In a pilot study, the control condition of kind support and attention (KAM) tended to outperform cognitive behavioral therapy (CBT) plus message framing to reduce post-traumatic stress disorder (PTSD) and alcohol misuse. These findings were published in the Journal of Anxiety Disorders.
This study was conducted at the University of Washington. Participants (N=109) with PTSD and alcohol misuse were randomly assigned to receive CBT + Framing or KAM. Both conditions were delivered using text messaging, in which participants received 4 total messages sent weekly. The primary outcomes were change in PTSD symptoms, weekly drinks, and heavy drinking episodes. Participants were recruited in 2 waves using differing community-based recruitment strategies.
The participants were a mean age of 30.63 to 34.73 years, 61.5%-80.0% were women, 70.0%-80.8% were White, and 54.2%-63.3% were college graduates. The intervention and control cohorts were well balanced.
In both waves 1 and 2, all of KAM recipients read the text messages compared with 96% of the CBT cohort. Among all participants, 86.2% found the messages interesting, 70.6% said they were at least somewhat helpful, and 70.0% thought they were relevant.
Among the CBT cohort, 81.0% said they at least occasionally used the skills endorsed in the messages. The majority (92.7%) of participants said they were at least slightly likely to participate in the study again.
In wave 1, significant group differences were observed for PTSD symptoms at postintervention (t, -3.27; P <.01) and at week 8 (t, -2.85; P <.01) and for symptoms of depression at postintervention (t, -3.28; P <.01) and at week 8 (t, -3.18; P <.01), all favoring KAM. No group differences were observed for anxiety, drinks per week, or heavy episodic drinking.
For wave 2, significant group differences were observed for PTSD symptoms at postintervention (t, 2.77; P <.05) and week 8 (t, 2.17; P <.05), favoring CBT. No other group differences were observed.
In the linear mixed effects model, time was a significant effect in all analyses, except for the proportion of heavy episodic drinking, indicating that both groups had significant reductions in symptom scores and most drinking measures over time. No covariates were significant for wave 2.
The major limitation of this study was the reliance on self-reported measures and not clinical assessors.
Study authors concluded, “Findings from this study suggest that a brief, self-directed CBT-based text-message intervention aimed at reducing co-occurring PTSD symptoms and alcohol misuse is feasible and acceptable to community participants. If efficacy is established in a fully-powered trial, this intervention would be promising as an additional option for individuals who cannot access or are not interested in more intensive treatment options. Further, because it is low burden via brief, self-directed technology, it may have applicability for public health campaigns.”
Bedard-Gilligan MA, Dworkin ER, Kaysen D, et al. A pilot study on the feasibility, acceptability, and preliminary efficacy of a brief text message intervention for co-occurring alcohol misuse and PTSD symptoms in a community sample. J Anxiety Disord. 2022;91:102615. doi:10.1016/j.janxdis.2022.102615