App helps curtail PTSD and drinking after sexual assault

A smartphone app tested among people who had recently experienced sexual assault showed promise in preventing post-traumatic stress.

THRIVE helped reduce post-traumatic stress and alcohol misuse in recent sexual assault survivors, said Emily Dworkin, assistant professor of psychiatry & behavioral sciences at the University of Washington School of Medicine. The app teaches coping skills and could be an important step, she said, in serving recent survivors who aren't ready or able to access a trained care provider.

"In a perfect world, we would have face-to-face care that uses evidence-based interventions for every single sexual assault survivor who needs it," Dworkin said. "But the fact is, we don't live in a perfect world, and sexual assault survivors often have trouble seeking or finding help so soon after their assault."

The results from a pilot randomized clinical trial of 41 participants are detailed in a paper published Monday in the journal Psychological Trauma: Theory, Research, Practice, and Policy. The research team, representing UW Medicine and the Stanford University School of Medicine, plans a larger trial next.

Approximately 41% of sexual assault survivors still meet criteria for post-traumatic stress disorder 12 months after their assault, Dworkin's prior research shows. Several factors increase the risk of long-term problems, such as coping by avoiding safe and healthy things that feel distressing or too difficult after the assault, and developing unhelpful beliefs such as self-blame.

"After a trauma like sexual assault, most people feel awful, and so they understandably stop doing a lot of things that they would be doing if they were feeling better," Dworkin said. "Some of those things are suddenly reminders of an awful thing that happened to them. And so obviously, they don't want to do those things. But those are often the exact things that give people a sense of hope and stability, so it can create a vicious cycle."

The THRIVE app, she said, teaches survivors how to identify and address this kind of coping to break that cycle.

Dworkin and colleagues began creating the app in 2018 with the help of a web development company. In crafting the content, they consulted with sexual assault survivors and health professionals who work with survivors. The THRIVE app is meant to be used within 10 weeks of an assault. It includes extensive coping skills training based on what Dworkin described as "gold standard treatments" for post-traumatic stress and alcohol use.

Participants in the trial were randomly chosen to use the THRIVE app or a simpler symptom-tracking app for three weeks. All received brief weekly coaching calls from Dworkin.

Use of the full THRIVE app reduced post-traumatic stress symptom severity and reduced the time participants spent drinking and intoxicated during a given week. In the THRIVE group, the percentage of participants who met the criteria for post-traumatic stress symptoms dropped from 90% before using the app to 25% three months later. The comparison group saw a smaller drop, from 70% to 46%.

"The app taught them how to identify and change unhelpful thinking patterns," Dworkin said. "It also taught them how to make a plan for their healthy routine that reduced the chances that they were avoiding things that they would otherwise want to do. We wanted to get them back to the things that were important to them and of value to them."