Najavits Lisa M, Cha Eugene, Demce Michelle G, Gupta Mahika, Haney Angelina M, Logounov Gabriel, Miket Alexis, Morency Michelle, Schulhof Atara E
Treatment Innovations, Newton Centre, Massachusetts, USA.
Department of Psychiatry, T.H. Chan School of Medicine, Worcester, MA.
Subst Use Misuse. 2024;59(3):459-466. doi: 10.1080/10826084.2023.2280540. Epub 2024 Jan 25.
Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur frequently and have deleterious impact. Seeking Safety (SS) - an evidence-based, present-focused, coping skills model - lends itself to mobile app delivery.
A novel SS mobile app is compared to a control app that lacks the interactivity, social engagement, and feature-richness of the SS app. We hypothesized that the SS app would outperform the control on primary outcome variables (substance use, trauma symptoms) and at least two secondary variables.
Outpatients with current PTSD and SUD ( = 116) were randomized to the apps; assessed were pre, post (12 weeks), and 3-month follow-up in this online study.
The SS app outperformed the control on the primary outcomes, but not on secondary outcomes. Also both conditions evidenced significant change over time from pre to post, with gains sustained at follow-up. External medication and supports during the trial did not differ by condition.
This first RCT on a SS mobile app had positive results for reduction in substance use and trauma symptoms compared to a control app. This is noteworthy as mental health mobile apps, in general, evidence few positive outcomes. Our substance use finding is also notable as psychosocial interventions in PTSD/SUD populations find it harder to achieve reduction in SUD than trauma symptoms. Our control app may have represented too strong a comparison and weakened our ability to find results on secondary outcomes by condition.
创伤后应激障碍（PTSD）和物质使用障碍（SUD）经常同时出现，并具有有害影响。“寻求安全”（SS）——一种基于证据、关注当下的应对技能模型——适合通过移动应用程序提供。
将一款新颖的SS移动应用程序与一款缺乏SS应用程序的交互性、社交参与度和丰富功能的对照应用程序进行比较。我们假设SS应用程序在主要结局变量（物质使用、创伤症状）和至少两个次要变量上的表现会优于对照应用程序。
患有当前PTSD和SUD的门诊患者（n = 116）被随机分配到应用程序组；在这项在线研究中，对患者进行了基线、12周后和3个月随访评估。
SS应用程序在主要结局方面的表现优于对照应用程序，但在次要结局方面并非如此。此外，两种情况均显示从基线到随访期间随时间有显著变化，且随访时保持改善。试验期间的外部药物治疗和支持在两组之间没有差异。
与对照应用程序相比，这项关于SS移动应用程序的首次随机对照试验在减少物质使用和创伤症状方面取得了积极成果。这一点值得注意，因为一般来说，心理健康移动应用程序很少有积极效果。我们在物质使用方面的发现也很显著，因为在患有PTSD/SUD的人群中，心理社会干预发现减少SUD比减少创伤症状更难。我们的对照应用程序可能代表了一个过于强大的比较对象，削弱了我们按情况在次要结局上发现结果的能力。
