Reductions in Cortisol Associated With Primary Care Brief Mindfulness Program for Veterans With PTSD
Reductions in Cortisol Associated With Primary Care Brief Mindfulness Program for Veterans With PTSD
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DOI：
10.1097/mlr.0000000000000224
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发表时间：
2014-12-01
期刊：
影响因子：
3
通讯作者：
Pigeon, Wilfred
中科院分区：
文献类型：
--
作者：
Bergen-Cico, Dessa;Possemato, Kyle;Pigeon, Wilfred
背景：创伤后应激障碍（PTSD）患者具有显著的医学发病率，其可能与下丘脑-垂体轴（HPA）功能障碍介导，并反映在皮质醇分泌上。许多患有创伤后应激障碍的退伍军人都不愿接受创伤暴露治疗；因此，需要更简短、非暴露性的治疗；其中一个很有希望的方法是一个简短的初级保健正念计划（PCbMP）。目的：探讨退伍军人PCbMP项目的剂量反应与皮质醇的关系。皮质醇反映HPA功能，PTSD与HPA失调有关。研究设计：患有创伤后应激障碍的退伍军人在PC中被确定，并随机分配到正常治疗（TAU, n = 21）或参加为期4周的基于正念的减压计划（n = 19）。研究对象：退伍军人（n = 40）（平均年龄48±16岁，90%为男性）通过退伍军人医疗服务提供者转介的PTSD患者，随机分配到PCbMP或TAU组。测量方法：作为HPA功能的客观指标，在基线和随访期间连续2天采集样本，测量唾液皮质醇的昼夜变化。结果：分析显示，皮质醇的显著变化与PCbMP治疗的参与和剂量（完成的正念课程的次数）有关。完成4次正念冥想的退伍军人显著降低了他们的皮质醇唤醒反应(P
Background: Patients with posttraumatic stress disorder (PTSD) have significant medical morbidity, which may be mediated by hypothalamic pituitary axis (HPA) dysfunction and reflected in cortisol output. Many veterans with PTSD are hesitant to engage in traumafocused exposure treatments; therefore briefer, non-exposure-based treatments are needed; one such promising approach is an abbreviated Primary Care brief Mindfulness Program (PCbMP).Objective: This study investigated the relationship between doseresponse to participation in a veterans PCbMP program and diurnal cortisol. Cortisol reflects HPA function and PTSD is associated with HPA dysregulation.Research Design: Veterans with PTSD were identified in PC and randomly assigned to treatment as usual (TAU, n = 21) or participation in brief 4-week Mindfulness Based Stress Reduction program (n = 19).Subjects: Veterans (n = 40) (mean age, 48 +/- 16 y; 90% men) with PTSD referred through their VA PC provider and randomly assigned to PCbMP or TAU.Measure: As an objective indicator of HPA function, salivary diurnal cortisol was measured from samples collected across 2 consecutive days at baseline and follow-up.Results: Analyses revealed that significant changes in cortisol were associated with PCbMP treatment engagement and dosing (number of mindfulness program sessions completed). Veterans completing 4 mindfulness-based meditation sessions significantly reduced their cortisol awakening response (P