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，其中包括数千名退伍军人，是一种 在美国是导致残疾的主要原因。虽然许多中风患者在急性发作期间接受康复治疗 和中风急性期后，许多人患有慢性营养不良，几乎没有选择 继续治疗。许多低成本的替代疗法现在正在测试其 治疗慢性中风患者神经心理缺陷的有效性。最好的研究之一 这些治疗是基于正念的压力减轻(MBSR)，包括一个为期8周的疗程 由一位训练有素的教练。MBSR教授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，MBSR是 有效地减轻中风患者的焦虑和抑郁症状，并增强 认知任务的表现。然而，只有一项MBSR治疗中风的随机对照试验 到目前为止已经发表了，这项研究存在一些缺点，比如缺乏 一个积极的控制组。此外，以前还没有研究评估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谨、随机的 MBSR在有中风病史的退伍军人中的对照试验，采用积极对照组，双盲 检查人员，以及为期6个月的跟踪会议，以确定MBSR的好处是否长期存在。 在这项研究中，将招募120名有慢性中风病史的退伍军人：60名参与者将 随机分配到MBSR干预，60名参与者将被分配到脑健康班 与MBSR干预相匹配的讲师、授课时数 作业活动和班级规模。盲人考官将完成一项神经心理评估 患者在三个时间点的情绪和认知状态：1)干预前，2)之后 干预，以及3)六个月后。对MBSR干预措施的评估将测试改进情况 在干预后的焦虑和抑郁症状学中，相对于大脑健康组， 以及对认知测试电池的改进。据预测，与以下方面相关的改进 在为期6个月的后续评估中，MBSR干预措施仍将存在。决赛 目前这项提议的目的是确定患者中风的部位是否在他们的 能够从MBSR中受益。先前的研究表明，左侧前额叶皮质在大脑中起着至关重要的作用 MBSR影响的潜在作用。因此，据预测，这一大脑区域的参与将 调整观察到的效果。这样的信息可以被用来瞄准那些最可能 从拟议的干预中受益。如果证明是有效的，MBSR可以提供一种低成本、非 退伍军人获得性脑损伤的侵入性康复治疗 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.