App-Based Stabilization Phase Within Blended Trauma-Focused Cognitive Behavioral Therapy With Compassion for Adolescents With Posttraumatic Stress Disorder: Formative Qualitative Study

Background: Digital tools may support early phases of trauma therapy for adolescents, yet little is known about how an app-based stabilization phase functions in routine child and adolescent psychiatry clinics. To our knowledge, no previous study has qualitatively examined a compassion-integrated, app-based stabilization phase delivered before trauma processing within trauma-focused cognitive behavioral therapy (TF-CBT) for adolescents. Objective: This formative qualitative pretrial study explored the acceptability, feasibility, and contextual fit of an app-based stabilization phase within blended TF-CBT with compassion (bTF-CBT-C) for adolescents with posttraumatic stress disorder (PTSD). The aim was to inform the refinement of intervention content, caregiver support, and clinical workflow prior to a planned pilot randomized controlled trial (RCT). Methods: Four adolescent girls with PTSD (aged 14-16 years) completed a 5-week app-based stabilization program integrating TF-CBT coping skills and compassion-focused practices, while 5 caregivers received parallel content in a nonapp format. Three adolescents and 4 caregivers participated in postintervention semistructured interviews, and 4 clinicians completed a brief open-ended survey. Data were analyzed using reflexive thematic analysis. Results: Navigating digital stabilization within shifting conditions," captured how engagement fluctuated with emotional capacity, cognitive load, relational dynamics, and logistical stability. Adolescents and caregivers experienced the intervention content as grounding and meaningful but difficult to sustain amid fatigue, school pressure, neurodivergent attention patterns, and family strain. Clinicians similarly noted varying capacity, the need for scaffolding, and the importance of reminders and smooth access. Clear content could exceed users' cognitive bandwidth; adolescents preferred autonomy, while caregivers were unsure how to support them; and technical friction sometimes disrupted momentum. Across the groups, participants described grounding and compassion-based practices as supporting emotional safety, shared understanding, and readiness for trauma-focused work. Conclusions: The findings suggest that app-based stabilization within bTF-CBT-C may be acceptable and potentially feasible for adolescents with PTSD, their caregivers, and clinicians. Feasibility appears to depend on flexible pacing, cognitive accessibility, caregiver guidance, and technical reliability. The study identifies candidate refinements to be evaluated in the pilot RCT and provides preliminary insight into how compassion-integrated digital stabilization may support preparation for trauma-focused therapy.