Date of Completion of Thesis/SIP

Spring 5-6-2022

Document Type


Degree Name

Master of Science in Nursing (MSN)



First Advisor

Sonja Meiers

Second Advisor

Dawn Box




Problem: Standard pharmacological anxiety treatment is not feasible for some patients who have co-occurring substance use disorder (SUD) due to potential side effects. Cranial electrotherapy stimulation (CES) is an effective non-pharmacological therapy for anxiety with SUD. Further research is needed to investigate the efficacy and applicability of the use of CES in patients with anxiety and SUD. Purpose: The purpose of this study was to explore the efficacy and acceptability of cranial electrical stimulation (CES) as a nonpharmacological therapy for patients with anxiety and coexisting SUD and overall patient satisfaction after CES use. Conceptual framework: The framework of the Cannon-Bard theory emphasizes key mediators in the brain. The primary study draws on this framework by using non-invasive brain stimulation to the thalamus to treat anxiety with SUD. Method: The primary measure for this study was GAD-7 scores, with an additional measure of social anxiety, the Social Phobia Inventory (SPIN), to determine baseline and post-treatment levels of anxiety while patients were undergoing inpatient SUD treatment. CES treatment was used three times a week for at least 20 minutes a day, with more than two weeks of treatment. A total of 24 patients completed this study in an inpatient treatment center. Results: 3 Our study showed statistically significant improvement in post treatment GAD-7 scores (p = 0.02), SPIN scores (p = 0.02), and GAD-7 anxiety severity (p = 0.02) as compared to baseline measures. Decrease in cravings (mean 3.4, SD 1.9), minimal difficulty of using the device (mean 1.2, SD 1.3), and moderate difficulty of continued use of the device after treatment (mean 6.2, SD 3.8) were identified in post-treatment self-report scores. Thematic analysis of descriptive comments (N = 24) showed subjective reduction in anxiety symptoms (n = 12, 50%) and improvement in other mental health conditions and treatments (n = 9). Ease of use (n = 4) and being willing to recommend to others and family members (n = 5) also added to the acceptability of using the CES device. Barriers to treatment included cost (n = 12, 50%) and device specific issues (n = 10). Conclusions/Implications: Our study demonstrated that CES is an acceptable and viable option to reduce anxiety for participants while undergoing inpatient SUD treatment. Previous research identifies that treatment for anxiety should be included during inpatient SUD treatment. The current study also found reduced general and social anxiety in individuals that used CES during inpatient SUD treatment. However, the cost of the CES device is the most common barrier to continuing use. The primary study found that the CES device was typically not covered by health insurance, thus making affordability harder for those with inadequate financial resources. More quantitative and qualitative research on generalized and social anxiety in patients undergoing inpatient SUD treatment is needed. This research of CES use during inpatient SUD treatment could help to decrease barriers and improve acceptability for using the CES device post inpatient SUD treatment. This may improve participants' success in overcoming cravings and decrease relapse.

Available for download on Tuesday, July 30, 2024

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