Results from a randomized controlled trial testing theory-driven enhancements – Growth mindsets and message framing -- to a brief CBT text-message invention for co-occurring PTSD symptoms and alcohol misuse

This paper describes the primary outcomes from a registered randomized clinical trial (RCT; NCT05372042) evaluating a brief, self-directed cognitive behavioral therapy-based (CBT) text message intervention for individuals with PTSD symptoms and co-occurring alcohol misuse (PTSD + AM). The trial aimed to refine the intervention by testing whether evidence-based techniques from cognitive psychology (message framing) and social psychology (growth mindsets) increased intervention efficacy. A combination of messages that highlighted using skills to avoid future losses (vs. for future gains vs. no framing) and that sought to facilitate a mindset that challenges setbacks and encourages growth opportunities (vs. a simple reminder to use skills) was predicted to increase efficacy. The trial had a three (framing: loss vs. gain vs. no framing) x two (mindset: growth vs. simple reminder) factorial design. A series of a priori decision rules was created to identify the most efficacious and simplest condition. A sample of 505 adults from Washington State was recruited (71 % female, 20 % male, 9 % identified as another gender). Trauma exposure, PTSD symptoms, AM, and other mental health concerns were assessed. The 4-week intervention had follow-ups at post-intervention, 1-month, and 3-months, with excellent retention (89+%). Participants’ PTSD symptoms and AM improved across all conditions with large effect sizes. Decision rule implementation indicated the selection of the loss framing and growth mindset condition. This condition will be tested in a subsequent RCT with longer-term follow-up. It is expected to yield an additional, effective brief treatment option for individuals with PTSD + AM—a high risk population facing multiple treatment barriers.