Symposia
Trauma and Stressor Related Disorders and Disasters
Kristen Lindgren, ABPP, Ph.D.
University of Washington School of Medicine
Seattle, Washington
Emily Dworkin, Ph.D.
Assistant Professor
University of Washington School of Medicine
Seattle, WA
Debra Kaysen, ABPP, Ph.D.
Professor
Stanford University
Palo Alto, California
Heidi J. Ojalehto, B.S.
Student
UNC Chapel Hill
Chapel Hill, NC
Cynthia Stappenbeck, Ph.D.
Associate Professor
Georgia State University
Atlanta, GA
Michele Bedard-Giligan, PhD
Associate Professor
University of Washington
Seattle, Washington
Post-traumatic stress disorder (PTSD) symptoms and alcohol misuse often co-occur following exposure to traumatic events. Efficacious in-person cognitive behavioral treatments led by a therapist are available, but key barriers have been identified, including low treatment engagement and high dropout rates. Existing treatments are costly to implement and can be difficult to access. Thus, there is a need for additional treatments for individuals with co-occurring PTSD symptoms and alcohol misuse (PTSD/AM)—especially, treatments that are briefer, accessible, self-directed, and delivered via widely available technology (e.g., text messages). We conducted a pilot study to evaluate the feasibility, acceptability, and efficacy of a brief text message intervention for individuals with PTSD/AM. We compared an intervention based on cognitive behavioral therapy skills plus message framing about using skills to avoid further losses (CBT + Framing) to one providing kind attention messages (KAM). Each intervention consisted of 4 weekly text messages. CBT+ Framing was expected to result in a greater reduction in PTSD/AM than KAM. Participants were recruited from a large city in the US Pacific Northwest in 2 waves (Wave 1 n = 50; Wave 2 n = 59) and were randomly assigned to condition. PTSD/AM were assessed at baseline, immediate post-intervention, and 4 weeks later. Across waves, participants reported finding the interventions to be interesting, relevant, and helpful, and that they would have liked to receive more messages. Enrollment was fast and efficient (3 months or less for each wave); retention was excellent ( >85% at the final post-assessment for each wave). Both interventions reduced PTSD symptoms (medium to large effects) and alcohol misuse (small to medium effects). Support for the hypothesis that CBT + Framing would outperform KAM was mixed: it did for alcohol misuse in Wave 1 and PTSD symptoms in Wave 2. However, KAM outperformed CBT + Framing for PTSD in Wave 1. Study findings suggest that both interventions are feasible and acceptable to individuals with PTSD/AM and have initial efficacy, suggesting their potential utility as additional treatment options that may address barriers identified with existing treatment options. Further, the interventions’ efficiency and lower costs, coupled with their acceptability and initial efficacy, suggest that they could be useful in the aftermath of a disaster or during a public health emergency where PTSD/AM is often a substantial concern.