Past Research Studies

Past Research

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Risk Reduction through Family Therapy (RRFT)

Integrative Treatment for Teen Substance Use Problems & PTSD; NIDA R01DA031285

Principal Investigator: Carla Kmett Danielson, Ph.D.

Co-Investigator: Zachary Adams, Ph.D.

The goal of this research was to conduct a Stage II RCT to evaluate the efficacy of Risk Reduction through Family Therapy (RRFT). RRFT is an integrative treatment for adolescents who have experienced interpersonal traumatic events (ITEs). Treatment targets include reductions in substance use problems, PTSD, HIV sexual risk behaviors from pre-treatment through 18 months post-entry. ITEs are among the strongest and most consistent predictors of adolescent problems, including substance use disorders and heightened HIV risk. Remarkably, no behavioral interventions have been developed and rigorously evaluated for this population that take an integrated approach to targeting such sequelae through use of existing empirically-supported interventions, including exposure. RRFT was developed by the candidate to address this gap. RRFT is an integrative, ecologically-based treatment. Stage 1A feasibility trial and a Stage 1B pilot randomized controlled trial (RCT) evaluating RRFT have been completed. Preliminary findings from these studies are promising, indicating that RRFT can be readily learned and implemented with fidelity and can lead to improvements in substance use problems, PTSD symptoms, and HIV sexual risk behaviors.

The RCT follows a 2 (treatment) × 5 (timepoints) factorial design. The sample comprises 250 teens (14 to17 yrs) with a memorable ITE experience that report current substance use and ≥ 5 PTSD symptoms. Assessments with youth and caregivers are conducted at pre-treatment and 3, 6, 12, and 18 months post study-entry. Demographics, lifetime trauma history, psychopathology, substance use, abuse (including urine drug screens), risk and resiliency factors (e.g., family environment), and gold standard treatment assessment (e.g., fidelity checklist, chart reviews) are measured. Dr. Danielson provides the therapist training and supervision of all RRFT cases. Adolescents assigned to the TAU condition receive the standard treatment typically administered in the community. All sessions in both conditions are audiotaped. Two raters are reviewing 20 percent of tapes for fidelity.

Selected Publications:

Danielson, C. K., Adams, Z. W., McCart, M. M., Chapman, J., Sheidow, A., Walker, J., Smalling, A. & de Arellano, M. (2020). The safety and efficacy of exposure-based treatment of co-occurring substance use problems and PTSD among adolescents: A randomized clinical trial of Risk Reduction through Family Therapy (RRFT). JAMA Psychiatry. PMCJournal In Process.

Danielson, C. K., Adams, Z. A., & Hanson, R. (2019). Risk Reduction through Family Therapy (RRFT): Exposure-Based Treatment for Co-Occurring PTSD and Substance Use Problems among Adolescents (pgs. 165-182). In A. A. Vujanovic & S. E. Back (Eds.), Posttraumatic stress and substance use disorders: A comprehensive clinical handbook. New York: Routledge.

Danielson, C.K., McCart, M., Walsh, K., de Arellano, M.A., White, D., & Resnick, H. (2012). Reducing substance use risk and mental health problems among sexually assaulted adolescents: A pilot randomized controlled trial. Journal of Family Psychology, 26, 628-635. PMCID: PMC3419329.

Danielson, C.K., McCart, M., de Arellano, M.A., Macdonald, A., Silcott, L., Resnick, H. (2010).  Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: Findings from an open trial. Child Maltreatment, 15, 261-268. PMCID: PMC3105119.

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Mentorship and Research in HIV and Addiction Prevention Among Traumatized Youth: TIPS Study

This is a pilot randomized controlled study, funded through a NIDA K24 that aims to target substance use and risky sexual behavior prevention among adolescents who have experienced trauma by using an app developed by our team called TIPS (Trauma Informed Prevention), which has been specially tailored for use with adolescents engaged in TF-CBT. Participants eligible for this study include TF-CBT trained clinicians, youth who have experienced at least one traumatic event and who are engaging in TF-CBT, and a caregiver. Clinicians are trained in how to use the TIPS app in conjunction with TF-CBT. Study participants are randomized to one of two study groups- TF-CBT as usual or TF-CBT plus the TIPS app. Data collection methods include self-administered surveys for the clinician, adolescent, and caregiver as well as brief clinical interviews with the adolescent and caregiver to be administered at several time periods during treatment.

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Web-Based Intervention for Disaster-Affected Adolescents and FamiliesNIMH R01MH081056 ; PI: Kenneth Ruggiero, Ph.D.

Evaluation of Novel PTSD Risk Assessment Tools for Disaster-Exposed YouthNIMH R21MH086313 ; PI: Carla Kmett Danielson, Ph.D.

Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including posttraumatic stress disorder (PTSD), depression, and substance use. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several Web based evaluation studies with various adult populations has shown that Web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This innovative study involved evaluation of a self-help Web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and Web-based assessments (including behavioral tasks designed to measure distress tolerance and risk taking propensity), and development and evaluation of a highly individualized Web intervention for adolescents.

Selected Publications:

Adams, Z. W., Danielson, C. K., Sumner, J. A*., McCauley, J. L., & Ruggiero, K. J. (2015). Comorbidity of PTSD, major depression, and substance use disorder among adolescent victims of the Spring, 2011 tornadoes in Alabama and Joplin, Missouri. Psychiatry: Interpersonal and Biological Processes.

Adams, Z. W., Sumner, J. A*., Danielson, C. K., McCauley, J. L., Resnick, H. S., Grös, K., ... & Ruggiero, K. J. (2014). Prevalence and predictors of PTSD and depression among adolescent victims of the Spring 2011 tornado outbreak. Journal of child psychology and psychiatry. Prevalence and predictors of PTSD

Ruggiero, K. J., Davidson, T. M., McCauley, J., Gros, K. S., Welsh, K., Price, M.*, ... & Amstadter, A. B. (2015). Bounce Back Now. Protocol of a population-based randomized controlled trial to examine the efficacy of a Web-based intervention with disaster-affected families. Contemporary clinical trials, 40, 138 to 149. Bounce Back Now

Sumner, J. A.*, Pietrzak, R. H., Danielson, C. K., Adams, Z. W., & Ruggiero, K. J. (2014). Elucidating dimensions of posttraumatic stress symptoms and their functional correlates in disaster-exposed adolescents. Journal of psychiatric research, 59, 85 to 92. Elucidating dimensions

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MUSC Charleston Alcohol Research Center

Stress-Induced Drinking in Emerging Adults: The Role of Trauma History Component #5 of the Charleston Alcohol Research Center

NIAAA P50AA010761-20 Sub-Project ID: 8172; Center Grant PI: Howard Becker, Ph.D.

Clinical Research Component PI: Carla Kmett Danielson, Ph.D.

Co-Is: Suzanne Thomas, Ph.D.; Zachary Adams, Ph.D.

Individuals exposed to a traumatic event at any time in their life, particularly those who develop posttraumatic stress disorder (PTSD), have a higher incidence of problematic drinking. However, little is known about the relationship between trauma, PTSD, and drinking in “emerging adults” (ages 21 to 30 years), in spite of this age group being at highest risk of developing subsequent drinking problems. This clinical research component used a three-group design. The target population had no trauma exposure, trauma exposure without PTSD, and trauma exposure with PTSD. The type of traumatic event exposure history was limited to interpersonal trauma. This project used a well-established clinical laboratory paradigm of stress induction to investigate the role of a history of exposure to trauma on reactivity to a social stress test, and on stress-induced voluntary drinking. Study subjects in this component were individuals who do not meet diagnostic criteria for alcohol dependence. Half of each group received the stress test and the other half were randomized to the no stress condition. Using subjective as well as biological indices of stress, the first aim of this project examined the effect of trauma history on stress reactivity, using subjective, neuroendocrine, and physiological measures of stress. The second aim examined the effect of trauma history on subsequent drinking behavior and subjective response to alcohol using established procedures in a clinical laboratory paradigm. This study data will advance our understanding of the relationship between a history of interpersonal trauma, stress, and drinking. The ultimate goal of this line of research is to identify “at risk” groups early in their drinking careers, before unhealthy drinking practices and/or dependence develop. This information has the potential to inform prevention and intervention alcohol research. Data from this study is available for analysis. 

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mHealth Tools to Address Stress-Related Substance Use in Adolescents

K12 Scholar and Sub-award PI: Zachary Adams, Ph.D.

K12 DA031794, PI: K. Brady, M.D. Ph.D. “Clinical Scientists Training in Addictions at MUSC”

Comorbidity between substance use disorders (SUD) and mental illness affects over 9 million people in the U.S., emerges as early as adolescence, and is associated with greater symptom severity, functional impairment, and risk of premature treatment disengagement than either disorder alone. Innovative, ecologically valid assessment and treatment delivery models are needed to uncover the mechanisms linking risk factors, such as traumatic stress, and SUDs and to extend the efficacy and reach of clinical care. This project focused on leveraging contemporary mobile devices (smartphones, wireless biosensors for salivary stress hormones) to gather real-time, multi-modal data that can be used to guide treatment planning or to provide real-time feedback and support to patients during the moments when symptoms of distress or craving may be most challenging. An integrated, developmentally tailored mobile health (mHealth) platform that applies these tools to assessment and treatment of comorbid SUDs and mental illness in adolescents has potential to enhance the efficiency and effectiveness of treatment, in part by extending the reach of clinical services beyond the clinic walls and enriching the data available to clinicians and clinical researchers toward refinement of personalized treatment plans.

The proposed study entailed the critical first steps in a program of research designed to enhance treatment effectiveness of treatment for adolescents with comorbid SUD and mental illness via innovative technologies. The three research components involved: (I) design and development of a mobile application and data management system to support real time experience sampling (i.e., ecological momentary assessment, EMA) along with remote acquisition of salivary alpha amylase (sAA); (II) usability tests of the newly developed tools with adolescents and providers to guide refinements; and (III) pilot feasibility trial to assess acceptability of methods for larger scale studies. 

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Weaving Interdisciplinary Screeners into the Emergency Room: AWISERApproach to Identifying At-Risk Youth in the ER

PI: Joseph Cohen, Ph.D.

Co-Is: Carla Danielson, Ph.D., Scott Russell, M.D., Cynthia Hipp, D.D.S.

MUSC Interprofessional Collaboration Grant Opportunity Pilot Project Program ($15,568)

A crucial Health care challenge is identifying youth at highest risk for negative health outcomes. A-risk youth often present at the Emergency Department (ED), where experts in specific pediatric issues (e.g., mental and oral health), may not be available to assess and establish routine care. In response, health professionals from various fields have developed ED screeners to identify youth who may not receive regular care and are at-risk for specific health conditions. The sheer number of narrowly focused screeners, coupled with the resource-sensitive nature of emergency care, makes it difficult for standardized screening procedures to emerge and sustain in the ED. Furthermore, most ED screeners are self-report, limiting their validity and/or requiring extensive training of ED personnel on lengthy protocols.

This multi-method study addressed this fundamental, translational problem by testing objective, potentially transdiagnostic indicators for risk (i.e., single predictor of interdisciplinary health outcomes) in the ED. Specifically, we are testing whether (1) emergency severity index (ESI; a universal triaging tool for patient acuity), (2) a dental screen, and (3) a laboratory test of hair cortisol independently convey risk for poor psychosocial functioning. Specifically, we are examining whether a child’s ESI score, dental screen, and hair cortisol results are interrelated and associated with psychological distress and family functioning (i.e., neglect, interpersonal conflict, social support). This applied developmental psychopathology program of research has the potential to demonstrate the feasibility of objective, biomarker screeners for psychosocial functioning in public health settings, and subsequently, connect at-risk youth and families to important health resources.

WISER is funded by the Interprofessional Collaboration Grant Opportunity Pilot Project Program at MUSC. The mission of this funding opportunity was to promote the scholarship of interprofessional collaboration and practice in the areas of clinical care and research in order to improve health care services for patients. This research was conducted along with the Pediatric Emergency Department at MUSC and MUSC’s College of Dental Medicine.

Click for more information: MUSC Interprofessional Initiatives.