Phone App for Grounding
Condition: Substance-Related Disorders
MeSH terms: Substance-Related Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      The goal of this project is to continue to develop a smartphone application ("app") to help
      youth from ages 18-25 who have a substance abuse problem. The app will engage them in
      grounding, which is a sensory-based experience to help them feel calm by reducing intense
      negative feelings and impulses (such as the urge to use a substance or hurt themselves or
      others).
    

Detailed description: 
      Substance use disorder (SUD) is the second most common psychiatric diagnosis in the U.S.
      population. Transition-age youth (TAY) from ages 18-25 are especially vulnerable to substance
      use and SUD. This time period represents a distinct stage separate from adolescence and later
      adulthood. It includes tasks such as leaving home to enter college, the workforce, or the
      military; clarifying vocational goals; and attaining legal drinking age. This period is also
      prime for experimentation with substance use and associated risks such as driving under the
      influence, accidents, fighting and violence, HIV, and vulnerability to sexual assault. This
      project focused on a major strategy, grounding, to help TAY de-escalate (reduce) intense
      negative emotions and impulses. Grounding has long been used in psychiatric hospitals to
      provide a safe, quick, and powerful way to reduce any intense negative feeling such as
      impulses to hurt self or others, substance craving, anger, anxiety, etc. Described in detail
      in the book Seeking Safety (SS), grounding using three pathways to focus the mind (mental),
      body (physical), and heart (soothing). Grounding provides a way to regulate emotion, which is
      a major challenge for TAY, especially given their hormone changes and emotional intensity.
      Indeed substance use is often described as a short-term way to regulate emotion. Grounding is
      a key module of SS, a widely-implemented, evidence-based SUD treatment model. In phase 1 the
      investigator developed a beta version of a grounding app. The app promotes the use of
      grounding in any environment in which emotions and impulses need to be regulated. It
      capitalizes on TAYs' widespread use of mobile devices; and because grounding is a stand-alone
      skill and sensory-oriented, it lends itself wonderfully to an app approach. An iterative
      product development methodology was used based on end-user feedback and the impact of the app
      was studied in a pilot randomized controlled trial (RCT) with 24 TAY. Half received the app
      and the other half received grounding handouts. Results showed that the app was consistently
      more positively rated than the handouts and was associated with significantly more use of
      grounding and a higher score on a grounding knowledge test. All phase 1 benchmarks were met.
      In phase 2 the investigator proposes to scale up both the app and the evaluation of it. There
      are two specific aims: (1) To enhance the mobile grounding app by using exciting, innovative
      technology approaches as well as expanding the grounding content in amount and type. (2) To
      conduct an RCT with 68 TAY to evaluate the grounding app versus a control app. The control
      app would control for both the use of a mobile device and the grounding content. The primary
      outcome is based on power analysis from the phase 1 pilot; other outcomes and measures are
      also included. The RCT uses rigorous scientific methods in its design, measures, and
      statistics.
    

Intervention name(s): Grounding enhanced app; Grounding text-only app
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A mobile app that uses the Seeking Safety grounding chapter content, enhanced with features designed to create strong engagement and interactivity; A mobile app that uses the Seeking Safety grounding chapter content in text format only
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: transition-age youth; mobile app; grounding; Seeking Safety