Indirect effects of Seeking Safety plus sertraline on alcohol use: The mediating role of reductions in posttraumatic stress disorder symptom severity
Bibliographic record
Abstract
Posttraumatic stress disorder (PTSD) symptoms and alcohol use frequently co-occur and are mutually reinforcing. Few studies have examined how changes in PTSD severity influence subsequent changes in alcohol use, particularly in the context of comorbidity treatments. This secondary analysis utilized data from a clinical trial comparing 12 weeks of Seeking Safety plus sertraline (SS+S) versus Seeking Safety plus placebo (SS+P) among individuals (N = 69) with co-occurring PTSD and alcohol use disorder. A mediational analysis, using a latent growth modeling framework from five points throughout treatment, was conducted to examine whether reductions in alcohol use were mediated by treatment-led (SS+S vs. SS+P) reductions in PTSD severity. Results revealed a nonsignificant treatment effect on PTSD severity reductions over time, Est. = -0.440. The link between PTSD severity reductions and reductions in alcohol use was significant, Est. = 0.644. Despite the nonsignificant path between treatment group and PTSD severity (and in the presence of bias correction for small sample size), the formal test of mediation was significant such that for participants in the SS+S group, alcohol use reductions were fully mediated by reductions in PTSD severity, Est. = -0.283. These findings suggest one of the mechanisms through which SS+S exerts its effects on alcohol use is through reductions in PTSD severity. Clinicians working within the SS treatment platform may consider augmenting their treatment plan with sertraline in collaboration with clients. Future research is necessary to understand how medication and behavioral therapies synergize over a treatment course to improve PTSD and alcohol use.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".