2/2 MINDFULNESS-BASED STRESS REDUCTION AND COGNITIVE FUNCTION IN STRESS AND AGING

2/2 基于正念的减压以及压力和衰老中的认知功能

• 批准号: 8332292
• 负责人: Julie L Wetherell
• 金额: $ 26.32万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8332292
• 关键词: Address; Adherence; Adverse effects; Adverse event; Aging; Anxiety; Anxiety Disorders; Awareness; Basic Science; Biological; Chronic; Clinical; Clinical Trials; Cognition; Collaborations; Competence; Complementary and alternative medicine; Data; Depressed mood; Disease; Elderly; Functional disorder; Future; Guidelines; Health Care Costs; Health Priorities; Health education; Hydrocortisone; Hyperactive behavior; Impaired cognition; Impairment; Individual; Intervention; Investigation; Lead; Link; Major Depressive Disorder; Measurement; Mediator of activation protein; Meditation; Memory; Memory impairment; Mental Depression; Mental disorders; Methods; Moods; Movement; National Center for Complementary and Alternative Medicine; National Institute of Mental Health; Neuraxis; Neurocognition; Neurocognitive; Neurosecretory Systems; Outcome; Output; Phase; Pilot Projects; Procedures; Process; Production; Protocols documentation; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Research; Safety; Salivary; Severities; Site; Stress; Symptoms; Testing; Training; Translational Research; Validity and Reliability; base; biological adaptation to stress; cognitive function; compliance behavior; data management; depressive symptoms; efficacy testing; executive function; experience; hypothalamic-pituitary-adrenal axis; improved; inhibitor/antagonist; innovation; mindfulness; mindfulness-based stress reduction; minimal risk; novel; open label; psychologic; therapy development; treatment effect; treatment response; treatment strategy; young adult

DESCRIPTION (provided by applicant): This application responds to the collaborative R34 mechanism co-sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Mental Health (NIMH). We will evaluate the feasibility of adapting and testing Mindfulness-Based Stress Reduction (MBSR), a promising CAM treatment, for improving clinical outcomes and neurocognitive function in older adults with anxiety disorders or major depressive disorder (MDD) along with cognitive impairment. This project is important because these disorders are very common and cause cognitive impairment in older adults; together, these clinical and neurocognitive impairments are highly disabling and inadequately helped by existing treatments. Our treatment development proposal is based on well-known links in aging between a hyperactive hypothalamic-pituitary-adrenal (HPA) axis stress response and cognitive impairment. We have demonstrated that HPA axis hyperactivity is dependent on worry severity and is reversible with treatment, improving memory as well as clinical symptoms. These findings suggest that novel treatments that inhibit HPA axis hyperactivity in late-life mental disorders will remediate cognitive impairment. We have also shown that mindfulness-based interventions are acceptable, feasible, and reduce anxiety and depression in older adults. MBSR counteracts anxiety and depression by increasing mindfulness and decreasing worry and rumination; it also inhibits HPA axis hyperactivity, generating the hypothesis that MBSR can improve clinical symptoms and cognitive impairment in older adults with anxiety disorders and MDD via increased mindfulness, resulting in reduced worry/rumination and reducing the HPA axis stress response. We therefore propose to adapt and test MBSR for older adults with depression or anxiety and mood-related cognitive impairment. Phase 1 will pilot an MBSR protocol for depressed or anxious older adults with memory impairment or executive dysfunction, modify the intervention as needed, develop adherence and competency measurement, and test a control condition. Phase 2 (pilot RCT) will randomize 100 older adults to the MBSR protocol or a control condition and will examine feasibility. Anxiety and depressive symptoms and memory and executive function are outcomes; changes in mindfulness, worry/rumination, and cortisol are mediators. MBSR is a promising, novel treatment strategy for late-life anxiety disorders and MDD. We propose to develop the treatment while exploring putative psychological and biological mechanisms (mindfulness and neuroendocrine changes) underlying the treatment effect, giving this study clinical and scientific significance.

描述（由申请人提供）：该申请响应由国家补充和替代医学中心（NCCAM）和国家心理健康研究所（NIMH）共同赞助的合作R34机制。我们将评估适应和测试基于正念的压力减轻（MBSR）的可行性，这是一种有希望的CAM治疗，用于改善焦虑症或严重抑郁症（MDD）老年人的临床结局和神经认知功能以及认知障碍。该项目很重要，因为这些疾病非常普遍，并且会导致老年人的认知障碍。总之，这些临床和神经认知障碍是高度残疾，并且对现有治疗方法不足。我们的治疗开发建议基于多活跃下丘脑 - 垂体 - 肾上腺（HPA）轴应激反应和认知障碍之间衰老的众所周知联系。我们已经证明，HPA轴的多动症取决于忧虑严重程度，并且可以通过治疗，改善记忆力和临床症状而逆转。这些发现表明，在晚期精神障碍中抑制HPA轴多动的新型治疗方法将补救认知障碍。我们还表明，基于正念的干预措施是可以接受的，可行的，并减少了老年人的焦虑和抑郁。 MBSR通过增加正念，减少忧虑和反省来抵消焦虑和抑郁。它还抑制了HPA轴的过度活跃性，产生了以下假设：MBSR可以通过增加正念来改善患有焦虑症的老年人和MDD的临床症状和认知障碍，从而减少了忧虑/反思和减少HPA轴应激反应。因此，我们建议对患有抑郁症或焦虑症和与情绪相关的认知障碍的老年人进行适应和测试MBSR。第1阶段将针对患有记忆力障碍或执行功能障碍的沮丧或焦虑的老年人进行MBSR方案，根据需要修改干预措施，发展依从性和能力测量并测试控制条件。第2阶段（Pilot RCT）将将100名老年人随机为MBSR方案或控制条件，并将检查可行性。焦虑，抑郁症状，记忆和执行功能是结果；正念，忧虑和皮质醇的变化是介体。 MBSR是晚年焦虑症和MDD的一种有前途的新型治疗策略。我们建议在探索假定的心理和生物学机制（正念和神经内分泌变化）的同时开发治疗方法，从而使这项研究具有临床和科学意义。