Mindfulness-based Group Intervention for an Adolescent Girl at Risk for Type 2 Diabetes: A Case Report.
Mindfulness-based Group Intervention for an Adolescent Girl at Risk for Type 2 Diabetes: A Case Report.
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发表时间：
2018
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通讯作者：
Stephanie L Dalager;Shelly K. Annameier;Stephanie M Bruggink;Bernadette Pivarunas;J. Coatsworth;A. Schmid;Christopher Bell;Patricia C. Broderick;K. Brown;Jordan T. Quaglia;L. Shomaker
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作者：
Stephanie L Dalager;Shelly K. Annameier;Stephanie M Bruggink;Bernadette Pivarunas;J. Coatsworth;A. Schmid;Christopher Bell;Patricia C. Broderick;K. Brown;Jordan T. Quaglia;L. Shomaker
行为生活方式干预降低体重指数（BMI; kg/m2）是预防青少年发病2型糖尿病（T2D）的标准方法。不幸的是，现有的方案在降低胰岛素抵抗（T2D的关键生理风险指标）方面的长期成功有限。潜在的社会心理因素，特别是抑郁症状，与胰岛素抵抗有关，与BMI或体脂无关。初步证据表明，以正念为基础的项目有望干预抑郁症和T2D；然而，这种方法是新颖的，青少年的数据很少。本研究的目的是(1)评估基于正念的干预对有抑郁症状的T2D风险青少年的益处和潜在的潜在机制，(2)考虑在这一特定的、心理上和医学上有风险的青少年人群中临床实施。研究小组进行了一个案例研究报告。实验地点是一所大学的门诊治疗诊所和研究实验室。参与者为16岁女性，抑郁症状加重，肥胖，胰岛素抵抗，有糖尿病家族史。干预和结果干预是一个为期6周的以正念为基础的小组项目。主要结果是在1年的随访过程中，特质正念、抑郁和胰岛素抵抗的变化模式。次要结果是报告的暴饮暴食模式和皮质醇觉醒反应的改变模式。结果：与基线时的得分相比，参与者表现出一种特征正念增加的模式，抑郁症状减少，胰岛素抵抗减轻，在小组计划结束后和1岁时，BMI和体脂稳定。报告的暴饮暴食有所缓解，1年后皮质醇觉醒反应下降。参与者对干预的反馈通常是积极的，但也提供了潜在的修改，以加强可接受性和有效性。结论目前的病例结果表明，向有抑郁症状的T2D风险的青春期女孩教授正念技能可能在治疗抑郁症和T2D风险方面具有独特的优势。在这一人群中，提高正念项目实施成功率的临床意义包括注重促进群体内的社会联系，实施策略以增加对家庭实践活动的依从性，以及使用促进技术来促进对抽象正念概念的具体理解。未来，需要足够有力的临床试验数据来测试治疗机制和推荐的适应性。
Context Behavioral lifestyle interventions to lower body mass index (BMI; kg/m2) are the standard approach for preventing adolescent-onset type 2 diabetes (T2D). Unfortunately, existing programs have had limited long-term success of lessening insulin resistance, the key physiological risk indicator for T2D. Underlying psychosocial factors, particularly depressive symptoms, have been related to insulin resistance, independent of BMI or body fat. Preliminary evidence indicates that mindfulness-based programs show promise for intervening with depression and T2D; yet, this approach is novel and data in adolescents are scarce. Objective The objectives of this study were (1) to evaluate the benefits, and potential underlying mechanisms, of a mindfulness-based intervention in adolescents at-risk for T2D with depressive symptoms and (2) to consider clinical implementation with this specific, psychologically, and medically at-risk adolescent population. Design and Setting The research team conducted a case study report. The setting was an outpatient therapy clinic and research laboratory at a university. Participant The participant was a 16-y-old female with elevated depressive symptoms, obesity, and insulin resistance, and a family history of T2D. Intervention and Outcomes The intervention was a 6-wk mindfulness-based group program. The key outcomes were patterns of change in trait mindfulness, depression, and insulin resistance in the course of a 1-y follow-up. Secondary outcomes were patterns of change in reported-overeating patterns and cortisol awakening response. Results Compared with her scores at baseline, the participant displayed a pattern of increased trait mindfulness, decreased depressive symptoms, and lessening of insulin resistance immediately following the group program and at 1 y. BMI and body fat were stable. There was a remission in reported-overeating and a pattern of declining cortisol awakening response 1 y later. Participant feedback on the intervention was generally positive but also provided potential modifications to strengthen acceptability and effectiveness. Conclusions The current case results suggest that teaching mindfulness skills to adolescent girls at risk for T2D with depressive symptoms may offer distinctive advantages for treating depression and T2D risk. Clinical implications for increasing the success of implementing mindfulness-based programs in this population include a focus on promotion of social connectedness within the group, implementation of strategies to increase adherence to home practice activities, and the use of facilitation techniques to promote concrete understanding of abstract mindfulness concepts. Future, adequately powered clinical trial data are required to test therapeutic mechanisms and recommended adaptations.