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Heart rate variability\u2010biofeedback (HRV\u2010BF) has been shown to decrease symptoms of stress, anxiety, depression, and PTSD. However, HRV\u2010BF has not been tested with the most vulnerable of populations, homeless adults. The purpose of this randomized controlled trial was to compare the effectiveness of an HRV\u2010BF intervention versus a Health Promotion (HP) active control intervention focused on improving mental health symptoms among homeless adults. Guided by a community advisory board, homeless adults residing in Skid Row, Los Angeles (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a040) were randomized to either the HRV\u2010BF or an active HP control group and received eight weekly, 30\u2010min sessions over two months, delivered by a nurse\u2010led community health worker team. Dependent variables of HRV, mental health, anxiety, depression, and PTSD were measured at baseline, the 8\u2010week session, and\/or 2\u2010month follow\u2010up. All intervention sessions were completed by 90% (36\/40) of participants. Both the HRV\u2010BF and HP interventions showed significant increases in HRV from baseline to 2\u2010month follow\u2010up, with no significant difference between the intervention groups. The HRV\u2010BF programme revealed a somewhat greater, although non\u2010significant, improvement in anxiety, depression, and PTSD symptoms than the HP programme. The usefulness of both interventions, focused on emotional and physical health, warrants future studies to examine the value of a combined HRV\u2010BF and HP intervention.\n                  <\/jats:p>","DOI":"10.1002\/smi.3366","type":"journal-article","created":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T06:23:46Z","timestamp":1703571826000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pilot randomized controlled trial of biofeedback on reducing psychological and physiological stress among persons experiencing homelessness"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4979-6620","authenticated-orcid":false,"given":"Adeline M.","family":"Nyamathi","sequence":"first","affiliation":[{"name":"Sue &amp; Bill Gross School of Nursing University of California  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7018-7454","authenticated-orcid":false,"given":"Benissa E.","family":"Salem","sequence":"additional","affiliation":[{"name":"School of Nursing University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9772-0116","authenticated-orcid":false,"given":"Lillian","family":"Gelberg","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA University of California Los Angeles Fielding School of Public Health  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0435-9307","authenticated-orcid":false,"given":"Dana Rose","family":"Garfin","sequence":"additional","affiliation":[{"name":"Community Health Sciences\/Fielding School of Public Health  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6199-4350","authenticated-orcid":false,"given":"Kate","family":"Wolitsky\u2010Taylor","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9982-4373","authenticated-orcid":false,"given":"Sanghyuk S.","family":"Shin","sequence":"additional","affiliation":[{"name":"Sue &amp; 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