Electrical Vestibular Nerve Stimulation (VeNS) as a Treatment for Anxiety

A Randomized, Double Blind Sham Controlled Clinical Trial to Evaluate The Efficacy of Vestibular Nerve Stimulation (VeNS), Compared to a Sham Control For Treatment Of Anxiety.

Anxiety is known to be one of the most common health concerns in in the general population, and the most common mental health issue, and has been associated with several health consequences. Medications are known to be effective, and currently serve as the primary treatment for anxiety but comes with a risk of adverse effects. Cognitive Behavioral Therapy (CBT-1) has also been shown to be effective and safer in the treatment of anxiety but presents its own limitations such as the time, cost, and training required. The relationship between vestibular stimulation and anxiety continues to be explored, however its usefulness in the treatment of anxiety is still unknown. Vestibular stimulation itself has been shown to be safe across multiple populations. If vestibular stimulation is shown to be effective in the treatment of anxiety, it could serve as a safer alternative to medications. It could also require less cost, time, and training than CBT-1, providing a treatment option that is not only safe and effective, but broadly available to the general population. It also could present an alternative intervention for patients who are non-responsive or refuse medication. Consequently this trial seeks to evaluate the efficacy of non-invasive electrical vestibular nerve stimulation as a method of improving sleep quality and quantity, as compared to a sham control, in patients newly diagnosed with anxiety.

The active device utilizes a technology termed vestibular nerve stimulation (VeNS). The device will be placed on the head in a manner analogous to headphones and will deliver a small electrical current to the skin behind the ears, over the mastoid processes. Participants will be advised to use the device at home for 1 hour per day.

The sham device looks identical to the active device and interacts with the app in a similar manner to the active device. It will apply some stimulation to a user for a limited period of time (30 seconds), before tapering down to zero over a further 20 seconds, thus creating the impression of an active device. The device will be placed on the head in a manner analogous to headphones with hydrogel electrodes placed over the mastoid processes. Participants will be advised to use the device at home for 1 hour per day.

The VeNS device utilizes a technology called galvanic vestibular stimulation (GVS) (sometimes termed vestibular nerve stimulation (VeNS)). The device will be placed on the head in a manner analogous to headphones and will deliver a small electrical current to the skin behind the ears, over the mastoid processes. Participants will be advised to use the device at home for 1 hour per day.

To evaluate the effect of the VeNS device, relative to control group on participants with anxiety (range 0-21) with higher score indicating more severe anxiety.

To evaluate the safety of the VeSTAL device relative to control group, in terms of the occurrence of adverse events.

To evaluate the effect of the VeNS device, relative to control group, on quality of life. SF-36 is a 36-item short form survey (range 0-100) with higher scores indicating a better quality of life.

To evaluate the effect of the VeNS device, relative to control group on participants with insomnia. ISI is a self-report rating scale assessing the severity of insomnia symptoms (range 0-28) with higher scores indicating a more severe insomnia.

Inclusion Criteria Signed informed consent Male or female, age ≥ 18 years and ≤ 80 years at the time of signing informed consent. Report clinically significant symptoms of anxiety, defined as a score of 10 or greater on the Generalized Anxiety Disorder Scale, 7th edition (GAD-7) Ability and willingness to complete all study visits and procedures Agreement to engage with using the device on a daily basis Agreement to engage with trial mentors Agreement not to use prescription, or over the counter, anxiety medications for the duration of the trial Access to Wi-Fi Access to Apple smart phone (If not an Apple iPod will be supplied) Exclusion Criteria History of skin breakdown, eczema or other dermatological condition (e.g. psoriasis) affecting the skin behind the ears. Previous diagnosis of HIV infection or AIDS (HIV is known to cause a vestibular neuropathy which would prevent VeNS from working) Use of beta-blockers within 1 month of starting the study Use of antidepressants or unstable dose within 3 months of starting study Medication for anxiety (unless regime stable for last 3 months). A history of stroke or severe head injury (as defined by a head injury that required a craniotomy or endotracheal intubation). (In case this damaged the neurological pathways involved in vestibular stimulation). Presence of permanently implanted battery powered medical device or stimulator (e.g., pacemaker, implanted defibrillator, deep brain stimulator, vagal nerve stimulator etc.). Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using an adequate contraceptive method (adequate contraceptive measure as required by local regulation or practice) History of epilepsy History of active migraines with aura History of head injury requiring intensive care or neurosurgery History of cognitive impairment History of of bipolar, psychotic or substance use disorders Regular use (more than twice a month) of antihistamine medication within the last 6 months. History or presence of malignancy within the last year (except basal and squamous cell skin cancer and in-situ carcinomas) A diagnosis of myelofibrosis or a myelodysplastic syndrome. Previous use of Modius device Participation in other clinical trials sponsored by Neurovalens Participation in any other anxiety studies Have a member of the same household who is currently participating in this study. Not fluent in English language History of vestibular dysfunction or other inner ear disease as indicated by the following screening questions: Do you have a history of any of the following? Have you had hearing trouble? Do you need hearing aids? Have you had Ear Surgery resulting in hearing or balance loss? Do you have Ear Pain? Do you have tinnitus? (A ringing or buzzing in one or both ears) Do you have dizziness? Do you have trouble with balance?

Data will be transferred in an encrypted PDF format. Trial staff will be given direction on how to share the trial data and given access to one specific section of a controlled cloud service which is controlled via role based access. Once they have authenticated with the service and the service verifies that they have the correct role to access the system they will be directed to a single webpage within the application where they will be able to upload the encrypted PDF. This PDF is generated on the fly and is therefore not stored in another location that could become compromised. Generating the PDF on the fly means that the source data is extracted from the database, processed and delivered in the context of a single request. These data will be transferred for each subject when they complete participation in the study.