant Events
LI
Change your perspective
LI
Seek Support
LI
Grounding
LI
Distract from Intense Emotions
LI
Make a Plan to Reduce Isolation
LI
Soothe Yourself
LI
Take a Time Out
LI
Inspiring Quotes
3d. A wide range of tools were offered to help manage your stress, which one did you use least often?
4
I
LI
Relaxation Exercise
LI
Sleep Hygiene Tips
LI
RID
LI
Schedule Pleasant Events
Change your perspective
LI
Seek Support
Grounding
LI
Distract from Intense Emotions
Make a Plan to Reduce Isolation
LI
Soothe Yourself
Take a Time Out
LI
Inspiring Quotes
P a g e
a
BARRIERS TO USE OF THE PTSD Coach App
There are different reasons why people might not use the PTSD Coach App, or might use it infrequently.
Please indicate to what extent each of the following factors limit your use of the PTSD Coach App...
Not a
barrier
Somewhat of
a barrier
Moderate barrier
Extreme barrier
11.Idid nothave enough
time.
1
2
3
4
12.Ihavealackof
family/friend support.
13. It was hard to use the
app.
14. I’m not getting much
out of it.
15. I couldn’t find what I
needed.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
7IPag
PERCEIVED HELPFULNESS OF THE PTSD Coach App
Please indicate the extent to which the PTSD Coach has (or has not) been helpful in working towards each
of the following goals:
16. Helping me learn about symptoms
of PTSD
17. Helping me learn about treatments
for PTSD
18. Helping me find effective ways of
managing my symptoms
19. Helping me feel more comfortable
in seeking support
20. Helping me feel that there’s
something I can do about my PTSD
21. Helping me track my symptoms
22. Helping me know when I’m doing
better or when I’m doing worst
23. Increasing my access to additional
resources
24. Providing practical solutions to the
problems I experience
25. Helping me overcome the stigma of
seeking Mental health services
26. Helping me better understand what
I have been experiencing
27. Enhancing my knowledge of PTSD
28. Helping clarify some of the myths
about PTSD
29. Providing a way for me to talk
about what I have been experiencing
Not at all
Helpful
Slightly
Helpful
Moderately
Helpful
Very
Helpful
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
Not at
all
Satisfied
30. Overall, how satisfied are you with
the PTSD CoachApp?
8
I Paga
0
Slightly
Satisfied
1
Moderately
Satisfied
2
Very
Satisfied
3
Extremely
Helpful
Extremely
Satisfied
4
The following questions are designed to test your knowledge of PTSD. Please select the best response.
1. Who was the PTSD Coach App developed for?
El
Men only
El
Service members only
El
Children
El
Trauma survivors
2. The PTSD Coach App was designed to:
El
Help you learn more about PTSD and ways to manage stress
El
Getajob
El
Get rid of your problems
El
Increase vigilance
3. WhatisPTSD?
El
PTSD is a genetic disorder that you are born with
El
PTSD is a mood state consisting of high mood and decreased need for sleep
El
PTSD is an anxiety problem that can develop after experiencing a traumatic event
LI
PTSD means you have a bad brain
4. Who can develop PTSD?
El
Those that are weak
El
Anyone who has experienced a traumatic event
El
Anyone that does not seek professional help
El
Those who have Type 0 blood
5. How is PTSD diagnosis?
9
I
El
By using the PTSD Coach App
El
By a friend or family member
El
By a trained mental health professional
El
By a brain scan
P a g e
6. How long does PTSD last?
El
Forever
El
It goes away immediately
El
It varies from person to person
El
24-72 hours
7. How is PTSD treated?
El
With surgery
El
With acceptance
LI
With exercise and a good diet
El
With either medication or talk therapy, or both
8. Talk therapies that have research showing that they work for PTSD are:
El
Psychodynamic Psychotherapy
El
Cognitive behavioral therapies
El
Interpersonal Psychotherapy
El
Meditation
Who is least likely to provide services for PTSD?
9.
El
Psychiatrists
El
Social Workers
El
Police Officers
El
Psychologists
10. What is the PTSD Checklist (PCL)?
10
I
P
El
A list of materials needed for deployment
El
A movie
El
A restaurant
El
A tool used to track your symptoms to see how you are doing over time
g
E
11. Practicing relaxation exercises can reduce stress by all of the following except:
El
Slowing down your heart rate
El
Stimulating your brain
LI
Reducing anger
El
Improving concentration
12. RID is a tool used:
El
To eliminate negative feelings
El
To help you relax, identify the triggers of stress, and decide what to do next
El
During an emergency or crisis situation
El
To help with drinking problems
13. Changing your perspective is a
El
Behavioral
El
Thinking
El
Activating
LI
Sensing
strategy?
14. What is the goal of grounding exercises?
El
To focus on the present moment
El
To manage problems with sleep
LI
To manage your weight
LI
To keep you in place
15. In the following situations, when would taking a time out be most helpful?
11
I
El
Feeling depressed
El
Watching a movie
El
Inanargument
LI
Inajob interview
Fa g
16. What can you do when you’re having difficulty falling asleep?
El
Stay in bed until you fall asleep
LI
Watch a movie
El
Listen to relaxing music
El
Play videogames
17. Scheduling pleasant events is a tool designed to?
El
Improve your organizational skills
LI
Help you make more friends
El
Increase the amount of pleasure in your life
El
Change your thinking
18. When would using DISTRACTION not be a useful tool?
El
In an airplane
El
Giving a presentation in class
El
Feeling overwhelmed at a BBQ
El
In the grocery store
19. How is soothing yourself and inspiring quotes alike?
LI
Provides comfort and calmness
El
Helps you lose weight
El
Helps you forget your problems
El
Encourages you to do volunteer work
20. What should you do in a crisis?
12
I
El
Watch a movie
El
Go to the nearest Emergency Room
LI
Take a shower
El
Hide in your room
PCL-S
Instructions: Below is a list of problems and complaints that people sometimes have in response to
stressful life experiences. Please read each one carefully, and then circle one of the numbers to the
right to indicate how much you have been bothered by that problem in the past month.
The event you experienced was___________________________________________
Not at all
1. Repeated, disturbing
memories, thoughts,
or images of the
stressful experience?
2. Repeated, disturbing dreams of
the stressful experience?
3. Suddenly acting or feeling as if
the stressful experience were
happening again (as if you were
reliving it)?
4. Feeling very upset when
something reminded you of the
stressful experience?
5. Having physical reaction (e.g.,
heart pounding, trouble
breathing, sweating) when
something reminded you of the
stressful experience?
6. Avoiding thinking about or
talking about your stressful
experience or avoiding having
feelings related to it?
7. Avoiding activities or situations
because they reminded you of
your stressful experience?
8. Trouble remembering important
parts of the stressful
experience?
9. Loss of interest in activities that
you used to enjoy?
10. Feeling distant or cut off from
others?
1 1. Feeling emotionally numb or
being unable to have loving
feelings for those close to
you?
12. Feeling as if your future
somehow will be cut short?
A little
bit
Moderately
Quite a bit
Extremely
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
-
13. Trouble falling or staying
asleep?
14. Feeling irritable or having
angry outbursts?
15. Having difficulty
concentrating
16. Being “super-alert” or
watchful or on guard?
17. Feeling jumpy or easily
startled?
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
| File Type | application/pdf |
| File Modified | 2012-12-11 |
| File Created | 2012-10-31 |