Skills Training in Affective Recovery Video and Text Programs for Recent Sexual Assault Survivors

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