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

摘要 物质使用障碍（SUD）是美国人口中第二常见的精神病诊断，占14.6%。 在他们的一生中发展它。18-25岁的过渡年龄青年（TAY）特别容易受到药物使用的影响， SUD。这一时期，被称为“不稳定的时代”，现在被理解为代表一个独立的阶段， 青春期和成年期。它包括诸如离开家进入大学，工作或军队的任务; 明确职业目标;达到法律的饮酒年龄;对一些人来说， 在18岁时结束。这段时间也是试验药物使用和相关风险的黄金时期，例如驾驶 影响、事故、打斗和暴力、艾滋病毒和易受性攻击。在这个项目中，我们专注于一个 主要策略，接地，以帮助TAY降级（减少）强烈的负面情绪和冲动。接地时间长 在精神病医院使用，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， 伤害自己或他人的冲动，物质渴望，愤怒，焦虑等，在《寻求安全》一书中有详细描述 (SS)根植使用三个途径来集中思想（精神），身体（身体）和心灵（抚慰）。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， 情感强度事实上，物质使用经常被描述为调节情绪的短期方式。接地是关键 SS模块，一种广泛实施的循证SUD治疗模型。在本提案中，我们只关注 接地，因为它是一项基本技能，并被广泛认为是易于学习，即使是最复杂和最脆弱的客户。 在第一阶段，我们开发了一个接地应用程序的测试版。该应用程序促进在任何环境中使用接地， 哪些情绪和冲动需要被调节它利用了TAY广泛使用移动的设备; 因为接地是一个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，并在试点中研究了应用程序的影响 随机对照试验（RCT），24例TAY。一半人收到了应用程序，另一半人收到了接地讲义。 结果显示，该应用程序始终比讲义得到更积极的评价， 明显更多地使用接地和接地知识测试的更高分数。第1阶段的所有基准均已达到。 在第二阶段，我们建议扩大应用程序及其评估的规模。我们有两个具体目标：（1）加强 移动的接地应用程序通过使用令人兴奋的，创新的技术方法，以及扩大接地内容， 数量和类型。(2)对68例TAY患者进行随机对照试验，以评估接地应用程序与对照应用程序的对比。 app将控制移动终端的使用和基础内容。然而，它缺乏游戏化， 和技术创新的实验应用程序，以便我们可以确定这些的影响。我们的主要成果是 根据我们第一阶段试点的功率分析;我们还包括其他成果和措施。RCT采用严格的 在设计、测量和统计方面采用科学方法。我们的团队代表了SUD的专业知识， TAY、应用程序和游戏技术、接地、SBIR和基于循证护理的公共卫生导向产品。

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.