Abstract Objectives Mindfulness-based digital interventions have shown promise for improving health outcomes. The Mindfulness Coach (MC) mobile app was found to improve posttraumatic stress disorder (PTSD) and depression symptoms in a pilot randomized controlled trial (RCT). The current secondary analyses expand on these findings by assessing changes in mindfulness-related processes targeted by the app and by qualitatively exploring users’ experiences to better understand how Mindfulness Coach may support these processes in the context of PTSD. Method U.S. veterans with PTSD ( n = 173) were randomized to an 8-week MC ( n = 86) or waitlist control (WL; n = 87) condition. After study attrition due to technical issues and participant dropout, 56 participants (MC: n = 19; WL: n = 37) completed follow-up surveys. A secondary quantitative intent-to-treat analysis was conducted on process outcomes related to facets of mindfulness, psychological flexibility, interoceptive awareness, and thought suppression using linear mixed modeling with maximum likelihood estimation for missing values. A Rapid Qualitative Analysis of 1-year follow-up interviews with a subsample of participants in the MC condition ( n = 21) examined PTSD-related coping responses, knowledge and experiences related to mindfulness practice prior to the study, as well as use and perceptions of Mindfulness Coach and its potential impact. Results Among study completers (MC: n = 19; WL: n = 37), there were significant between-group effects for two facets of mindfulness (i.e., describing and nonjudgment; p -values < 0.05). Significant within-group effects for both conditions were also found for psychological flexibility ( p -values < 0.05). Qualitative results revealed mostly positive user experiences, potential barriers to use, and perceived improvements in stress, PTSD symptoms, and sleep. Conclusions This study showed improvements in mindfulness processes targeted by Mindfulness Coach and perceived mental health benefits with app use, supporting its value as an on-demand resource for veterans with PTSD. High attrition rates limit the strength and generalizability of these findings and underscore the challenges of sustaining engagement with self-guided digital interventions. However, this low-cost and scalable tool holds promise as an option for veterans with PTSD that can extend the reach of evidence-based mindfulness strategies to improve mental health care. Preregistration ClinicalTrials.gov, TRN: NCT04035304, Registration date: 24 July 2019.
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