Testing the efficacy of a CBT-enhanced text message intervention to reduce symptom burden in individuals with post-traumatic stress disorder symptoms and co-occurring hazardous drinking

项目总结 创伤后应激障碍(PTSD)和危险饮酒(HD：酗酒和酗酒-- 相关后果)通常在创伤暴露后发展并同时发生。个人和公众 创伤后应激障碍和共发病的HD的健康负担是巨大的。尽管有基于证据的行为 对于同时发生的创伤后应激障碍和HD的治疗，它们具有局限性，导致许多人无法访问 这些治疗和有限的干预范围--即现有的干预措施往往很复杂， 繁重，而且需要与面对面的治疗师联系。因此，有必要开发额外的、新颖的 使用循证战略并具有更大的可移植性和覆盖面的干预措施。有一个 评估这种针对退伍军人的干预措施的文献还很少，而且我们还不知道有哪一种是针对 普罗大众。因此，当前的应用程序寻求提炼和测试简短的、自我导向的、针对 普通公众中患有创伤后应激障碍和共同发生的HD的个人，可以通过短信传递。 拟议的干预措施借鉴了认知行为疗法(CBT)的循证策略 治疗创伤后应激障碍和共患的HD，在最近由 研究团队。该应用程序寻求通过测试理论上驱动的、 基础认知心理学(信息框架)和社会心理学的循证策略 (促进增长思维)通过解决飞行员问题，改善创伤后应激障碍症状和HD的结果 参与者反馈与回避和动机有关。我们将确定最有效的干预措施，并 在全功率RCT中进行测试。因此，研究1将招募成人社区样本(N=500)，将测试 通过消息成帧增强CBT文本消息干预的有效性(防止丢失与 想象未来的收益与没有框架的对比)和心态(提供使用技能与简单的成长心态信息 提醒使用技能)通过完全交叉的3x2析因设计。研究2将在研究1的基础上，通过进行 完全有效(N=333)随机对照试验(RCT)，将测试比较和长期疗效 来自研究1的最有效的基于CBT的短信干预与仅评估对照 在社区样本中，患有HD和PTSD的成年人。这项建议在方法上是创新的 增加了治疗PTSD和HD并存的治疗选项的菜单，并对 将基本的社会和认知心理学策略与CBT中的策略相结合。如果成功，它将导致 一种有效的、新颖的、理论驱动的、低负担的行为干预同时发生的创伤后应激障碍和HD，即 易于扩展。这种干预可以作为单独的干预实施，也可以集成到 分步护理办法，包括在大规模创伤暴露(自然灾害、大规模伤亡事件、 大流行)，因此有可能对公共卫生产生重大影响。

PROJECT SUMMARY Posttraumatic stress disorder (PTSD) and hazardous drinking (HD: heavy alcohol use and negative alcohol- related consequences) commonly develop and co-occur following trauma exposure. The individual and public health burden of PTSD and co-occurring HD is substantial. Although there are evidence-based behavioral treatments for co-occurring PTSD and HD, they have limitations that result in many individuals not accessing these treatments and limited intervention reach – i.e., existing interventions tend to be complicated, burdensome, and require contact with an in-person therapist. Thus, there is a need to develop additional, novel interventions that use evidenced-based strategies and that have greater portability and reach. There is a nascent, scant literature evaluating such types of interventions for veterans, and we know of none aimed at the general public. The current application, therefore, seeks to refine and test a brief, self-directed, intervention for individuals from the general public with PTSD and co-occurring HD that can be delivered via text-messaging. The proposed intervention draws on evidence-based strategies from cognitive behavioral therapy (CBT) for treating PTSD and co-occurring HD, and it yielded promising findings in a recent pilot study conducted by the research team. This application seeks to refine the intervention further by testing whether theoretically-driven, evidence-based strategies from basic cognitive psychology (message framing) and social psychology (facilitating growth mindsets) result in better outcomes for PTSD symptoms and HD by addressing pilot participant feedback related to avoidance and motivation. We will identify the most efficacious intervention and test it in a fully-powered RCT. Thus, Study 1, which will recruit an adult community sample (N = 500), will test the efficacy of enhancing the CBT text message intervention with message framing (protect against loss vs. imagine future gains vs. no framing) and mindsets (provide growth mindset message for using skills vs. simple reminder to use skills) via a fully-crossed 3x2 factorial design. Study 2 will build on Study 1, by conducting a fully powered (N = 333) randomized controlled trial (RCT) that will test the comparative and long-term efficacy of the most efficacious CBT-based text message intervention from Study 1 versus an assessment only control in a community sample of adults with co-occurring HD and PTSD. This proposal is innovative in its approach to adding to the menu of treatment options for co-occurring PTSD and HD and with its evaluation of the utility of integrating basic social and cognitive psychology strategies with those from CBT. If successful, it will result in an efficacious, novel, theory-driven, low burden behavioral intervention co-occurring PTSD and HD that is readily scalable. Such an intervention could be implemented as a stand-alone intervention or be integrated into stepped-care approaches, including following mass trauma exposure (natural disasters, mass casualty events, pandemics) and thus, has the potential for a substantial impact on public health.