Neural Mechanisms of Mindfulness-Based Cognitive Therapy (MBCT) for Post-Traumatic Stress Disorder (PTSD)

摘要。我们资助的R61是一项基于正念的认知疗法（MBCT）治疗创伤后应激的随机对照试验

Abstract. Our funded R61 is an RCT of Mindfulness-based Cognitive Therapy (MBCT) for posttraumatic stress disorder (PTSD) vs a well-matched comparator and pre-post fMRI. We are testing the hypothesis that MBCT engages a novel therapeutic mechanism involving increased capacity for metacognitive emotion regulation (“decentering”), and this is underlain by increased functional connectivity (FC) between the posterior cingulate cortex (PCC) and the dorsolateral prefrontal cortex (DLPFC). We hypothesized that MBCT-linked increases in decentering would reduce perservative negative thinking (PNT), a transdiagnostic process common to distress disorders. However, at present our entire planet is caught in the grip of a global COVID-19 pandemic, which has led to suspension of in-person research. Nearly half of US adults report negative mental health impact due to worry and stress over the virus, and disease and social burdens of the COVID-19 pandemic, as well as stress from the resulting economic downturn are profoundly impacting mental health. The state of Michigan (>52K COVID-19 cases/>5K deaths) is among the most impacted “hot zones” in the US. Communities with high densities of low-income African Americans are the hardest hit and disproportionately bear the brunt of this pandemic. African Americans account for 32% of all Michigan COVID cases and 44% of all COVID-related deaths, yet are only 14% of the Michigan population. Wayne County, which includes the city of Detroit, is the single hardest hit location in Michigan, with >19K cases and >2K deaths. African Americans are also often exposed to everyday racial discrimination, a prevalent and pernicious form of psychological stress, and have higher rates of physical health disorders that amplify COVID risk. Childhood adversity, trauma exposures, and poverty, disproportionately elevated in African Americans, as well as PNT, likely also substantially increase risk for anxiety, depression, and SUD in the context of COVID-related stress. Mental health treatments are needed for COVID-impacted individuals, especially low income African Americans who are disproportionately impacted; however, social distancing measures and increased financial insecurity create additional barriers. To adequately serve these communities we now face an urgent need to test the feasibility and efficacy of already validated, remotely-delivered stress management programs in health disparity populations. Such remotely delivered interventions, including MBCT, are feasible and recent data suggest are highly efficient and efficacious for depression, anxiety, PTSD and SUD. Based on this evidence, we propose to conduct a RCT of remotely delivered MBCT (N=30) & PMR (N=30) in underserved, trauma-exposed health disparity populations disproportionately impacted by COVID in South East Michigan. We will test hypotheses about the efficacy of remotely-delivered stress management for COVID-related stress, anxiety and depression in this population, as well as hypotheses about the specific psychological mechanism of MBCT, involving increased decentering / metacognitive emotional regulation, and how this relates to improvement in PNT and related distress.