Impact of Community-Based Biofeedback Program on Drug Use and Mental Health Among People Experiencing Homelessness

NCT ID: NCT05897580

Last Updated: 2023-06-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-02-22

Study Completion Date

2022-10-21

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The purpose of this randomized controlled trial was to compare the effectiveness of an HRV-BF intervention versus a health promotion active control intervention focused on improving mental health symptoms among people experiencing homelessness (PEH), who were residing in Skid Row, Los Angeles. In total, 40 PEH were randomized to either the HRV-BF or an active health promotion control group, and received 8 weekly, 30-minute sessions over a two month period, delivered by a nurse-led community health worker team. Dependent variables of HRV, mental health, anxiety, depression and PTSD were measured at baseline, the 8-week session, and/or 2-month follow up.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

In this pilot randomized controlled trial, conducted over one year, beginning in April 2021, 40 PEH were recruited from a larger sample of 100 PEH that were participating in a survey on COVID-19. Our outcomes were HRV and symptoms of anxiety, depression and PTSD.

Prior to the intervention, a Community Advisory Board (CAB) met to assess feasibility and acceptability of the HRV-BF program, which was presented in a theater-style approach. The CAB, composed of 6 PEH, and 3 healthcare providers, spoke quite favorably about the program, and provided exceptional feedback in terms of acceptability and feasibility in delivery logistics and cultural sensitivity. PEH shared the high levels of stress and anxiety they were experiencing; how helpful they perceived the program to be, the best timing for delivery, length of time for the intervention (under 60 minutes), and how to minimize attrition. Our study was approved by the Human Subjects Protection Committee at the University of California, Irvine and the University of California, Los Angeles.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Heart Rate Variability

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Heart rate variability-biofeedback (HRV-BF) has been shown to decrease symptoms of stress, anxiety, depression, and PTSD, however HRV-BF has not been tested with the most vulnerable of populations, homeless adults
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Heart Rate Variability-Biofeedback (HRV-BF)

Heart Rate Variability-Biofeedback (HRV-BF) is a process by which physiological markers such as heart rate, respiration, and HRV are measured and "fed" back to the person on a computer screen. Guided paced slowed breathing, a skill taught in HRV-BF, maximizes the natural acceleration of heart rate with inspiration and deceleration with expiration and produces a rhythmic stimulation of the vagus nerve, providing the basis for the overall increase in parasympathetic/vagal tone over time if practiced regularly.

Group Type EXPERIMENTAL

Heart Rate Variability - Biofeedback (HRV-BF)

Intervention Type BEHAVIORAL

The HRV-BF was delivered over 30 minutes once weekly for 8 weeks by our nurse-led Community Health Worker (RN/CHW) team trained to deliver scripted material created by a trained biofeedback practitioner on our study team. The weekly sessions included the use of a tablet device to share a 10-minute video which teaches the basic techniques and breathing practices of HRV-BF and guiding the participant through a 20-minute practice, using the techniques while watching their heart rate data in real time using an HRV-BF device, the EmWave Pro (HeartMath).

Participants were also asked to complete daily practices on their own, without the HRV-BF device, for 10 minutes, twice a day, to reinforce topics and skills taught in videos. Practices logged by the participant were collected weekly by the CHW and referral to resources were provided.

Health Promotion (HP)

The Health Promotion (HP) active control group was originally developed utilizing community-based participatory research elements, including the establishment of a Community Advisory Board (CAB), with community stakeholders, social service providers and academicians and a manualized program was developed for the HP program. The 8-week program focused on the most common physical chronic diseases PEH experience, and included discussions of hypertension, diabetes, heart disease and arthritis; total over eight weeks, along with full discussion and referrals provided based on needs expressed by PEH.

Group Type ACTIVE_COMPARATOR

Health Promotion (HP)

Intervention Type BEHAVIORAL

The HP active control group was delivered over 30 minutes, once weekly for 8 weeks by our nurse-led Community Health Worker team, trained to deliver scripted materialized content created. In the HP program, PEH were educated on common physical chronic diseases PEH experience, including hypertension, diabetes, heart disease and arthritis, along with referrals provided based on needs expressed by PEH.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Heart Rate Variability - Biofeedback (HRV-BF)

The HRV-BF was delivered over 30 minutes once weekly for 8 weeks by our nurse-led Community Health Worker (RN/CHW) team trained to deliver scripted material created by a trained biofeedback practitioner on our study team. The weekly sessions included the use of a tablet device to share a 10-minute video which teaches the basic techniques and breathing practices of HRV-BF and guiding the participant through a 20-minute practice, using the techniques while watching their heart rate data in real time using an HRV-BF device, the EmWave Pro (HeartMath).

Participants were also asked to complete daily practices on their own, without the HRV-BF device, for 10 minutes, twice a day, to reinforce topics and skills taught in videos. Practices logged by the participant were collected weekly by the CHW and referral to resources were provided.

Intervention Type BEHAVIORAL

Health Promotion (HP)

The HP active control group was delivered over 30 minutes, once weekly for 8 weeks by our nurse-led Community Health Worker team, trained to deliver scripted materialized content created. In the HP program, PEH were educated on common physical chronic diseases PEH experience, including hypertension, diabetes, heart disease and arthritis, along with referrals provided based on needs expressed by PEH.

Intervention Type BEHAVIORAL

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* age 18 and older
* self-reported as residing in a homeless living condition during the previous night
* self-reported having used illicit substances or alcohol during the past year

Exclusion Criteria

Persons who:

* exclusively spoke languages other than English or Spanish
* were unable to understand informed consent
* had cardiac deficiency, arrhythmias or pacemakers or who took medications affecting autonomic function.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University of California, Irvine

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Adeline Nyamathi

Distinguished Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Amity Foundation, Los Angeles

Los Angeles, California, United States

Site Status

Downtown Women Center, Los Angeles

Los Angeles, California, United States

Site Status

Los Angeles Christian Health Centers (LACHC)

Los Angeles, California, United States

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United States

References

Explore related publications, articles, or registry entries linked to this study.

Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991 Feb;29(2):169-76. doi: 10.1097/00005650-199102000-00008.

Reference Type BACKGROUND
PMID: 1994148 (View on PubMed)

Blackburn L, Owens GP. The effect of self efficacy and meaning in life on posttraumatic stress disorder and depression severity among veterans. J Clin Psychol. 2015 Mar;71(3):219-28. doi: 10.1002/jclp.22133. Epub 2014 Sep 30.

Reference Type BACKGROUND
PMID: 25270887 (View on PubMed)

Forbes D, Creamer M, Biddle D. The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behav Res Ther. 2001 Aug;39(8):977-86. doi: 10.1016/s0005-7967(00)00084-x.

Reference Type BACKGROUND
PMID: 11480838 (View on PubMed)

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.

Reference Type BACKGROUND
PMID: 11556941 (View on PubMed)

Laborde S, Mosley E, Thayer JF. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol. 2017 Feb 20;8:213. doi: 10.3389/fpsyg.2017.00213. eCollection 2017.

Reference Type BACKGROUND
PMID: 28265249 (View on PubMed)

Leake B, Nyamathi A, Gelberg L. Reliability, validity, and composition of a subset of the Centers for Disease Control and Prevention acquired immunodeficiency syndrome knowledge questionnaire in a sample of homeless and impoverished adults. Med Care. 1997 Aug;35(8):747-55. doi: 10.1097/00005650-199708000-00001.

Reference Type BACKGROUND
PMID: 9268248 (View on PubMed)

Lehrer P, Kaur K, Sharma A, Shah K, Huseby R, Bhavsar J, Sgobba P, Zhang Y. Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis. Appl Psychophysiol Biofeedback. 2020 Sep;45(3):109-129. doi: 10.1007/s10484-020-09466-z.

Reference Type BACKGROUND
PMID: 32385728 (View on PubMed)

McDonald SD, Calhoun PS. The diagnostic accuracy of the PTSD checklist: a critical review. Clin Psychol Rev. 2010 Dec;30(8):976-87. doi: 10.1016/j.cpr.2010.06.012. Epub 2010 Jul 6.

Reference Type BACKGROUND
PMID: 20705376 (View on PubMed)

Nyamathi A. Comprehensive health seeking and coping paradigm. J Adv Nurs. 1989 Apr;14(4):281-90. doi: 10.1111/j.1365-2648.1989.tb03415.x.

Reference Type BACKGROUND
PMID: 2661620 (View on PubMed)

Porges SW. The polyvagal perspective. Biol Psychol. 2007 Feb;74(2):116-43. doi: 10.1016/j.biopsycho.2006.06.009. Epub 2006 Oct 16.

Reference Type BACKGROUND
PMID: 17049418 (View on PubMed)

Salem BE, Ma-Pham J. Understanding Health Needs and Perspectives of Middle-Aged and Older Women Experiencing Homelessness. Public Health Nurs. 2015 Nov-Dec;32(6):634-44. doi: 10.1111/phn.12195. Epub 2015 Mar 31.

Reference Type BACKGROUND
PMID: 25832775 (View on PubMed)

Samuelson KW, Bartel A, Valadez R, Jordan JT. PTSD symptoms and perception of cognitive problems: The roles of posttraumatic cognitions and trauma coping self-efficacy. Psychol Trauma. 2017 Sep;9(5):537-544. doi: 10.1037/tra0000210. Epub 2016 Oct 13.

Reference Type BACKGROUND
PMID: 27736138 (View on PubMed)

Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003 Apr 15;49(2):156-63. doi: 10.1002/art.10993.

Reference Type BACKGROUND
PMID: 12687505 (View on PubMed)

Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705-14. doi: 10.1016/0277-9536(91)90150-b.

Reference Type BACKGROUND
PMID: 2035047 (View on PubMed)

Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092.

Reference Type BACKGROUND
PMID: 16717171 (View on PubMed)

Wilkins KC, Lang AJ, Norman SB. Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety. 2011 Jul;28(7):596-606. doi: 10.1002/da.20837. Epub 2011 Jun 16.

Reference Type BACKGROUND
PMID: 21681864 (View on PubMed)

Wingood GM, DiClemente RJ. The ADAPT-ITT model: a novel method of adapting evidence-based HIV Interventions. J Acquir Immune Defic Syndr. 2008 Mar 1;47 Suppl 1:S40-6. doi: 10.1097/QAI.0b013e3181605df1.

Reference Type BACKGROUND
PMID: 18301133 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

20216820

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Ginger.io Behavioral Health Study
NCT02491307 TERMINATED NA
The Healthy Heroes Study
NCT03533023 COMPLETED NA
New Technology and Child Health
NCT02622035 COMPLETED NA
Working Toward Wellness
NCT00694681 COMPLETED NA