StressCALSTARNCT06063174
Stress & Resilience Study
A study testing Education Program, Think Well Program and Be Well Program in people with Stress and Stress, Psychological, run by University of California, Los Angeles at 1 site in United States.
Trial summary
Goal 1: The investigators will quantify lifetime stress burden and examine mechanisms linking Adverse Childhood Experiences (ACEs) and health. The investigators will quantify the early life and total lifetime stress burden of a representative sample of about 725 adults (aged 18+) across northern and southern… Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Stress, Stress, Psychological, Stress, Physiological
- What is being tested?
- Education Program, Think Well Program and Be Well Program
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 712 participants
- Where
- 1 siteUnited States
- Study dates
- 30 Jun 2023to 30 Oct 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- A participant must meet all of the following criteria to be eligible to participate in this study:
- Be able to understand and agree to comply with planned study procedures in English.
- Participants must be aged 18 or over.
- Participants must reside in the state of California.
Who cannot join
- A participant who meets any of the following criteria will be excluded from participation in this study:
- History of disease(s):
- Has a positive test result for human immunodeficiency virus (HIV) types 1 or 2 antibodies.
- Has had a heart attack or stroke within the past year.
- Has had and/or been treated for any type of cancer in the past two years.
- Medication(s):
Show all 30Show fewer
- Participants who check off any of the following medications and/or treatment listed below over the past month will be excluded in the study.
- Prednisolone (e.g., Omnipred, Pred Mild, Pred Forte, Orapred ODT, Veripred 20, Millipred DP)
- Prednisone (e.g., Prednisone Intensol, Deltasone, Rayos)
- Betamethasone (e.g., Celestone Soluspan, Sernivo, Diprolene AF, ReadySharp Betamethasone, Betaloan SUIK, Beta-1)
- Dexamethasone (e.g., Ozurdex, Maxidex, DexPak 6 Day/10 day/13 Day, LoCort, ZonaCort, ReadySharp dexamethasone, DoubleDex)
- Hydrocortisone (e.g., Hydrocort, Alphosyl, Aquacort, Cortef, Cortenema, and Solu-Cortef)
- Methylprednisolone (e.g., Depo-Medrol, Solu-Medrol, Medrol, ReadySharp Methylprednisolone, P-Care D80, and P-Care D40)
- Deflazacort (e.g., Emflaza)
- Immunomodulators
- Cyclosporine (Sandimmune, Neoral, Gengraf, Restasis MultiDose)
- Tacrolimus (Protopic, Envarsus XR, Astagraf XL, Prograf)
- Methotrexate (Rheumatrex, Trexall, Otrexup (PF), Xatmep, Rasuvo, Mexate, MTX)
- Azathioprine (Immuran, Azasan)
- Mercaptopurine (6-MP, Purinethol, Purixan)
- Other Immunomodulators not listed above
- Monoclonal antibody therapy
- Infliximab (Remicade)
- Etanercept (Enbrel, Benepali, Erelzi)
- Adalimumab (Humira)
- Secukinumab (Cosentyx)
- Tofacitinib (Xeljanz)
- Rituximab (Rituxan)
- Other Monoclonal antibody therapy not listed above
- Intravenous immunoglobulin treatment (IVIG)
Trial locations and contacts
1 site in 1 country.
United States1 site
University of California, Los Angeles
Los Angeles, California, 90024
About this study
Official title: Identifying Social, Molecular, & Immunological Processes for Mitigating Toxic Stress & Enhancing Personalized Resilience
Goal 1: The investigators will quantify lifetime stress burden and examine mechanisms linking Adverse Childhood Experiences (ACEs) and health. The investigators will quantify the early life and total lifetime stress burden of a representative sample of about 725 adults (aged 18+) across northern and southern California. In addition, the investigators will examine how prior life stress exposure and current stress levels are associated with differences in psychosocial, immune, metabolic, physiologic, and clinical outcomes for all participants at baseline.
Goal 2: The investigators will develop and test a biopsychosocial intervention using existing programs, platforms, resources, and core components from trauma and resilience research that will target five stress-related domains (i.e., cognitive response style, social relationships, eating, sleep, and physical activity) using cognitive restructuring and mindfulness, interpersonal skills training, mindful eating training, sleep training, and behavioral activation/mobility training. The investigators will then assess the efficacy and acceptability of the intervention in about 425 high stress exposure participants from Goal 1. Following their baseline assessment, about 425 participants will be randomly assigned to receive for 12 weeks (a) personalized intervention, (b) environmental education (active control) or (c) nothing (non-active control). The investigators will also assess the efficacy of the personalized intervention by comparing changes in outcomes by condition from baseline (prior to randomization) to immediately after the intervention, and then again after 12 weeks following intervention completion. The interventions will be entirely online/remote.
Read the detailed description
Aim 1: The investigators will quantify lifetime stress burden and examine mechanisms linking Adverse Childhood Experiences (ACEs) and health. The investigators will quantify the early life and total lifetime stress burden of a representative sample of about 725 adults (aged 18+) across California. In addition, the investigators will examine how prior life stress exposure and current stress levels are associated with differences in psychosocial, immune, metabolic, physiologic, and clinical outcomes for all participants at baseline.
Objective 1.1. Characterize associations between stress levels and psychosocial and clinical functioning by collecting self-report data from participants (see below) and by using any available electronic health records.
Objective 1.2. Examine cross-sectional relations between stress levels and physiological, biological, and behavioral processes using (1) immune and metabolic functioning assessed by non-invasive blood microsampling and the investigators' unique multi-omics approach, and (2) continuously monitored physiologic and behavioral functioning using smartwatches that have the ability to assess a variety of physiologic \& behavioral processes (e.g., cardiac function, sleep, activity levels).
Objective 1.3. Develop a Personal Health Dashboard for processing data with an algorithm that will generate personalized results to inform individualized health risk assessments and provide an opportunity to deliver tailored clinical feedback and biopsychosocial resiliency training by targeting five key stress-related risk factors (see Aim 2).
Aim 2: Reduce ACEs-related health disparities by developing and testing a behavioral intervention for about 425 of the higher stress participants from Aim 1. To reduce negative stress-related effects and bolster resilience, the investigators will examine the acceptability and effectiveness of a 12 week, online, precision behavioral intervention.
Objective 2.1. Develop a behavioral intervention using existing programs, platforms, resources, and core components from trauma and resilience research that will target five stress-related domains (i.e., perceived stress, social relationships, diet, sleep, and physical activity) using cognitive restructuring and mindfulness, interpersonal skills training, personalized diet training, sleep training, and behavioral activation.
Objective 2.2. Assess the efficacy of the above-described intervention in about 425 high stress exposure participants from Goal 1. Following their baseline assessment, participants will be randomly assigned to receive (a) the personalized intervention (about 55 participants per stress-related domain), (b) stress \& health psychoeducation/active control group, or (c) nonactive control group. For participants receiving the intervention, the investigators will identify each person's most dysregulated biobehavioral process using the comprehensive biopsychosocial data obtained from Goal 1, focusing on five major stress-related domains: cognitive response style, social relationships, eating, sleep, and physical activity. The investigators will pilot the use of online coach-assisted personalized interventions to target a dysregulated domain for each participant. The investigators will also assess the efficacy of the intervention by comparing changes in outcomes by condition from baseline (prior to randomization) to immediately after the intervention, and then again several months following intervention completion. The primary outcome of interest will be perceived stress (PSS-10). The secondary outcomes of the RCT include five domain specific surveys: the Five-Factor Mindfulness Scale short form (cognitive response style), Conflict Scale and UCLA Loneliness Scale (social relationship domain), Salzburg Stress Eating Scale (eating domain), Insomnia Severity Index (sleeping domain), and International Physical Activity Questionnaire short form (IPAQ, physical activity domain). Exploratory outcomes include the multiomics measures (including untargeted metabolomics, lipidomics, immune proteins, cytokines and the microbiome), physiological measures from the wearable device (i.e., heart rate variability), and continuous glucose monitoring measures.
- Being tested
- Education Program, Think Well Program, Be Well Program, Eat Well Program, Sleep Well Program
- Keywords
- Stress, Immunology, Psychosocial, Clinical, Resilience
- Medical subject headings
- Stress, Psychological, Fractures, Stress
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Education ProgramBehavioural
12-week online psychoeducation program on environmental pollution exposures, the health impacts and sources of these exposures, and practical ways to reduce these exposures. Participants in the active control group will receive this form of intervention.
Think Well ProgramBehavioural
12-week online program in which participants learn to identify negative emotion and thinking patterns and participate in live online group coaching. Participants whose thinking style domain is dysregulated will be assigned to this intervention program.
Be Well ProgramBehavioural
12-week online program in which participants learn about the importance of social relationships, connectedness, and interpersonal conflicts, and participate in live online group coaching. Participants whose social relationship/conflict domain is dysregulated will be assigned to this intervention program.
Eat Well ProgramBehavioural
12-week online program in which participants learn about mindful eating and participate in live online group coaching. Participants whose diet domain is dysregulated will be assigned to this intervention program.
Sleep Well ProgramBehavioural
12-week online program in which participants learn about the importance of good sleep and participate in live online group coaching. Participants whose sleep domain is dysregulated will be assigned to this intervention program.
Move Well ProgramBehavioural
12-week online program in which participants learn about the importance of adequate physical activity for health and participate in live online group coaching. Participants whose physical activity domain is dysregulated will be assigned to this intervention program.
| Study group | Role | What they receive |
|---|---|---|
| Baseline-Only | No intervention | Baseline-only condition will be cross-sectional, and participants will be only completing the first portion of the study. Participants in this arm will be asked to wear a research-grade smartwatch for at least one week and complete the baseline package at one time point which includes self-reported questionnaires, micro-blood collection, and optional stool collection. |
| Active Control | Active comparator | Active control condition will be longitudinal. Participants in this arm will be asked to wear a research-grade smartwatch for at least 24 weeks and complete the baseline package as well as two follow-ups over a period of 24 weeks. After completing the baseline package, participants in the active control group will receive a 12 week psychoeducation training on stress and health called the Environmental Education Program. Receives: Behavioral: Education Program |
| Nonactive Control | No intervention | Nonactive control condition will be longitudinal. Participants in this arm will be asked to wear a research-grade smartwatch for at least 24 weeks and complete the baseline package as well as two follow-ups over a period of 24 weeks. After completing the baseline package, participants in the nonactive control group will not be receiving any forms of intervention. Participants in this program called the Follow-up Program will be tracked over 12 weeks in parallel to participants receiving an intervention and another 12 weeks after. |
| CAL STAR Personalized Intervention | Experimental | CAL STAR Personalized Intervention condition will be longitudinal. Participants in this arm will be asked to wear a research-grade smartwatch for at least 24 weeks and complete the baseline package as well as two follow-ups over a period of 24 weeks. After completing the baseline package, participants will be assigned to one of the five CAL STAR Personalized Intervention training programs (Think Well, Be Well, Eat Well, Sleep Well, Move Well programs) depending on their score on a self-reported survey called Consequences of Stress Scale (CSS). Based on the CSS score, a participant will be assigned to one of the five programs to work on a domain that is dysregulated when they are stressed. When eligible for multiple, their availability to attend coaching sessions and preferences will be accounted for, or they will be randomly assigned to conditions for which they are eligible. Receives: Behavioral: Think Well Program; Behavioral: Be Well Program; Behavioral: Eat Well Program; Behavioral: Sleep Well Program; Behavioral: Move Well Program |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in PSS-10
The primary endpoint will be the change in Perceived Stress Scale (PSS-10) score between the nonactive control, active control, and the treatment groups (combined) from screening to Follow-up 1 \& 2. A meaningful clinically significant score in the PSS-10 score is a difference of 5 points. The range of the PSS-10 is 0-40, with higher scores indicating more perceived stress. As such PSS-10 change scores could range from -40 to 40. A positive PSS-10 change score indicates increased stress and is a negative outcome. A negative PSS-10 change score indicates decreased stress and is a positive outcome.
Measured: PSS-10 will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Secondary outcomes (6)
Change in CSS subscale Score
The change in participants' specific intervention risk score between screening and Follow-up 1 \& 2 from the Consequences of Stress scale (CSS) within intervention groups. Each CSS subscale has a range of 3-21, with higher scores indicating more dysfunction. As such, CSS subscale change scores could be from -18 to 18. A positive CSS subscale change score indicates increased dysfunction and is a negative outcome. A negative CSS subscale change score indicates decreased dysfunction and is a positive outcome.
Measured: Consequences of Stress scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in Five-Factor Mindfulness Scale short form (cognitive response style domain)
The change in participants' specific domain score between screening and Follow-up 1 \& 2 from the Five Factor Mindfulness Scale (FFMS) partial short form within the cognitive response style group. The FFMS-15 short form was reduced to a 6-item questionnaire to include only non-judgement and non-reactivity subscales. The scale has a range of 6-30, which higher scores indicating increased mindfulness. FFMS change scores could be from -24 to 24. A positive FFMS scale change score indicates decreased mindfulness and is a negative outcome. A negative FFMS scale change score indicated increased mindfulness and is a positive outcome.
Measured: Five-Factor Mindfulness scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in Conflict Scale and UCLA Loneliness Scale (social relationship domain)
The change in participants' specific domain score between screening and Follow-up 1 \& 2 from the Conflict Scale and UCLA Loneliness Scale short form within the social relationship group. The revised Conflict Scale has a range of 6-42, with higher scores indicating more conflict. Conflict scale change scores could be from -36 to 36. A positive Conflict scale change score indicates increased conflict and is a negative outcome. A negative Conflict scale change score indicates decreased conflict and is a positive outcome. The UCLA Loneliness Scale has a range of 3-9, which higher score indicating more loneliness. UCLA Loneliness Scale change scores could be from -6 to 6. A positive UCLA Loneliness scale change score indicates increased loneliness and is a negative outcome. A negative UCLA Loneliness scale change score indicates decreased loneliness and is a positive outcome.
Measured: Five-Factor Mindfulness scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in Salzburg Stress Eating Scale (eating domain)
The change in participants' specific domain score between screening and Follow-up 1 \& 2 from the Salzburg Stress Eating Scale (SSES) within the eating group. The scale has a range of 10-50, which higher scores indicating tendency to eat more when stressed, medium score indicating tendency to eat just as much as usual when stressed, and lower score indicating tendency to eat less when stressed. SSES change scores could be from -40 to 40. A mean score towards a medium mean score (=3) indicates tendency to eat just as much has usual when stressed and is a positive outcome. Higher or lower means indicate tendency to over and/or under eat and is a negative outcome.
Measured: Salzburg Stress Eating scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in Insomnia Severity Index (sleeping domain)
The change in participants' specific domain score between screening and Follow-up 1 \& 2 from the Insomnia Severity Index (ISI) within the sleep group. The scale has a range of 0-28, which higher scores indicating increased insomnia or sleep issues. ISI scale change scores could be from -28 to 28. A positive ISI scale change score indicates increased insomnia and is a negative outcome. A negative FFMS scale change score indicated decreased insomnia and is a positive outcome.
Measured: Insomnia Severity Index scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in International Physical Activity Questionnaire short form (physical activity domain)
The change in participants' specific domain score between screening and Follow-up 1 \& 2 from the International Physical Activity Questionnaire (IPAQ) short form within the physical activity group. The scale has two forms of output from scoring. Results can be reported in categories (low activity levels, moderate activity levels or high activity levels) or as a continuous variable (MET minutes a week). The continuous variable will be used for analysis purposes by estimating total MET minutes/week (range 0- 10080). MET minutes represent the amount of energy expended carrying out physical activity. Higher scores indicate increased level of physical activity and is a positive outcome. Lower scores indicate decreased levels of physical activity and is a negative outcome.
Measured: International Physical Activity Questionnaire scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Oct 2023
- Study start30 Jun 2023
- Primary completion30 Oct 2024
- Study completion30 Oct 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (25)Papers the sponsor has linked to this study.
- Other trials for StressStudies of the same condition, open and under way.
- More trials run by University of California, Los AngelesThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 712 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of California, Los Angeles
- Sponsor type
- University, hospital or other
- Collaborators
- Stanford University, University of California, San Francisco, California Initiative to Advance Precision Medicine
- Responsible party
- Principal investigator, George M. Slavich, PhD, University of California, Los Angeles
- Investigators
- George M Slavich, PhD, Principal investigator, University of California, Los AngelesMichael P Snyder, PhD, Principal investigator, Stanford UniversityAlicia F Lieberman, PhD, Principal investigator, University of California, San FranciscoShannon Thyne, MD, Principal investigator, Los Angeles County Department of Public HealthPatricia E Lester, MD, Principal investigator, University of California, Los AngelesAtul J Butte, MD,PhD, Principal investigator, University of California, San Francisco
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06063174
- Sponsor's protocol ID
- OPR21101
- Acronym
- CALSTAR
- Status last verified
- Sep 2024
- First submitted
- 6 Sep 2023
- Last updated
- 15 Apr 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017 Aug;2(8):e356-e366. doi: 10.1016/S2468-2667(17)30118-4. Epub 2017 Jul 31.
PubMed 29253477California Department of Public Health and Department of Social Services. Adverse Childhood Experiences Data Report: Behavioral Risk Factor Surveillance System (BRFSS), 2011-2017: An Overview of Adverse Childhood Experiences in California. (2020). doi:10.48019/PEAM8812.
Hargreaves MK, Mouton CP, Liu J, Zhou YE, Blot WJ. Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population. J Health Care Poor Underserved. 2019;30(2):749-767. doi: 10.1353/hpu.2019.0054.
PubMed 31130549Birn RM, Roeber BJ, Pollak SD. Early childhood stress exposure, reward pathways, and adult decision making. Proc Natl Acad Sci U S A. 2017 Dec 19;114(51):13549-13554. doi: 10.1073/pnas.1708791114. Epub 2017 Dec 4.
PubMed 29203671Slavich GM. Social Safety Theory: A Biologically Based Evolutionary Perspective on Life Stress, Health, and Behavior. Annu Rev Clin Psychol. 2020 May 7;16:265-295. doi: 10.1146/annurev-clinpsy-032816-045159. Epub 2020 Mar 6.
PubMed 32141764Slavich GM, Way BM, Eisenberger NI, Taylor SE. Neural sensitivity to social rejection is associated with inflammatory responses to social stress. Proc Natl Acad Sci U S A. 2010 Aug 17;107(33):14817-22. doi: 10.1073/pnas.1009164107. Epub 2010 Aug 2.
PubMed 20679216Cohodes EM, Kitt ER, Baskin-Sommers A, Gee DG. Influences of early-life stress on frontolimbic circuitry: Harnessing a dimensional approach to elucidate the effects of heterogeneity in stress exposure. Dev Psychobiol. 2021 Mar;63(2):153-172. doi: 10.1002/dev.21969. Epub 2020 Mar 29.
PubMed 32227350Gee DG, Casey BJ. The Impact of Developmental Timing for Stress and Recovery. Neurobiol Stress. 2015 Jan 1;1:184-194. doi: 10.1016/j.ynstr.2015.02.001.
PubMed 25798454Miller TR, Waehrer GM, Oh DL, Purewal Boparai S, Ohlsson Walker S, Silverio Marques S, Burke Harris N. Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences. PLoS One. 2020 Jan 28;15(1):e0228019. doi: 10.1371/journal.pone.0228019. eCollection 2020.
PubMed 31990957Waehrer GM, Miller TR, Silverio Marques SC, Oh DL, Burke Harris N. Disease burden of adverse childhood experiences across 14 states. PLoS One. 2020 Jan 28;15(1):e0226134. doi: 10.1371/journal.pone.0226134. eCollection 2020.
PubMed 31990910Bhushan D, Kotz K, McCall J, etal. Road map for Resilience: The California Surgeon General's Report on Adverse Childhood Experiences, Toxic Stress, and Health.(2020). doi:10.48019/PEAM8812
Giano Z, Wheeler DL, Hubach RD. The frequencies and disparities of adverse childhood experiences in the U.S. BMC Public Health. 2020 Sep 10;20(1):1327. doi: 10.1186/s12889-020-09411-z.
PubMed 32907569Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Mackenbach JP, van Lenthe FJ, Mokdad AH, Murray CJL. Inequalities in Life Expectancy Among US Counties, 1980 to 2014: Temporal Trends and Key Drivers. JAMA Intern Med. 2017 Jul 1;177(7):1003-1011. doi: 10.1001/jamainternmed.2017.0918.
PubMed 28492829Stork BR, Akselberg NJ, Qin Y, Miller DC. Adverse Childhood Experiences (ACEs) and Community Physicians: What We've Learned. Perm J. 2020;24:19.099. doi: 10.7812/TPP/19.099. Epub 2020 Jan 24.
PubMed 32069204Valderhaug TG, Slavich GM. Assessing Life Stress: A Critical Priority in Obesity Research and Treatment. Obesity (Silver Spring). 2020 Sep;28(9):1571-1573. doi: 10.1002/oby.22911. Epub 2020 Jul 29.
PubMed 32729167
Study at a glance
From the registry record, last updated by the sponsor on 15 Apr 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Identifying Social, Molecular, & Immunological Processes for Mitigating Toxic Stress & Enhancing Personalized Resilience
- ClinicalTrials.gov ID
- NCT06063174
- Acronym / sponsor ID
- CALSTAR / OPR21101
- Keywords
- Stress, Immunology, Psychosocial, Clinical, Resilience
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 712 participants (actual)
- Lead sponsor
- University of California, Los AngelesUniversity, hospital or other
- Collaborators
- Stanford University, University of California, San Francisco, California Initiative to Advance Precision Medicine
- Study start
- 30 Jun 2023 (actual)
- Primary completion
- 30 Oct 2024 (actual)
- Study completion
- 30 Oct 2024 (actual)
- First posted
- 2 Oct 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Goal 1: The investigators will quantify lifetime stress burden and examine mechanisms linking Adverse Childhood Experiences (ACEs) and health. The investigators will quantify the early life and total lifetime stress burden of a representative sample of about 725 adults (aged 18+) across northern and southern California. In addition, the investigators will examine how prior life stress exposure and current stress levels are associated with differences in psychosocial, immune, metabolic, physiologic, and clinical outcomes for all participants at baseline.
Goal 2: The investigators will develop and test a biopsychosocial intervention using existing programs, platforms, resources, and core components from trauma and resilience research that will target five stress-related domains (i.e., cognitive response style, social relationships, eating, sleep, and physical activity) using cognitive restructuring and mindfulness, interpersonal skills training, mindful eating training, sleep training, and behavioral activation/mobility training. The investigators will then assess the efficacy and acceptability of the intervention in about 425 high stress exposure participants from Goal 1. Following their baseline assessment, about 425 participants will be randomly assigned to receive for 12 weeks (a) personalized intervention, (b) environmental education (active control) or (c) nothing (non-active control). The investigators will also assess the efficacy of the personalized intervention by comparing changes in outcomes by condition from baseline (prior to randomization) to immediately after the intervention, and then again after 12 weeks following intervention completion. The interventions will be entirely online/remote.
Detailed description
Aim 1: The investigators will quantify lifetime stress burden and examine mechanisms linking Adverse Childhood Experiences (ACEs) and health. The investigators will quantify the early life and total lifetime stress burden of a representative sample of about 725 adults (aged 18+) across California. In addition, the investigators will examine how prior life stress exposure and current stress levels are associated with differences in psychosocial, immune, metabolic, physiologic, and clinical outcomes for all participants at baseline.
Objective 1.1. Characterize associations between stress levels and psychosocial and clinical functioning by collecting self-report data from participants (see below) and by using any available electronic health records.
Objective 1.2. Examine cross-sectional relations between stress levels and physiological, biological, and behavioral processes using (1) immune and metabolic functioning assessed by non-invasive blood microsampling and the investigators' unique multi-omics approach, and (2) continuously monitored physiologic and behavioral functioning using smartwatches that have the ability to assess a variety of physiologic \& behavioral processes (e.g., cardiac function, sleep, activity levels).
Objective 1.3. Develop a Personal Health Dashboard for processing data with an algorithm that will generate personalized results to inform individualized health risk assessments and provide an opportunity to deliver tailored clinical feedback and biopsychosocial resiliency training by targeting five key stress-related risk factors (see Aim 2).
Aim 2: Reduce ACEs-related health disparities by developing and testing a behavioral intervention for about 425 of the higher stress participants from Aim 1. To reduce negative stress-related effects and bolster resilience, the investigators will examine the acceptability and effectiveness of a 12 week, online, precision behavioral intervention.
Objective 2.1. Develop a behavioral intervention using existing programs, platforms, resources, and core components from trauma and resilience research that will target five stress-related domains (i.e., perceived stress, social relationships, diet, sleep, and physical activity) using cognitive restructuring and mindfulness, interpersonal skills training, personalized diet training, sleep training, and behavioral activation.
Objective 2.2. Assess the efficacy of the above-described intervention in about 425 high stress exposure participants from Goal 1. Following their baseline assessment, participants will be randomly assigned to receive (a) the personalized intervention (about 55 participants per stress-related domain), (b) stress \& health psychoeducation/active control group, or (c) nonactive control group. For participants receiving the intervention, the investigators will identify each person's most dysregulated biobehavioral process using the comprehensive biopsychosocial data obtained from Goal 1, focusing on five major stress-related domains: cognitive response style, social relationships, eating, sleep, and physical activity. The investigators will pilot the use of online coach-assisted personalized interventions to target a dysregulated domain for each participant. The investigators will also assess the efficacy of the intervention by comparing changes in outcomes by condition from baseline (prior to randomization) to immediately after the intervention, and then again several months following intervention completion. The primary outcome of interest will be perceived stress (PSS-10). The secondary outcomes of the RCT include five domain specific surveys: the Five-Factor Mindfulness Scale short form (cognitive response style), Conflict Scale and UCLA Loneliness Scale (social relationship domain), Salzburg Stress Eating Scale (eating domain), Insomnia Severity Index (sleeping domain), and International Physical Activity Questionnaire short form (IPAQ, physical activity domain). Exploratory outcomes include the multiomics measures (including untargeted metabolomics, lipidomics, immune proteins, cytokines and the microbiome), physiological measures from the wearable device (i.e., heart rate variability), and continuous glucose monitoring measures.
Study design
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Baseline-Only | No intervention | –Baseline-only condition will be cross-sectional, and participants will be only completing the first portion of the study. Participants in this arm will be asked to wear a research-grade smartwatch for at least one week and complete the baseline package at one time point which includes self-reported questionnaires, micro-blood collection, and optional stool collection. |
| Active Control | Active comparator | Behavioral: Education ProgramActive control condition will be longitudinal. Participants in this arm will be asked to wear a research-grade smartwatch for at least 24 weeks and complete the baseline package as well as two follow-ups over a period of 24 weeks. After completing the baseline package, participants in the active control group will receive a 12 week psychoeducation training on stress and health called the Environmental Education Program. |
| Nonactive Control | No intervention | –Nonactive control condition will be longitudinal. Participants in this arm will be asked to wear a research-grade smartwatch for at least 24 weeks and complete the baseline package as well as two follow-ups over a period of 24 weeks. After completing the baseline package, participants in the nonactive control group will not be receiving any forms of intervention. Participants in this program called the Follow-up Program will be tracked over 12 weeks in parallel to participants receiving an intervention and another 12 weeks after. |
| CAL STAR Personalized Intervention | Experimental | Behavioral: Think Well Program, Behavioral: Be Well Program, Behavioral: Eat Well Program, Behavioral: Sleep Well Program, Behavioral: Move Well ProgramCAL STAR Personalized Intervention condition will be longitudinal. Participants in this arm will be asked to wear a research-grade smartwatch for at least 24 weeks and complete the baseline package as well as two follow-ups over a period of 24 weeks. After completing the baseline package, participants will be assigned to one of the five CAL STAR Personalized Intervention training programs (Think Well, Be Well, Eat Well, Sleep Well, Move Well programs) depending on their score on a self-reported survey called Consequences of Stress Scale (CSS). Based on the CSS score, a participant will be assigned to one of the five programs to work on a domain that is dysregulated when they are stressed. When eligible for multiple, their availability to attend coaching sessions and preferences will be accounted for, or they will be randomly assigned to conditions for which they are eligible. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- A participant must meet all of the following criteria to be eligible to participate in this study:
Key exclusion criteria (30 listed)
- A participant who meets any of the following criteria will be excluded from participation in this study:
- Has a positive test result for human immunodeficiency virus (HIV) types 1 or 2 antibodies.
- Has had a heart attack or stroke within the past year.
- Has had and/or been treated for any type of cancer in the past two years.
- Participants who check off any of the following medications and/or treatment listed below over the past month will be excluded in the study.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Education Program12-week online psychoeducation program on environmental pollution exposures, the health impacts and sources of these exposures, and practical ways to reduce these exposures. Participants in the active control group will receive this form of intervention. | Behavioural | Active Control |
| Think Well Program12-week online program in which participants learn to identify negative emotion and thinking patterns and participate in live online group coaching. Participants whose thinking style domain is dysregulated will be assigned to this intervention program. | Behavioural | CAL STAR Personalized Intervention |
| Be Well Program12-week online program in which participants learn about the importance of social relationships, connectedness, and interpersonal conflicts, and participate in live online group coaching. Participants whose social relationship/conflict domain is dysregulated will be assigned to this intervention program. | Behavioural | CAL STAR Personalized Intervention |
| Eat Well Program12-week online program in which participants learn about mindful eating and participate in live online group coaching. Participants whose diet domain is dysregulated will be assigned to this intervention program. | Behavioural | CAL STAR Personalized Intervention |
| Sleep Well Program12-week online program in which participants learn about the importance of good sleep and participate in live online group coaching. Participants whose sleep domain is dysregulated will be assigned to this intervention program. | Behavioural | CAL STAR Personalized Intervention |
| Move Well Program12-week online program in which participants learn about the importance of adequate physical activity for health and participate in live online group coaching. Participants whose physical activity domain is dysregulated will be assigned to this intervention program. | Behavioural | CAL STAR Personalized Intervention |
Primary outcome
Change in PSS-10
Time frame: PSS-10 will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
The primary endpoint will be the change in Perceived Stress Scale (PSS-10) score between the nonactive control, active control, and the treatment groups (combined) from screening to Follow-up 1 \& 2. A meaningful clinically significant score in the PSS-10 score is a difference of 5 points. The range of the PSS-10 is 0-40, with higher scores indicating more perceived stress. As such PSS-10 change scores could range from -40 to 40. A positive PSS-10 change score indicates increased stress and is a negative outcome. A negative PSS-10 change score indicates decreased stress and is a positive outcome.
6 secondary outcomes
Change in CSS subscale Score
Time frame: Consequences of Stress scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in Five-Factor Mindfulness Scale short form (cognitive response style domain)
Time frame: Five-Factor Mindfulness scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in Conflict Scale and UCLA Loneliness Scale (social relationship domain)
Time frame: Five-Factor Mindfulness scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in Salzburg Stress Eating Scale (eating domain)
Time frame: Salzburg Stress Eating scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in Insomnia Severity Index (sleeping domain)
Time frame: Insomnia Severity Index scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Change in International Physical Activity Questionnaire short form (physical activity domain)
Time frame: International Physical Activity Questionnaire scale will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Apr 2025.
- Background: PubMed 29253477Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017 Aug;2(8):e356-e366. doi: 10.1016/S2468-2667(17)30118-4. Epub 2017 Jul 31.
- BackgroundCalifornia Department of Public Health and Department of Social Services. Adverse Childhood Experiences Data Report: Behavioral Risk Factor Surveillance System (BRFSS), 2011-2017: An Overview of Adverse Childhood Experiences in California. (2020). doi:10.48019/PEAM8812.
- Background: PubMed 31130549Hargreaves MK, Mouton CP, Liu J, Zhou YE, Blot WJ. Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population. J Health Care Poor Underserved. 2019;30(2):749-767. doi: 10.1353/hpu.2019.0054.
- Background: PubMed 29203671Birn RM, Roeber BJ, Pollak SD. Early childhood stress exposure, reward pathways, and adult decision making. Proc Natl Acad Sci U S A. 2017 Dec 19;114(51):13549-13554. doi: 10.1073/pnas.1708791114. Epub 2017 Dec 4.
- Background: PubMed 32141764Slavich GM. Social Safety Theory: A Biologically Based Evolutionary Perspective on Life Stress, Health, and Behavior. Annu Rev Clin Psychol. 2020 May 7;16:265-295. doi: 10.1146/annurev-clinpsy-032816-045159. Epub 2020 Mar 6.
- Background: PubMed 20679216Slavich GM, Way BM, Eisenberger NI, Taylor SE. Neural sensitivity to social rejection is associated with inflammatory responses to social stress. Proc Natl Acad Sci U S A. 2010 Aug 17;107(33):14817-22. doi: 10.1073/pnas.1009164107. Epub 2010 Aug 2.
- Background: PubMed 32227350Cohodes EM, Kitt ER, Baskin-Sommers A, Gee DG. Influences of early-life stress on frontolimbic circuitry: Harnessing a dimensional approach to elucidate the effects of heterogeneity in stress exposure. Dev Psychobiol. 2021 Mar;63(2):153-172. doi: 10.1002/dev.21969. Epub 2020 Mar 29.
- Background: PubMed 25798454Gee DG, Casey BJ. The Impact of Developmental Timing for Stress and Recovery. Neurobiol Stress. 2015 Jan 1;1:184-194. doi: 10.1016/j.ynstr.2015.02.001.
- Background: PubMed 31990957Miller TR, Waehrer GM, Oh DL, Purewal Boparai S, Ohlsson Walker S, Silverio Marques S, Burke Harris N. Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences. PLoS One. 2020 Jan 28;15(1):e0228019. doi: 10.1371/journal.pone.0228019. eCollection 2020.
- Background: PubMed 31990910Waehrer GM, Miller TR, Silverio Marques SC, Oh DL, Burke Harris N. Disease burden of adverse childhood experiences across 14 states. PLoS One. 2020 Jan 28;15(1):e0226134. doi: 10.1371/journal.pone.0226134. eCollection 2020.
- BackgroundBhushan D, Kotz K, McCall J, etal. Road map for Resilience: The California Surgeon General's Report on Adverse Childhood Experiences, Toxic Stress, and Health.(2020). doi:10.48019/PEAM8812
- Background: PubMed 32907569Giano Z, Wheeler DL, Hubach RD. The frequencies and disparities of adverse childhood experiences in the U.S. BMC Public Health. 2020 Sep 10;20(1):1327. doi: 10.1186/s12889-020-09411-z.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
George M Slavich, PhD principal investigator
University of California, Los Angeles
Michael P Snyder, PhD principal investigator
Stanford University
Alicia F Lieberman, PhD principal investigator
University of California, San Francisco
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Education Program, Think Well Program and Be Well Program in people with Stress and Stress, Psychological, run by University of California, Los Angeles at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 30 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 15 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in PSS-10 (time frame: PSS-10 will be assessed at all three time points during the baseline period (first 1-3 weeks of the study), follow-up1 (after 12-week intervention), and follow-up2 (at 24 week mark from baseline).). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06063174, which also lists 25 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Apr 2025.