Primary-Care Based Mindfulness Intervention for Chronically Traumatized Individuals

项目摘要/摘要 城市低收入人群中反复暴露于创伤的比率和创伤相关精神障碍的水平 少数族裔社区远远超过全国平均水平。尽管如此，不充分的机会和实质性的障碍 城市受创伤人口的治疗仍在继续。基于正念的干预可能针对情绪 自主神经系统的失调和功能障碍，这是与创伤相关的机制 精神后果，如创伤后应激障碍(PTSD)和严重抑郁障碍(MDD)。排队 NCCIH的战略目标是改善对难以管理的症状的护理，本研究的目的是 是为长期遭受创伤的非裔美国人试行基于初级保健的正念干预 在城市公立医院的初级保健诊所筛查创伤后应激障碍和MDD阳性。这项研究将 采用随机对照试验(RCT)设计，同时采用多种心理和生理方法 评估方法以确定基于正念的认知疗法的可行性和可接受性 在患有慢性创伤的非裔美国人中[初级保健干预(MBCT)]与等待名单对照 暴露并合并创伤后应激障碍和MDD。也符合NCCIH推进的战略目标 理解心身干预方法的潜在机制，初步机制 与MBCT相关的行为和结局的变化，包括情绪调节障碍，自主神经功能， 并将评估创伤后应激障碍和MDD症状。数据收集和[8次会议]小组干预将 在主要为低收入少数族裔提供服务的城市公立医院内的初级保健诊所进行 个人(&gt；80%非裔美国人)。培训活动将在学术医疗环境下进行 这是一个更广泛项目的总称，旨在了解创伤后应激障碍的心理和生物风险因素。 该K23项目的培训目标包括1)学习如何设计、实施和评估 相辅相成的综合行为健康干预措施，2)[加强正念训练 和综合护理]，3)学习纵向数据分析技术，4)收集和分析 心理生理学变量，并将心理生理学数据纳入治疗研究。最终， 申请者的职业目标包括努力改善对服务不足的平民创伤人群的治疗 在城市环境中采取互补的综合健康观点，并加强对 创伤相关治疗背景下的变化机制。带来客观的衡量标准 在行为健康的背景下，将自主神经功能等生理标志纳入初级保健环境 治疗也将有助于我们理解这些可能导致的生物机制的改变 以及这些潜在的生物机制如何能够长期对健康结果产生积极影响。

Project Summary/Abstract Rates of repeated exposure to trauma and levels of trauma-related psychiatric disorders in low-income, urban minority communities far exceed national averages. Despite this, inadequate access and substantial barriers to treatment in urban traumatized populations remain. Mindfulness-based interventions may target emotion dysregulation and dysfunction of the autonomic nervous system, mechanisms that contribute to trauma-related psychiatric outcomes like posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In line with the strategic goals of the NCCIH to improve care for hard-to-manage symptoms, the purpose of this study is to pilot a primary-care based mindfulness intervention for chronically traumatized African Americans screening positive for PTSD and MDD in primary care clinics within an urban public hospital. The study will utilize a randomized controlled trial (RCT) design along with a multi-method psychological and physiological assessment approach to establish the feasibility and acceptability of a [mindfulness-based cognitive therapy intervention for primary care (MBCT)] versus wait-list control in African Americans with chronic trauma exposure and comorbid PTSD and MDD. Also in line with the strategic goal of NCCIH to advance understanding of mechanisms underlying mind-body intervention approaches, preliminary mechanisms of action and change in outcomes associated with MBCT including emotion dysregulation, autonomic function, and PTSD and MDD symptoms will be evaluated. The data collection and [8-session] group intervention will take place in primary care clinics within an urban public hospital serving primarily low-income, minority individuals (>80% African American). Training activities will take place in an academic medical setting under the umbrella of a broader project aimed at understanding psychological and biological risk factors for PTSD. Training goals for this K23 project include 1) learning how to design, implement, and evaluate the outcomes of complementary and integrative behavioral health interventions, 2) [gaining enhanced training in mindfulness and integrated care], 3) learning longitudinal data analytic techniques, and 4) gathering and analyzing psychophysiological variables and integrating psychophysiological data into treatment research. Ultimately, career goals for the applicant include working to improve treatment for underserved civilian trauma populations in urban settings by taking a complementary integrative health perspective and enhance understanding of mechanisms of change in the context of trauma-related treatment. Bringing measures of objective physiological markers like autonomic function into primary care settings in the context of behavioral health treatments will also aid in our understanding of the biological mechanisms that may change as a result of these treatments and how those underlying biological mechanisms can positively impact health outcomes long term.