Mindfulness-Based Stress Reduction to Improve Neuropsychological Functioning in Acquired Brain Injury

中风每年影响大约80万美国人，包括数千名退伍军人，是一种严重的疾病。 是美国残疾人的主要原因。虽然许多中风患者在急性期接受康复治疗， 和中风的急性期后，许多人患有慢性缺陷， 继续治疗。一些低成本的替代治疗方法现在正在进行测试， 可用于治疗慢性中风患者的神经心理缺陷。最好的研究之一 这些治疗是基于正念的减压（MBSR），包括8周的课程， 由一个训练有素的教练。正念减压疗法教导个人应对伤害的策略，例如 冥想呼吸技巧和瑜伽一些初步研究表明，正念减压疗法是一种 有效减轻中风患者的焦虑和抑郁症状， 认知任务的表现。然而，只有一个随机对照试验的正念减压治疗中风， 该研究报告存在一些缺陷，如缺乏 一个积极的对照组。此外，以前没有研究评估过MBSR对中风的有效性 在退伍军人群体中。因此，目前的研究建议进行严格的，随机的 在有卒中史的退伍军人中进行的正念减压疗法对照试验，采用活性对照组，设盲 检查员，和6个月的随访会议，以确定是否MBSR的好处是持久的。 对于这项研究，将招募120名有慢性中风史的退伍军人：60名参与者将被 随机分配到MBSR干预，60名参与者将被分配到大脑健康课程 与正念减压疗法相匹配的指导者，指导的小时数， 家庭作业和班级规模。一名不知情的检查员将完成一项神经心理学评估， 在三个时间点患者的情绪和认知状态：1）干预前，2）干预后 干预，3）六个月后。对正念减压疗法干预的评估将测试其改善情况 在干预后的焦虑和抑郁情绪中，相对于大脑健康组， 以及认知测试组合的改进。据预测，改善与 在6个月的随访评估中，正念减压疗法干预措施仍将存在。最终 目前建议的目的是确定患者中风的部位是否在其 从MBSR中受益的能力。以前的研究表明，左前额叶皮层在大脑中起着关键的作用。 MBSR的作用。因此，据预测，这一大脑区域的参与将 调节观察到的效果。这些信息可以用来针对那些退伍军人谁可以最 从拟议的干预中受益。如果被证明是有效的，正念减压疗法可以提供一种低成本，非 对获得性脑损伤的退伍军人进行侵入性康复治疗， 神经心理功能和一般幸福感。

Stroke affects approximately 800,000 Americans every year, including thousands of Veterans, and is a leading cause of disability in the US. While many stroke patients receive rehabilitation during the acute and post-acute phases of stroke, many individuals suffer chronic deficits and have few options for continued treatment. A number of low-cost, alternative treatments are now being tested for their usefulness in treating neuropsychological deficits in chronic stroke patients. One of the best studied of these treatments is Mindfulness-Based Stress Reduction (MBSR), which involves an 8-week course led by a trained instructor. MBSR teaches individuals strategies for coping with their injury, such as meditation, breathing techniques, and yoga. A handful of preliminary studies have shown that MBSR is effective in reducing symptoms of anxiety and depression in stroke patients, as well as enhancing performance on cognitive tasks. However, only a single randomized controlled trial of MBSR in stroke has been published to date, and that study suffered from a number of weaknesses such as the lack of an active control group. Moreover, no previous study has assessed the usefulness of MBSR for stroke in a Veteran population. Therefore, the current study proposes to undertake a rigorous, randomized controlled trial of MBSR in Veterans with a history of stroke, using an active control group, blinded examiners, and a 6-month follow-up session to determine whether the benefits of MBSR are long-lasting. For the study, 120 Veterans with a history of chronic stroke will be recruited: 60 participants will be randomly assigned to the MBSR intervention, and 60 participants will be assigned to a Brain Health class that is matched to the MBSR intervention with respect to the instructor, number of hours of instruction, homework activities, and class size. A blinded examiner will complete a neuropsychological assessment of patients’ emotional and cognitive status at three time points: 1) prior to the intervention, 2) following the intervention, and 3) six months later. Evaluation of the MBSR intervention will test for improvements in anxiety and depressive symptomatology following the intervention, relative to the Brain Health group, as well as improvements on a cognitive test battery. It is predicted that improvements associated with the MBSR intervention will still be present at the 6-month follow-up assessment as well. The final objective of the current proposal is to determine whether the site of a patient’s stroke plays a role in their ability to benefit from MBSR. Previous research has suggested that left prefrontal cortex plays a critical role underlying the effects of MBSR. Thus, it is predicted that involvement of this brain region will modulate the observed effects. Such information could be used to target those Veterans who can most benefit from the proposed intervention. If shown to be effective, MBSR could provide a low-cost, non- invasive rehabilitative treatment for Veterans with acquired brain injury that can improve their neuropsychological functioning and general sense of well-being.