Aggression, Anger
Conditions
Keywords
Yoga, Health Education, Aggression, Anger, Incarceration
Brief summary
The investigators will conduct a pilot randomized clinical trial (n = 40) of hatha yoga vs. a health education group (attention control) for prisoners high in self-reported anger dysregulation. The investigators will assess feasibility and acceptability of the yoga program, the health education control group, and research procedures.
Detailed description
In the criminal justice (CJ) system in the US, there are high rates of mental health and substance use disorders. Although prisons must provide treatment, the CJ system is resource-poor and the presenting problems of prisoners are diverse. To maximize efficiency in the CJ context, recent efforts focus adjunctive interventions on symptoms that are most detrimental to prisoners, and that are shared across diverse conditions. Of particular interest has been anger dysregulation, as this is prevalent in CJ-involved populations, contributing not only to distress and exacerbation of other mental health problems, but also to risk of aggression. Overt aggression further increases risk for prison behavioral infractions or placement in restraints or seclusion, and may delay parole or release decisions. There are many limitations to existing approaches to anger management in prison. The investigators propose that hatha yoga could serve as a useful adjunctive treatment for anger within prisons. In addition to preliminary research showing that yoga programs may improve anger regulation, research has also demonstrated benefits of yoga for related symptoms of depression, anxiety, and trauma-related emotion reactivity and arousal. Yoga may be delivered in a relatively low-cost fashion. Finally, prisoners may view yoga as less stigmatizing than more traditional anger management interventions, particularly given its focus on physical body awareness/movement and on overall wellness. Despite a recent proliferation of yoga programs for various problems in prisons, empirical research on this topic is minimal, with a small number of studies limited by significant methodological concerns. The investigators propose to conduct systematic treatment development research that would prepare us to study whether yoga (vs. a health education control group) is an effective adjunctive treatment for prisoners with anger dysregulation. The investigators will conduct a pilot randomized clinical trial (n = 40) of hatha yoga vs. a health education group (attention control) for prisoners high in self-reported anger dysregulation. Participants will be enrolled in the active intervention for 10 weeks, and then followed for 8 weeks. The investigators will assess feasibility and acceptability of the yoga program, the health education control group, and research procedures. To assess safety, they will track all adverse events in a structured fashion. The investigators will iteratively revise manuals and materials, making final revisions at the end of the pilot RCT. If successful, this project will provide us with materials, experience, and pilot data needed for the next stage of this line of research, namely, a fully powered RCT.
Interventions
BEHAVIORALHatha Yoga
Weekly hatha yoga classes lasting 10 weeks.
BEHAVIORALHealth Education
Weekly health education classes lasting 10 weeks.
Sponsors
National Center for Complementary and Integrative Health (NCCIH)
Butler Hospital
The Miriam Hospital
Brown University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Masking description
One of the study MPIs and all but one of the Co-Investigators will be blind to group assignment.
Intervention model description
Participants will be randomly assigned to either a 10 week hatha yoga class or health education class.
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-70 * Clinically significant anger dysregulation, as evidenced by a score ≥ 86 on the Novaco Anger Scale (NAS) * Prisoner or jail detainee, with anticipated duration of remaining time incarcerated of 90 days or more, allowing for participation in the 10 week intervention * Ability and willingness to provide informed consent * Willingness to be audio recorded in the intervention condition sessions (e.g., yoga or health education groups).
Exclusion criteria
* Presence of current manic or psychotic symptoms, or suicide risk (warranting referral to prison mental health clinical staff) * Any endorsed item on the Physical Activity Readiness Questionnaire (PAR-Q) except for item 6 (i.e., participants can be included even if they endorse item 6) * Current weekly yoga practice or current participation in mindfulness- based programming * Pregnancy * Inability to understand English sufficiently well to understand the consent form or assessment instruments when read aloud.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Program Satisfaction | Assessed at the end of the program (hatha yoga or health education) at week 10 | Program Satisfaction as measured by the Client Satisfaction Questionnaire (CSQ-8) total score. The CSQ-8 is an 8-item measure with each item measured on a 1-4 scale. Items are summed, with a total score range from 8-32. Higher scores indicate greater client satisfaction. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Program Credibility | Assessed at beginning of the program at week 1 | Credibility as assessed by Credibility Expectancy Questionnaire (CEQ), credibility subscale. The credibility subscale of the CEQ consists of 3 items from the 6 item CEQ. The 3 items are scored on a range of 0-1, and the mean of these is used in analysis. Higher scores indicate greater intervention credibility. |
| Program Expectancy | Assessed at beginning of the program at week 1 | Expectancy assessed with the Credibility Expectancy Questionnaire (CEQ), expectancy subscale. The expectancy subscale is a 3 item subscale of the 6 item CEQ. The 3 items are each scored on a range of 0-1, and the mean of of this is used in analysis. Higher scores indicate greater expectations that the intervention will be beneficial. |
| Class Attendance | Assessed at each weekly class for 10 weeks | Number of participants who met class attendance target (6/10 classes total) as assessed through weekly attendance ratings. |
| Novaco Anger Scale | Change from baseline to the 10 week follow-up | Anger severity was assessed using the Novaco Anger Scale (NAS) from the Novaco Anger Scale and Provocation Inventory (NAS-PI). The NAS is a 48 item measure with each item rated from 1-3. Items are summed, with scores that range from 48-144. Higher scores are indicative of greater experiences of anger. For this study, we report average change in scores from the baseline to the 10 week-follow-up, upon completion of the study intervention. Hence, a positive (vs. negative) change score reflects a reduction in anger from baseline to 10 week follow-up. Higher change scores reflect larger reductions in anger severity. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Hatha Yoga 10 weeks of hatha yoga
Yoga: Hatha yoga for incarcerated adults | 20 |
| Health Education 10 weeks of health education
Health Education: Health education classes for incarcerated adults | 20 |
| Total | 40 |
Baseline characteristics
| Characteristic | Total | Hatha Yoga | Health Education |
|---|---|---|---|
| Age, Continuous | 32.10 years STANDARD_DEVIATION 7.8 | 30.85 years STANDARD_DEVIATION 6.52 | 33.35 years STANDARD_DEVIATION 8.88 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 11 Participants | 6 Participants | 5 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 29 Participants | 14 Participants | 15 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 10 Participants | 6 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 3 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) White | 22 Participants | 10 Participants | 12 Participants |
| Region of Enrollment United States | 40 participants | 20 participants | 20 participants |
| Sex: Female, Male Female | 20 Participants | 10 Participants | 10 Participants |
| Sex: Female, Male Male | 20 Participants | 10 Participants | 10 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 20 | 0 / 20 |
| other Total, other adverse events | 1 / 20 | 0 / 20 |
| serious Total, serious adverse events | 0 / 20 | 0 / 20 |
Outcome results
Primary
Program Satisfaction
Program Satisfaction as measured by the Client Satisfaction Questionnaire (CSQ-8) total score. The CSQ-8 is an 8-item measure with each item measured on a 1-4 scale. Items are summed, with a total score range from 8-32. Higher scores indicate greater client satisfaction.
Time frame: Assessed at the end of the program (hatha yoga or health education) at week 10
Population: Results for this outcome are reported for the 34 participants of 40 randomized who completed this measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Hatha Yoga | Program Satisfaction | 29.76 score on a scale | Standard Deviation 3.09 |
| Health Education | Program Satisfaction | 26.69 score on a scale | Standard Deviation 4.01 |
Secondary
Class Attendance
Number of participants who met class attendance target (6/10 classes total) as assessed through weekly attendance ratings.
Time frame: Assessed at each weekly class for 10 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Hatha Yoga | Class Attendance | 10 Participants |
| Health Education | Class Attendance | 12 Participants |
Secondary
Novaco Anger Scale
Anger severity was assessed using the Novaco Anger Scale (NAS) from the Novaco Anger Scale and Provocation Inventory (NAS-PI). The NAS is a 48 item measure with each item rated from 1-3. Items are summed, with scores that range from 48-144. Higher scores are indicative of greater experiences of anger. For this study, we report average change in scores from the baseline to the 10 week-follow-up, upon completion of the study intervention. Hence, a positive (vs. negative) change score reflects a reduction in anger from baseline to 10 week follow-up. Higher change scores reflect larger reductions in anger severity.
Time frame: Change from baseline to the 10 week follow-up
Population: Of the 40 participants randomized, 31 (n=15 in Hatha Yoga; n=16 in Health Education) completed the NAS at the follow-up assessment time point.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Hatha Yoga | Novaco Anger Scale | 11.87 score on a scale | Standard Deviation 14.32 |
| Health Education | Novaco Anger Scale | 5.94 score on a scale | Standard Deviation 9.84 |
Secondary
Program Credibility
Credibility as assessed by Credibility Expectancy Questionnaire (CEQ), credibility subscale. The credibility subscale of the CEQ consists of 3 items from the 6 item CEQ. The 3 items are scored on a range of 0-1, and the mean of these is used in analysis. Higher scores indicate greater intervention credibility.
Time frame: Assessed at beginning of the program at week 1
Population: Results for this outcome are reported for the 37 participants of 40 randomized who completed this measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Hatha Yoga | Program Credibility | 0.86 score on a scale | Standard Deviation 0.13 |
| Health Education | Program Credibility | 0.81 score on a scale | Standard Deviation 0.13 |
Secondary
Program Expectancy
Expectancy assessed with the Credibility Expectancy Questionnaire (CEQ), expectancy subscale. The expectancy subscale is a 3 item subscale of the 6 item CEQ. The 3 items are each scored on a range of 0-1, and the mean of of this is used in analysis. Higher scores indicate greater expectations that the intervention will be beneficial.
Time frame: Assessed at beginning of the program at week 1
Population: Results for this outcome are reported for the 37 participants of 40 randomized who completed this measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Hatha Yoga | Program Expectancy | 0.76 score on a scale | Standard Deviation 0.18 |
| Health Education | Program Expectancy | 0.67 score on a scale | Standard Deviation 0.21 |