Comparative Effectiveness of Stress Management
Condition: Stress
Study type: Interventional

Summary: 
      Many formerly homeless adults with chronic mental illness experience treatment resistant
      symptoms for which pharmaceutical agents and cognitive behavioral therapy are not effective.
      Although formerly homeless adults with chronic mental illness typically receive medical and
      psychiatric services to manage their illness, chronic stress and post-traumatic stress
      disorder (PTSD) acquired from homelessness are difficult to resolve and many adults
      experience relapse that can result in housing loss. Therapeutic touch is a complementary and
      alternative treatment that has been shown to be effective at reducing stress, anxiety, and
      pain in a variety of diagnoses including cancer, cardiac disease, chronic pain syndromes, and
      PTSD in veterans. In this study the investigators aim to determine whether a 30-minute
      therapeutic touch session combined with a conventional 1-hour psychoeducation group delivered
      over 6 weeks can more effectively reduce stress compared to conventional psychoeducation
      alone. The ability to reduce stress levels and maintain emotional equilibrium is critical for
      this population to manage illness symptoms effectively and stave off the incidence of
      relapse, rehospitalizations, and housing loss.
    

Detailed description: 
      In 2015, approximately 600,000 people were reported to be homeless on any given night in the
      United States and 1.6 million used homeless shelter services. One-third of homeless adults
      who received shelter services were diagnosed with chronic mental illness (e.g.,
      schizophrenia, bipolar disorder, major depression) and two-thirds had substance use
      disorders.

      Once housed in supportive living residences, formerly homeless adults with mental illness
      commonly continue to experience high levels of stress, anxiety, depression, and
      post-traumatic stress disorder (PTSD), despite receiving medical and psychiatric services.
      Stress that is not sufficiently addressed can frequently lead to rehospitalizations and
      subsequent loss of housing. Although stress has been successfully treated with anti-anxiety
      pharmaceuticals, cognitive behavioral therapies, and support groups in adults in the larger
      population, formerly homeless adults with chronic mental illness tend to experience greater
      treatment resistance to such interventions or respond positively for short intervals and then
      relapse.

      One nonpharmacological intervention that has gained increasing support in the last two
      decades is therapeutic touch. Therapeutic touch, also referred to as healing touch and touch
      therapy, is a complementary and alternative treatment in which practitioners seek to
      alleviate or reduce pain, stress, or anxiety through direct hand contact with a client's bio-
      or energy field. A bio- or energy field is defined in quantum physics as an interconnected
      web of energy that surrounds living organisms and may regulate emotional states and physical
      health. Although the existence of energy fields is increasingly accepted in the scientific
      community, the precise roles of and mechanisms through which energy fields work are not
      understood. While eastern health practitioners have for centuries used therapies addressing
      energy fields-for example, acupuncture, acupressure, Ayurveda, qi gong-western practitioners
      have only begun using such therapies in the last century. The most common western names for
      energy field therapy are therapeutic touch, healing touch, Reiki, and touch therapy-all of
      which have growing bodies of evidence supporting their effectiveness in the reduction of
      stress, anxiety, and pain in various diagnostic populations including cancer, cardiovascular
      disease, and chronic pain syndromes.

      Although there is evidence that therapeutic touch can help reduce symptoms of PTSD in
      veterans, and stress and anxiety in cancer and cardiac patients, little information exists
      about whether therapeutic touch can reduce stress in formerly homeless adults with chronic
      mental illness. The ability to reduce stress in formerly homeless adults may help them manage
      illness symptoms better and prevent relapse for longer intervals.

      In this comparative effectiveness study, the investigators will provide a conventional stress
      management psychoeducation group to 20 participants. Ten of these 20 participants will
      additionally receive 30 minutes of therapeutic touch delivered in a group setting. The
      remaining 10 participants will receive 30 minutes of sham therapeutic touch delivered in a
      group setting. Ten additional participants will be allocated to a control group with no
      intervention.
    

Intervention name(s): Psychoeducation and Therapeutic Touch
Intervention type(s): Other
Intervention description(s): 6-week, 1-hour psychoeducation group followed by 30-minute therapeutic touch
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Three arm, randomized controlled design
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Therapeutic touch; Post-traumatic Stress Disorder; Homeless