Smartphone-based mindfulness training for health following early life adversity

项目摘要 超过25%的美国人口报告暴露于早期生活逆境（ELA）-儿童时期的身体或情感创伤或忽视。ELA预测终身健康差异，包括慢性心脏代谢和自身免疫性疾病的风险增加以及早期死亡率。人们认为，童年时期的逆境会导致生物适应压力，从而导致成年后的疾病风险。目前还没有循证干预措施来抵消成年后的这些风险。正念冥想干预对于减轻压力和改善身体健康指标是有效的。然而，目前还不清楚正念干预是否可以接受，是否能有效地改善有ELA病史的人的健康状况。在一个样本的新兴和年轻的成年人与ELA的历史，拟议的研究评估的可行性，使用智能手机为基础的正念和控制干预措施，并测量压力在日常生活中使用动态评估和移动的传感器模型的长期目标，实施压力触发的即时（JIT）正念干预在未来的研究。有ELA病史的新兴/年轻成人（n=80）将提供两周的基线动态压力评级、连续移动的传感器数据（例如，心率、活动和来自可穿戴设备和智能手机的位置）和血液样本以评估炎症生物标志物。然后，参与者将被随机分配到一个14节课的基于智能手机的（a）正念训练干预或（B）匹配的应对控制干预，两者都通过随机提供的练习提示来增强，以允许对JIT提示进行回顾性评估。将在干预后和一个月随访时再次评估动态应激、传感器数据和炎症生物标志物。将测试以下主要假设：（1）干预和评估在ELA样本中是可行的，（2）正念训练将改善日常生活压力和炎症过程。此外，为了设计JIT正念干预，移动的传感器数据将用于开发预测日常生活压力的机器学习模型，并将评估在高压力时刻提供的练习提示以减轻压力。为了实现这些目标，候选人组建了一个导师团队和培训计划，重点关注（1）ELA和健康差异的概念和方法问题，（2）评估动态和生物学结果的先进方法，以及（3）优化结果评估和干预措施的新技术。结合候选人在机械正念研究的背景，拟议的研究和培训将启动一个独立的职业生涯，致力于最大限度地提高正念干预措施的有效性，以解决健康差距。这些目标与NCCIH的目标相一致，即利用新的评估技术促进对补充性健康干预措施的理解，以改善高危人群的健康状况。

PROJECT SUMMARY Over 25% of the US population reports exposure to early life adversity (ELA)—physical or emotional trauma or neglect in childhood. ELA predicts life-long health disparities, including increased risk for chronic cardiometabolic and autoimmune diseases and early mortality. Exposure to adversity in childhood is thought to program biological adaptations to stress that contribute to disease risk in adulthood. There are currently no evidence-based interventions to offset these risks in adulthood. Mindfulness meditation interventions have been effective for reducing stress and improving markers of physical health. However, it is unclear whether mindfulness interventions are acceptable and effective for improving health among people with a history of ELA. In a sample of emerging and young adults with a history of ELA, the proposed study evaluates feasibility of using smartphone-based mindfulness and control interventions and of measuring stress in daily life using ambulatory assessment and mobile sensor models with the long-term goal of implementing a stress-triggered just-in-time (JIT) mindfulness intervention in future research. Emerging/young adults with a history of ELA (n=80) will provide two weeks of baseline ambulatory stress ratings, continuous mobile sensor data (e.g., heart rate, activity, and location from wearable devices and smartphones), and blood samples to assess inflammatory biomarkers. Participants will then be randomly assigned to a 14-lesson smartphone-based (a) mindfulness training intervention or (b) matched coping control intervention, both boosted with randomly-delivered practice prompts to permit retrospective evaluation of JIT prompts. Ambulatory stress, sensor data, and inflammatory biomarkers will again be assessed at post-intervention and one-month follow-up. The following primary hypotheses will be tested: (1) interventions and assessments will be feasible in an ELA sample and (2) mindfulness training will improve daily life stress and inflammatory processes. Additionally, toward the design of a JIT mindfulness intervention, mobile sensor data will be used to develop machine-learning models predicting daily life stress, and practice prompts delivered at high stress moments will be evaluated for stress reduction benefit. To meet these aims, the candidate has assembled a mentorship team and training plan focused on (1) conceptual and methodological issues in ELA and health disparities, (2) advanced methods for assessing ambulatory and biological outcomes, and (3) new technology for optimizing outcome assessment and intervention delivery. Combined with the candidate’s background in mechanistic mindfulness research, the proposed research and training will launch an independent career dedicated to maximizing the efficacy of mindfulness interventions for addressing health disparities. These goals align with NCCIH’s objectives to advance understanding of complementary health interventions for improving health in at-risk populations using novel assessment technologies.