3 - (SYM 86) Project BETTER: Results from a Randomized Clinical Trial Evaluating Enhancements to a Brief CBT Text Message Intervention for Co-occurring PTSD Symptoms and Alcohol Misuse

There are efficacious treatments for co-occurring post-traumatic stress disorder (PTSD) and alcohol misuse (PTSD+AM), but existing treatments largely rely on traditional weekly therapy models, have high dropout rates and low engagement, and can be difficult to access. These gaps suggest a need for additional, low-burden intervention options. To help bridge this gap, we developed a brief, self-directed CBT-based text message intervention for individuals with PTSD+AM. Pilot data showed high satisfaction and significant reductions in PTSD and AM, but participant feedback also suggested opportunities for improvement. We drew from the cognitive and social psychology literatures and added two enhancements to address feedback (message framing to facilitate greater engagement skills and growth mindsets to increase motivation and provide support for overcoming setbacks). We are conducting a fully-powered RCT with a factorial design (3 [message framing: gain-framed vs. loss-framed vs. no-framing] x 2 [mindsets: growth mindset vs. no mindset]) to evaluate the enhancements. A priori decision rules will be used to identify the most effective at reducing PTSD+AM symptoms and simplest intervention condition. This design allows us to build the intervention from the ground up, ensuring we retain only components that are effective. Participants (N = 505, mean age = 36.27, SD = 11.03) with PTSD+AM were recruited from Washington State. The majority identified as female (71.3%); 19.6% identified as male, 2.4% as transgender, and 6.7% as agender/non-binary/gender-queer. Most identified as white (74.7%) or biracial (12.3%); 4.0% identified as Asian, 3.6% as Black, 2.6% as Native American, and 3.0% as unknown/prefer not to answer. Self-reported PTSD+AM were assessed at baseline, post, 1-month, and 3-month follow-up. Data collection will be complete in May 2024. Retention rates to date are excellent (91% at post, 92% at 1-month, and 88% at 3-month). Preliminary results suggest participants find texts helpful, relevant, and interesting. We will present primary outcomes for PTSD+AM, including which enhancements are most effective and simplest. This intervention has potential to reach an important, difficult-to-engage population.