AdministrativeSupplement to Understanding and Reversing the Effects of Early Life Adversity on Midlife Health: Improving Daily Psychological Stress Responses using an Ecological Momentary Intervention

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PROJECT SUMMARY/ABSTRACT Early life adversity (ELA), such as childhood maltreatment, can leave a “scar” into adult life and beyond, increasing risk for mental health problems and physical diseases of aging. ELA is also linked with biological indices that are reliable precursors to early disease, such as elevated blood pressure and C-reactive protein, and shortened telomere length–biomarkers I will study in this proposal. Identifying the persistent risk pathways by which ELA worsens midlife health can inform interventions. While research on the biological mechanisms has proliferated, our understanding of the psychological mechanisms, which can inform non-pharmacological interventions, has lagged behind. Congruent with the National Institute on Aging’s initiative on the reversibility of ELA, the proposed project aims to 1) understand daily psychological stress responses (e.g., negative affect, stress appraisals, and perseverative cognitions) as a promising psychological risk pathway, and to 2) develop and 3) pilot test an intervention that improves maladaptive psychological responses to daily stressors. The proposed intervention will use daily mindfulness-based practices that are incorporated into everyday life via mobile technology (Ecological Momentary Intervention). To this end, I will first identify intervention targets by examining relations between ELA, daily psychological stress responses, and health outcomes (mental/physical symptoms; biomarkers) in two existing midlife studies with prospective and retrospective assessments of ELA. Next, I will develop an Ecological Momentary Mindfulness-based Intervention (EMMI) that improves maladaptive daily psychological stress responses using a small micro-randomized trial (n=20). Lastly, I will pilot test acceptability, feasibility, and adherence by randomizing participants with ELA to EMMI (n=35) or Ecological Momentary Assessment-only (n=35). Preliminary findings will inform an R-level application to evaluate the EMMI in an adequately powered study. This research will advance our knowledge of the midlife reversibility of psychological risk pathways related to ELA. Building on my advanced training as a clinical and health psychologist with expertise in stress, psychoneuroendocrinology, and mental health, the K99/R00 Pathway to Independence Award addresses critical training needs in ecological momentary assessment and intervention, mechanism-focused intervention development and testing, mindfulness-based interventions, and measurement and interpretation of aging biomarkers. The training plan includes coursework, meetings, readings, and apprenticeships to fill these gaps; the research proposal provides opportunities to apply the new knowledge. I have assembled an outstanding team of renowned mentors (Drs. Epel, Hecht, Almeida) and specialized advisors (Drs. Danese, Murphy, Mendes, Delucchi) with expertise in these areas. The proposed award will provide me with the necessary experiences to become an independent, transdisciplinary, and translational clinical scientist dedicated to understanding the psychological pathways linking ELA and midlife health and to reversing risk pathways using mindfulness and other psychological interventions.