Trial Outcomes & Findings for CBT Texts for PTSD & Hazardous Drinking (Project Better) (NCT NCT05372042)

NCT ID: NCT05372042

Last Updated: 2025-06-26

Results Overview

Heavy Episodic Drinking (HED) assesses the quantity of heavy drinking episodes (i.e., \>4/5 drinks per occasion for women/men, based on the National Institute of Alcohol Abuse and Alcoholism's definition) over the last month. It is administered at pre-intervention (baseline), post-intervention (week 4), 1 month follow up (week 8), and 3 month follow up (week 16). The range of the scale is 0-10 (count of the number of heavy drinking episodes in the last month); 10 is described as 10 or more heavy drinking episodes. Higher scores represent a greater number of heavy drinking episodes.

Recruitment status

COMPLETED

Study phase

Target enrollment

505 participants

Primary outcome timeframe

Baseline, 4 weeks, 8 weeks, 16 weeks

Results posted on

2025-06-26

Participant Flow

2,751 completed the screening survey, and 1,397 of them were not eligible. Among 1,354 participants who were eligible for the verification call, 628 were excluded prior to verification call due to suspected fraud, missing contact information, etc. and 162 did not show up/declined participation. Among 564 participants who were sent baseline survey, 45 never completed baseline and 14 were identified as fraudulent upon review. 505 completed baseline/enrolled and were randomized.

Participant milestones

Participant milestones
Measure	Loss Framing + Growth Mindset Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Post Intervention STARTED	84	83	86	85	85	82
Post Intervention COMPLETED	78	78	76	79	80	78
Post Intervention NOT COMPLETED	6	5	10	6	5	4
1-Month Follow Up STARTED	84	83	86	85	85	82
1-Month Follow Up COMPLETED	77	78	74	82	80	79
1-Month Follow Up NOT COMPLETED	7	5	12	3	5	3
3-Month Follow Up STARTED	84	83	86	85	85	82
3-Month Follow Up COMPLETED	73	75	73	82	78	71
3-Month Follow Up NOT COMPLETED	11	8	13	3	7	11

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

CBT Texts for PTSD & Hazardous Drinking (Project Better)

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Total n=505 Participants Total of all reporting groups
Age, Continuous	36.45 years STANDARD_DEVIATION 10.98 • n=5 Participants	38.06 years STANDARD_DEVIATION 12.04 • n=7 Participants	36.83 years STANDARD_DEVIATION 10.7 • n=5 Participants	35.99 years STANDARD_DEVIATION 11.05 • n=4 Participants	34.47 years STANDARD_DEVIATION 10.19 • n=21 Participants	35.82 years STANDARD_DEVIATION 11.17 • n=8 Participants	36.27 years STANDARD_DEVIATION 11.03 • n=8 Participants
Sex/Gender, Customized Male	17 Participants n=5 Participants	15 Participants n=7 Participants	18 Participants n=5 Participants	16 Participants n=4 Participants	16 Participants n=21 Participants	17 Participants n=8 Participants	99 Participants n=8 Participants
Sex/Gender, Customized Female	55 Participants n=5 Participants	60 Participants n=7 Participants	59 Participants n=5 Participants	61 Participants n=4 Participants	63 Participants n=21 Participants	62 Participants n=8 Participants	360 Participants n=8 Participants
Sex/Gender, Customized Transgender	2 Participants n=5 Participants	1 Participants n=7 Participants	2 Participants n=5 Participants	4 Participants n=4 Participants	2 Participants n=21 Participants	1 Participants n=8 Participants	12 Participants n=8 Participants
Sex/Gender, Customized Another identity	10 Participants n=5 Participants	7 Participants n=7 Participants	7 Participants n=5 Participants	4 Participants n=4 Participants	4 Participants n=21 Participants	2 Participants n=8 Participants	34 Participants n=8 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	10 Participants n=5 Participants	6 Participants n=7 Participants	7 Participants n=5 Participants	12 Participants n=4 Participants	9 Participants n=21 Participants	12 Participants n=8 Participants	56 Participants n=8 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	70 Participants n=5 Participants	71 Participants n=7 Participants	75 Participants n=5 Participants	72 Participants n=4 Participants	76 Participants n=21 Participants	69 Participants n=8 Participants	433 Participants n=8 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	4 Participants n=5 Participants	6 Participants n=7 Participants	4 Participants n=5 Participants	1 Participants n=4 Participants	0 Participants n=21 Participants	1 Participants n=8 Participants	16 Participants n=8 Participants
Race (NIH/OMB) American Indian or Alaska Native	2 Participants n=5 Participants	2 Participants n=7 Participants	1 Participants n=5 Participants	2 Participants n=4 Participants	4 Participants n=21 Participants	2 Participants n=8 Participants	13 Participants n=8 Participants
Race (NIH/OMB) Asian	4 Participants n=5 Participants	2 Participants n=7 Participants	2 Participants n=5 Participants	6 Participants n=4 Participants	4 Participants n=21 Participants	2 Participants n=8 Participants	20 Participants n=8 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=8 Participants	0 Participants n=8 Participants
Race (NIH/OMB) Black or African American	2 Participants n=5 Participants	4 Participants n=7 Participants	2 Participants n=5 Participants	2 Participants n=4 Participants	4 Participants n=21 Participants	4 Participants n=8 Participants	18 Participants n=8 Participants
Race (NIH/OMB) White	64 Participants n=5 Participants	64 Participants n=7 Participants	69 Participants n=5 Participants	61 Participants n=4 Participants	59 Participants n=21 Participants	60 Participants n=8 Participants	377 Participants n=8 Participants
Race (NIH/OMB) More than one race	12 Participants n=5 Participants	9 Participants n=7 Participants	7 Participants n=5 Participants	14 Participants n=4 Participants	10 Participants n=21 Participants	10 Participants n=8 Participants	62 Participants n=8 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	2 Participants n=7 Participants	5 Participants n=5 Participants	0 Participants n=4 Participants	4 Participants n=21 Participants	4 Participants n=8 Participants	15 Participants n=8 Participants

PRIMARY outcome

Timeframe: Baseline, 4 weeks, 8 weeks, 16 weeks

Outcome measures

Outcome measures
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Heavy Episodic Drinking Timepoint: Pre-intervention (Baseline)	6.19 number of heavy drinking episodes Standard Deviation 3.03	6.00 number of heavy drinking episodes Standard Deviation 3.15	5.85 number of heavy drinking episodes Standard Deviation 3.20	6.69 number of heavy drinking episodes Standard Deviation 3.12	6.02 number of heavy drinking episodes Standard Deviation 3.12	6.33 number of heavy drinking episodes Standard Deviation 3.22
Heavy Episodic Drinking Timepoint: Post-intervention (Week 4)	3.71 number of heavy drinking episodes Standard Deviation 3.40	4.58 number of heavy drinking episodes Standard Deviation 3.73	3.63 number of heavy drinking episodes Standard Deviation 3.45	4.52 number of heavy drinking episodes Standard Deviation 3.47	3.48 number of heavy drinking episodes Standard Deviation 3.43	4.03 number of heavy drinking episodes Standard Deviation 3.44
Heavy Episodic Drinking Timepoint: Month 1 follow-up (Week 8)	3.27 number of heavy drinking episodes Standard Deviation 3.50	3.82 number of heavy drinking episodes Standard Deviation 3.71	3.32 number of heavy drinking episodes Standard Deviation 3.27	3.48 number of heavy drinking episodes Standard Deviation 3.61	3.01 number of heavy drinking episodes Standard Deviation 3.38	2.96 number of heavy drinking episodes Standard Deviation 3.31
Heavy Episodic Drinking Timepoint: Month 3 follow-up (Week 16)	2.53 number of heavy drinking episodes Standard Deviation 2.98	3.61 number of heavy drinking episodes Standard Deviation 3.75	3.18 number of heavy drinking episodes Standard Deviation 3.40	3.65 number of heavy drinking episodes Standard Deviation 3.70	3.04 number of heavy drinking episodes Standard Deviation 3.33	2.33 number of heavy drinking episodes Standard Deviation 3.01

PRIMARY outcome

Timeframe: Baseline, 4 weeks, 8 weeks, and 16 weeks

The Posttraumatic Stress Disorder Checklist for the 5th Edition of Diagnostic and Statistical Manual of Mental Disorders (PCL-5) assesses the severity of symptoms of posttraumatic stress disorder (PTSD) as defined by the 5th Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and is administered at pre-intervention (baseline), post-intervention (week 4), 1 month follow up (week 8), and 3 month follow up (week 16) to assess change in PTSD symptoms. The range of the scale is 0-80. Higher scores represent more severe PTSD symptoms.

Outcome measures

Outcome measures
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Posttraumatic Stress Disorder (PTSD) Timepoint: Pre-intervention (Baseline)	51.83 score on a scale Standard Deviation 11.43	49.99 score on a scale Standard Deviation 11.97	50.66 score on a scale Standard Deviation 11.43	51.67 score on a scale Standard Deviation 11.87	51.66 score on a scale Standard Deviation 11.44	51.33 score on a scale Standard Deviation 11.95
Posttraumatic Stress Disorder (PTSD) Timepoint: Post-intervention (Week 4)	39.72 score on a scale Standard Deviation 15.23	38.85 score on a scale Standard Deviation 15.75	38.78 score on a scale Standard Deviation 14.30	39.38 score on a scale Standard Deviation 15.91	39.40 score on a scale Standard Deviation 14.91	39.06 score on a scale Standard Deviation 15.72
Posttraumatic Stress Disorder (PTSD) Timepoint: Month 1 follow-up (Week 8)	34.19 score on a scale Standard Deviation 14.87	37.73 score on a scale Standard Deviation 14.90	38.46 score on a scale Standard Deviation 14.39	37.18 score on a scale Standard Deviation 15.40	35.83 score on a scale Standard Deviation 16.27	35.14 score on a scale Standard Deviation 14.23
Posttraumatic Stress Disorder (PTSD) Timepoint: Month 3 follow-up (Week 16)	33.72 score on a scale Standard Deviation 15.34	34.64 score on a scale Standard Deviation 18.60	36.53 score on a scale Standard Deviation 15.27	36.61 score on a scale Standard Deviation 15.36	34.23 score on a scale Standard Deviation 16.36	31.51 score on a scale Standard Deviation 16.79

PRIMARY outcome

Timeframe: Baseline, 4 weeks, 8 weeks, 16 weeks

The Daily Drinking Questionnaire (DDQ) assesses the number of standard drinks consumed each day of a typical week over the last month and is administered at pre-intervention (baseline), post-intervention (week 4), 1 month follow up (week 8), and 3 month follow up (week 16). The range for the scale to report drinks consumed each day is 0-25. Each day's score for the week is summed to created a total number of drinks consumed per week; the count of drinks consumed per week ranges from 0 to 175. Higher scores representing greater number of drinks consumed during a typical week.

Outcome measures

Outcome measures
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Typical Weekly Alcohol Consumption Timepoint: Pre-intervention (Baseline)	23.96 number of standard drinks per week Standard Deviation 22.19	26.00 number of standard drinks per week Standard Deviation 18.50	26.00 number of standard drinks per week Standard Deviation 26.01	26.15 number of standard drinks per week Standard Deviation 22.98	23.68 number of standard drinks per week Standard Deviation 20.97	25.63 number of standard drinks per week Standard Deviation 20.80
Typical Weekly Alcohol Consumption Timepoint: Post-intervention (Week 4)	16.65 number of standard drinks per week Standard Deviation 19.06	21.49 number of standard drinks per week Standard Deviation 19.47	19.72 number of standard drinks per week Standard Deviation 18.91	18.67 number of standard drinks per week Standard Deviation 13.90	18.20 number of standard drinks per week Standard Deviation 19.71	17.96 number of standard drinks per week Standard Deviation 16.46
Typical Weekly Alcohol Consumption Timepoint: Month 1 follow-up (Week 8)	14.85 number of standard drinks per week Standard Deviation 18.24	17.24 number of standard drinks per week Standard Deviation 16.85	16.46 number of standard drinks per week Standard Deviation 20.16	16.48 number of standard drinks per week Standard Deviation 15.21	15.89 number of standard drinks per week Standard Deviation 23.41	14.79 number of standard drinks per week Standard Deviation 16.57
Typical Weekly Alcohol Consumption Timepoint: Month 3 follow-up (Week 16)	11.80 number of standard drinks per week Standard Deviation 12.86	17.88 number of standard drinks per week Standard Deviation 22.83	17.05 number of standard drinks per week Standard Deviation 23.15	16.24 number of standard drinks per week Standard Deviation 17.60	14.46 number of standard drinks per week Standard Deviation 23.58	11.47 number of standard drinks per week Standard Deviation 13.78

PRIMARY outcome

Timeframe: Baseline, 4 weeks, 8 weeks, 16 weeks

The Short Index of Problems (SIP) assesses the negative consequences from alcohol consumption over the last month and is administered at pre-intervention (baseline), post-intervention (week 4), 1 month follow up (week 8), and 3 month follow up (week 16). The range for the scale is 0-15 and higher scores represent a greater number of alcohol-related consequences.

Outcome measures

Outcome measures
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Alcohol Use Consequences Timepoint: Pre-intervention (Baseline)	8.99 score on a scale Standard Deviation 3.65	9.00 score on a scale Standard Deviation 3.65	8.22 score on a scale Standard Deviation 4.07	9.02 score on a scale Standard Deviation 3.87	8.33 score on a scale Standard Deviation 4.06	9.28 score on a scale Standard Deviation 3.74
Alcohol Use Consequences Timepoint: Post-intervention (Week 4)	5.87 score on a scale Standard Deviation 3.90	6.54 score on a scale Standard Deviation 4.15	5.54 score on a scale Standard Deviation 4.33	6.14 score on a scale Standard Deviation 4.44	5.16 score on a scale Standard Deviation 4.31	5.83 score on a scale Standard Deviation 4.34
Alcohol Use Consequences Timepoint: Month 1 follow-up (Week 8)	4.68 score on a scale Standard Deviation 3.92	5.99 score on a scale Standard Deviation 5.10	4.84 score on a scale Standard Deviation 4.59	4.95 score on a scale Standard Deviation 4.55	4.76 score on a scale Standard Deviation 4.82	5.09 score on a scale Standard Deviation 4.72
Alcohol Use Consequences Timepoint: Month 3 follow-up (Week 16)	4.65 score on a scale Standard Deviation 4.41	5.06 score on a scale Standard Deviation 5.07	4.55 score on a scale Standard Deviation 4.76	4.83 score on a scale Standard Deviation 4.73	4.55 score on a scale Standard Deviation 5.05	3.49 score on a scale Standard Deviation 4.24

SECONDARY outcome

Timeframe: Baseline,16 weeks

The Alcohol Use Disorders Identification Test (AUDIT) assesses problem drinking and likely diagnosis of an alcohol use disorder over the last 12 months and is administered at pre-intervention (baseline) and 3 month follow up (week 16). The total range of scores is 0-40 and higher scores represent greater risks of having an alcohol use disorder.

Outcome measures

Outcome measures
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Risk of Alcohol Use Disorder (AUD) Timepoint: Pre-intervention (Baseline)	18.29 score on a scale Standard Deviation 7.35	18.49 score on a scale Standard Deviation 7.02	18.17 score on a scale Standard Deviation 8.35	18.89 score on a scale Standard Deviation 8.38	17.72 score on a scale Standard Deviation 9.01	18.54 score on a scale Standard Deviation 7.18
Risk of Alcohol Use Disorder (AUD) Timepoint: Month 3 follow-up (Week 16)	12.93 score on a scale Standard Deviation 7.26	15.63 score on a scale Standard Deviation 8.06	14.12 score on a scale Standard Deviation 8.06	15.21 score on a scale Standard Deviation 8.78	14.19 score on a scale Standard Deviation 9.43	13.23 score on a scale Standard Deviation 7.82

SECONDARY outcome

Timeframe: Baseline, 8 weeks, 16 weeks

The Depression Anxiety Stress Scale (DASS-21) assesses the general psychopathology symptoms over the last month and is administered at pre-intervention (baseline), 1 month follow up (week 8), and 3 month follow up (week 16). It has 3 subscales; two of which (anxiety and depression subscales) are outcomes for this study. The total range of scores of the anxiety subscale of the DASS-21 is 0-21 and higher scores indicate more severe symptoms. The total range of scores of the depression subscale of the DASS-21 is 0-21 and higher scores indicate more severe symptoms.

Outcome measures

Outcome measures
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Depression, Anxiety, and Stress Scale Timepoint: Pre-intervention (Baseline), Depression	11.15 score on a scale Standard Deviation 4.67	12.12 score on a scale Standard Deviation 4.89	12.13 score on a scale Standard Deviation 4.87	12.44 score on a scale Standard Deviation 4.97	11.79 score on a scale Standard Deviation 4.95	11.59 score on a scale Standard Deviation 4.69
Depression, Anxiety, and Stress Scale Timepoint: Month 1 follow-up (Week 8), Depression	9.40 score on a scale Standard Deviation 5.15	9.69 score on a scale Standard Deviation 5.46	10.73 score on a scale Standard Deviation 5.42	9.40 score on a scale Standard Deviation 5.53	9.61 score on a scale Standard Deviation 6.03	8.98 score on a scale Standard Deviation 5.55
Depression, Anxiety, and Stress Scale Timepoint: Month 3 follow-up (Week 16), Depression	8.93 score on a scale Standard Deviation 5.34	9.16 score on a scale Standard Deviation 6.25	10.22 score on a scale Standard Deviation 5.70	8.95 score on a scale Standard Deviation 5.65	8.96 score on a scale Standard Deviation 5.61	8.55 score on a scale Standard Deviation 5.12
Depression, Anxiety, and Stress Scale Timepoint: Pre-intervention (Baseline), Anxiety	7.92 score on a scale Standard Deviation 3.89	8.37 score on a scale Standard Deviation 4.74	8.70 score on a scale Standard Deviation 4.04	9.33 score on a scale Standard Deviation 3.96	9.05 score on a scale Standard Deviation 4.29	8.45 score on a scale Standard Deviation 4.27
Depression, Anxiety, and Stress Scale Timepoint: Month 1 follow-up (Week 8), Anxiety	6.88 score on a scale Standard Deviation 3.86	6.83 score on a scale Standard Deviation 4.01	7.14 score on a scale Standard Deviation 4.49	7.15 score on a scale Standard Deviation 4.25	6.85 score on a scale Standard Deviation 4.47	5.90 score on a scale Standard Deviation 4.20
Depression, Anxiety, and Stress Scale Timepoint: Month 3 follow-up (Week 16), Anxiety	7.00 score on a scale Standard Deviation 4.64	6.26 score on a scale Standard Deviation 4.76	6.64 score on a scale Standard Deviation 4.74	7.24 score on a scale Standard Deviation 4.82	6.27 score on a scale Standard Deviation 4.02	6.00 score on a scale Standard Deviation 4.08

SECONDARY outcome

Timeframe: 16 weeks

The Treatment Services Received (TSR) assesses the types of mental health and addictions treatments that individuals (e.g., inpatient, outpatient, 12-step, etc) received since enrolling in the study and is administered at 3 month follow up (week 16). Twelve types of treatment are listed and counted to calculate the number of types of treatment that individuals received over the 16-week study period. The minimum possible score is 0 (no services received) and the maximum is 12 types of treatment. Higher numbers indicate receiving more types of treatment.

Outcome measures

Outcome measures
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Treatment Seeking	0.61 unique mental health treatments Standard Deviation 1.03	0.49 unique mental health treatments Standard Deviation 0.80	0.43 unique mental health treatments Standard Deviation 0.73	0.82 unique mental health treatments Standard Deviation 1.19	0.47 unique mental health treatments Standard Deviation 0.92	0.42 unique mental health treatments Standard Deviation 0.88

SECONDARY outcome

Timeframe: Baseline,16 weeks

The Customary Drinking and Drug Use Record (CDDR) assesses comprehensive substance use, other than alcohol, over the last 3 months and is administered at pre-intervention (baseline) and 3 month follow up (week 16). The total range of scores is 0-12 and higher scores indicate more drug use.

Outcome measures

Outcome measures
Measure	Loss Framing + Growth Mindset n=84 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward preventing future losses from trauma exposure, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Loss Framing + Simple Reminder n=83 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward prevent future losses from trauma exposure, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Growth Mindset n=86 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	Gain Framing + Simple Reminder n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that is framed with toward future benefits from doing so, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Growth Mindset n=85 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a reminder that aims to instill a growth mindset about using the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks	No Framing + Simple Reminder n=82 Participants Participants in this condition will receive 3 days of text messages for 4 weeks. Day 1 will consist of psychoeducation about CBT skill, day 2 will be a remainder to use the skill that has no framing, and day 3 will have a simple reminder to use the skill. CBT Text Messages: CBT skills based text messages delivered 3x per week for four weeks
Drug Use Timepoint: Pre-intervention (Baseline)	3.82 score on a scale Standard Deviation 2.60	4.24 score on a scale Standard Deviation 3.12	3.51 score on a scale Standard Deviation 2.50	3.61 score on a scale Standard Deviation 2.74	3.79 score on a scale Standard Deviation 3.17	4.05 score on a scale Standard Deviation 3.11
Drug Use Timepoint: Month 3 follow-up (Week 16)	2.18 score on a scale Standard Deviation 2.04	2.00 score on a scale Standard Deviation 1.67	2.00 score on a scale Standard Deviation 2.25	1.87 score on a scale Standard Deviation 1.94	1.86 score on a scale Standard Deviation 2.12	1.81 score on a scale Standard Deviation 2.03

SECONDARY outcome

Timeframe: Baseline, 16 weeks

The Drug Abuse Screening Test (DAST-10) assesses the problems related to other substance use and likely drug use disorder diagnosis over the last 12 months and is administered at pre-intervention (baseline) and 3 month follow up (week 16). The total range of scores is 0-10 and higher scores indicate more substance use-related problems and likely drug use disorder diagnosis.