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

项目摘要 创伤后应激障碍（PTSD）和危险饮酒（HD：重度饮酒和负性饮酒- 相关后果）通常在创伤暴露后发展和共同发生。个人和公众 PTSD和同时发生HD的健康负担是巨大的。虽然有基于证据的行为 治疗共同发生的创伤后应激障碍和HD，他们有局限性，导致许多人无法获得 这些治疗和有限的干预达到-即，现有的干预往往是复杂的， 负担沉重，需要与治疗师亲自接触。因此，需要开发另外的、新颖的、 这些干预措施使用循证战略，具有更大的可移植性和覆盖面。有一个 新生的，缺乏文献评估这种类型的干预退伍军人，我们知道没有针对 马达加斯加国家顶级域名因此，本申请寻求改进和测试一种简短的、自我导向的干预， 患有PTSD和并发HD的普通公众个体，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同发生的HD，并在最近的一项试点研究中取得了可喜的成果， 研究团队。本申请旨在通过测试是否理论驱动， 从基本认知心理学（信息框架）和社会心理学的证据为基础的战略 （促进成长心态）通过解决试点项目， 参与者的反馈与回避和动机有关。我们将确定最有效的干预措施， 在全功率随机对照试验中进行测试因此，研究1将招募一个成年社区样本（N = 500）， 增强CBT文本消息干预与消息框架的功效（防止损失与 想象未来收益与没有框架）和心态（提供使用技能与简单的成长心态信息 提示使用技能）。研究2将在研究1的基础上， 完全把握度（N = 333）随机对照试验（RCT），将测试比较和长期疗效 研究1中最有效的基于CBT的短信干预与仅进行评估的对照 在一个社区样本的成年人共同发生的HD和创伤后应激障碍。这一建议在以下方面具有创新性： 将PTSD和HD合并发生的治疗方案添加到菜单中，并对其效用进行评估， 将基本的社会和认知心理学策略与CBT策略相结合。如果成功，将导致 一种有效的、新颖的、理论驱动的、低负担的行为干预， 易于扩展。这种干预措施可以作为单独的干预措施实施，也可以纳入 阶梯式护理方法，包括大规模创伤暴露（自然灾害，大规模伤亡事件， 大流行病），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.