Phone app for grounding (de-escalation) of substance-abusing transition-age youth

摘要 物质使用障碍(SUD)是美国人第二常见的精神疾病诊断，占14.6% 在他们的有生之年发展它。18-25岁的过渡年龄青年(Tay)特别容易使用药物和 苏德。这一时期被称为“不稳定时代”，现在被认为代表着一个与 青春期和成年以后。它包括诸如离开家进入大学、劳动力或军队等任务； 明确职业目标；达到法定饮酒年龄；对一些人来说，脱离寄养或国家监护而衰老，这 到18岁结束。这段时间也是尝试使用药物和相关风险的最佳时期，比如在 影响、事故、战斗和暴力、艾滋病毒和性侵犯的脆弱性。在这个项目中，我们关注的是一个 主要策略，扎根，帮助泰降低(减少)强烈的负面情绪和冲动。停飞已经很久了 用于精神病院提供一种安全、快速和有效的方法来减少任何强烈的负面情绪 如伤害自己或他人的冲动、对物质的渴望、愤怒、焦虑等，在《寻求安全》一书中有详细描述 (SS)，使用三个途径来集中精神(精神)、身体(身体)和心灵(抚慰)的根基。接地 提供了一种调节情绪的方法，这对Tay来说是一个重大挑战，特别是考虑到他们的激素变化和 情感上的强烈。事实上，物质使用经常被描述为调节情绪的一种短期方式。接地是关键 SS模块，一种广泛实施的循证SUD治疗模型。在这份提案中，我们专门关注 接地，因为它是一项基本技能，被广泛认为即使是最复杂和最脆弱的客户也很容易学习。 在第一阶段，我们开发了一个接地应用的测试版。该应用程序促进在以下任何环境中使用接地 哪些情绪和冲动需要加以控制。它利用了泰斯移动设备的广泛使用；以及 由于接地是一项独立的技能和感官导向，它非常适合应用程序的方法。我们使用了一个 基于最终用户反馈的迭代产品开发方法，并在试点中研究了APP的影响 随机对照试验(RCT)，24例。一半人收到了这款应用程序，另一半人收到了停飞讲义。 结果显示，与讲义相比，APP的评价一直更积极，并与 更多地使用接地，在接地知识测试中得分更高。所有阶段1的基准都达到了。 在第二阶段，我们建议扩大应用程序和对其进行评估。我们有两个具体目标：(1)加强 通过使用激动人心的创新技术方法以及扩展 数量和类型。(2)进行68个Tay的RCT，以评估接地APP和控制APP。该控件 App将控制移动设备的使用和接地内容。然而，它将缺乏游戏化 以及实验应用程序的技术创新，以便我们可以确定这些影响。我们的主要结果是 基于我们第一阶段试点的功率分析；我们还包括其他结果和措施。RCT使用严格的 在设计、测量和统计方面采用科学的方法。我们的团队代表了SUD领域的专业知识， Tay、应用程序和游戏技术、接地、SBIRS和基于循证护理的公共健康导向产品。

Abstract Substance use disorder (SUD) is the second most common psychiatric diagnosis in the U.S. population, with 14.6% developing it in their lifetime. Transition-age youth (TAY) from ages 18-25 are especially vulnerable to substance use and SUD. This time period, termed the “age of instability", is now understood to represent a distinct stage separate from adolescence and later adulthood. It includes tasks such as leaving home to enter college, the workforce, or the military; clarifying vocational goals; attaining legal drinking age; and, for some, aging out of foster care or state custody, which end at age 18. This period is also prime for experimentation with substance use and associated risks such as driving under the influence, accidents, fighting and violence, HIV, and vulnerability to sexual assault. In this project, we focus on a major strategy, grounding, to help TAY de-escalate (reduce) intense negative emotions and impulses. Grounding has long been used in psychiatric hospitals to provide a safe, quick, and powerful way to reduce any intense negative feeling such as impulses to hurt self or others, substance craving, anger, anxiety, etc. Described in detail in the book Seeking Safety (SS), grounding using three pathways to focus the mind (mental), body (physical), and heart (soothing). Grounding provides a way to regulate emotion, which is a major challenge for TAY, especially given their hormone changes and emotional intensity. Indeed substance use is often described as a short-term way to regulate emotion. Grounding is a key module of SS, a widely-implemented, evidence-based SUD treatment model. In this proposal we focus exclusively on grounding as it is an essential skill and widely identified as easy to learn for even the most complex and vulnerable clients. In phase 1 we developed a beta version of a grounding app. The app promotes the use of grounding in any environment in which emotions and impulses need to be regulated. It capitalizes on TAYs’ widespread use of mobile devices; and because grounding is a stand-alone skill and sensory-oriented, it lends itself wonderfully to an app approach. We used an iterative product development methodology based on end-user feedback and studied the impact of the app in a pilot randomized controlled trial (RCT) with 24 TAY. Half received the app and the other half received grounding handouts. Results showed that the app was consistently more positively rated than the handouts and was associated with significantly more use of grounding and a higher score on a grounding knowledge test. All phase 1 benchmarks were met. In phase 2 we propose to scale up both the app and the evaluation of it. We have two specific aims: (1) To enhance the mobile grounding app by using exciting, innovative technology approaches as well as expanding the grounding content in amount and type. (2) To conduct an RCT with 68 TAY to evaluate the grounding app versus a control app. The control app would control for both the use of a mobile device and the grounding content. However it would lack the gamification and technology innovations of the experimental app so that we can determine the impact of these. Our primary outcome is based on power analysis from our phase 1 pilot; we also include other outcomes and measures. The RCT uses rigorous scientific methods in its design, measures, and statistics. Our team represents an exceptional mix of expertise in SUD, TAY, app and gaming technology, grounding, SBIRs, and public health oriented products based on evidence-based care.