Skills Training in Affective Recovery Video and Text Programs for Recent Sexual Assault Survivors: A Pilot Randomized Clinical Trial.

Importance: Three-quarters of sexual assault (SA) survivors meet criteria for posttraumatic stress disorder (PTSD) 1 month after SA, and PTSD is highly comorbid with substance use disorders. Intervening early is critical to preventing the onset or escalation of these conditions. Objective: To assess the preliminary effectiveness of Skills Training in Affective Recovery (STAR), a brief video, and TextSTAR, a 3-week daily text message program on reducing posttraumatic stress and substance misuse symptoms among SA survivors during an SA medical forensic examination. Design, Setting, and Participants: This pilot sequential, multiple-assignment randomized clinical trial recruited women from 4 US SA medical forensic examination programs from March 12 to November 3, 2025, who had experienced past 7-day SA. Participants were randomized to the video program or treatment as usual (TAU; no video) at the SA medical forensic examination and reassessed at 1 week; nonresponders-those above the threshold for acute stress or opioid misuse-were randomized to the text program or no text program. Participants completed weekly follow-up surveys for 1 month. Data analysis was conducted from December 2025 to April 2026. Interventions: The study's video program is a 17-minute video that educates and encourages social support, positive coping including mindfulness, and self-exposure to feared but safe stimuli. The study's text program is a 3-week daily text message program that emphasizes social support, positive coping, and exposure. Main Outcomes and Measures: Primary outcome of acute or posttraumatic stress was measured at 1 and 4 weeks via the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Primary outcome of drug use was measured at 1 and 4 weeks with the Tobacco, Alcohol, Prescription Medication, and Other Substance Use Part 1. Exploratory outcome of pain was measured at 1 and 4 weeks with the Brief Pain Inventory. Results: Fifty women (mean [SD] age, 28.9 [10.1] years) were enrolled in the study. Those randomized to the study's video program had lower odds of acute stress (odds ratio, 0.13; 95% CI, 0.02-0.78). Those randomized to the video program also had lower pain at 1 week (mean [SD] score, 2.1 [2.2]) compared with those assigned to TAU (mean [SD] score, 3.6 [2.6]). Linear regression revealed that the video (mean [SE] estimate, -0.25 [0.14]; z = -1.73; P = .08) and text (mean [SE] estimate, -0.41 [0.14]; z = -2.95; P = .003) programs were negatively associated with week 4 pain scores. Conclusions and Relevance: In this preliminary randomized clinical study for recent SA survivors, the video program was associated with immediate reductions in acute stress and pain; the text program was associated with reductions in week 4 pain. These results suggest that the study's video and text programs were easy-to-administer interventions that can be used in the short-term clinical setting where survivors receive care in the immediate aftermath of SA. Trial Registration: ClinicalTrials.gov Identifier: NCT06456190.