Neurobehavioral Targets of Mindfulness in Youth At Risk for Mood Disorders

情绪不稳定，被定义为情绪的频繁和夸张的变化，是一种重要的跨诊断症状 这会造成严重的损伤，并增加自杀风险。这种症状是情绪的常见前兆。 精神障碍的发病，特别是在有家庭风险的青年中。由于青春期是情绪障碍发病的高峰期 这是神经可塑性的重要窗口，可能是干预降低情绪的最佳时机 不稳定。对年轻人的荟萃分析发现，基于正念的干预(Mbi)可以降低情绪。 症状和改善情绪/行为失调，与情绪不稳定密切相关；然而， 这些影响的神经/行为机制尚不清楚。了解如何以及为谁服务是至关重要的。 MBIS的工作是，设计干预措施，更有效地吸引适当的目标，并为那些 最有可能受益的是。在成人中，mbi已被证明可以增加静息状态功能连接(Rsfc)。 在后扣带回(PCC)和额顶控制网络(FPCN)之间，可能存在的神经回路 降低走神的意识。一个无意走神的行为指标，错误发生在 对反应任务(SART)的持续关注也被发现在MBIS之后减少。自.以来 无意走神放大负面情绪，意识到走神可能有助于适应 情绪调节策略的使用，导致压力反应的改善和情绪的不稳定。的确， 以前的研究已经将PCC-FPCN rsFC的增加与焦虑和抑郁的下游影响联系起来 抑郁；我们最近在年轻人中的先导研究发现，与运动负荷相关的PCC-FPCN rsFC增加预测 后来，情绪不稳定程度有所下降。考虑到这些有希望的试点数据，下一步是进行随机的 对照试验以评估MBI对走神相关目标和情绪不稳定的特定影响。在样本中 在100名有情绪不稳定的青少年(11-13岁)和有严重情绪障碍的父母中，我们建议 测试：(1)为期8周的MBI(与对照组相比)是否改变了走神相关的目标(PCC-FPCN rsFC，SART 表现)；(2)走神措施的改变导致较少的情绪不稳定；和(3)摄入心智- 游荡的衡量标准预测了不同的MBI收益。参与者将被随机分成不同的情绪 DSM-5诊断和青春期性行为-到8周的MBI或对照。我们会在4周前扫描年轻人 进入干预后、立即干预后和干预后3个月，以评估以下变化之间的纵向关系 PCC-FPCN、rsFC和行为/临床测量。行为/临床结果也将在9点进行评估 干预后几个月。我们将通过自我报告和生态瞬时评估来评估情绪不稳定， 关注消极情绪的可变性和维持积极情绪的能力。这一设计将允许我们评估， 随着时间的精确度和跨层次的分析，减少无意走神的影响 随后的情绪变化，关注高危青少年的关键发展阶段；也将使我们能够 评估谁将从mbi中受益最大，走向个性化医疗方法。

Mood lability, defined as frequent and exaggerated changes in mood, is an important transdiagnostic symptom that causes significant impairment and increases suicide risk. This symptom is a common precursor to mood disorder onset, particularly in youth at familial risk. Since adolescence is a peak period for mood disorder onset and an important window of neural plasticity, it may be an optimal time for an intervention to decrease mood lability. Meta-analyses in youth have found that mindfulness-based interventions (MBIs) decrease mood symptoms and improve emotion/behavioral dysregulation, constructs closely related to mood lability; however, neural/behavioral mechanisms of these effects are unknown. It is essential to understand how and for whom MBIs work, to design interventions that more efficiently engage appropriate targets and deliver treatment to those most likely to benefit. In adults, MBIs have been shown to increase resting-state functional connectivity (rsFC) between the posterior cingulate (PCC) and the frontoparietal control network (FPCN), neural circuitry which may subserve awareness of mind-wandering. A behavioral indicator of unintentional mind-wandering, errors on the Sustained Attention to Response Task (SART), has also been found to decrease following MBIs. Since unintentional mind-wandering amplifies negative affect, awareness of mind-wandering may facilitate the adaptive use of emotion regulation strategies, leading to improved stress response and decreased mood lability. Indeed, previous studies have linked increased PCC-FPCN rsFC to downstream effects of decreased anxiety and depression; and our recent pilot study in youth found that MBI-related increases in PCC-FPCN rsFC predicted later decreases in mood lability. Given these promising pilot data, the next step is to conduct a randomized controlled trial to assess MBI-specific effects on mind-wandering related targets and mood lability. In a sample of 100 adolescents (11-13 years old) with mood lability and a parent with a major mood disorder, we propose to test whether: (1) an 8-week MBI (vs. control) modifies mind-wandering-related targets (PCC-FPCN rsFC, SART performance); (2) changes in mind-wandering measures lead to less mood lability; and (3) intake mind- wandering measures predict differential MBI benefit. Participants will be randomized – stratified on non-mood DSM-5 diagnosis and sex-by-pubertal status – to an 8-week MBI or control. We will scan youth before, 4 weeks into, immediately after, and 3 months after intervention to assess longitudinal relationships amongst changes in PCC-FPCN rsFC and behavioral/clinical measures. Behavioral/clinical outcomes will also be assessed at 9 months post-intervention. We will assess mood lability via self-report and ecological momentary assessment, focusing on variability in negative affect and ability to sustain positive mood. This design will allow us to assess, with temporal precision and across levels of analysis, the impact of decreasing unintentional mind-wandering on subsequent mood lability, focusing on a crucial developmental period in at-risk youth; and will also allow us to assess who will benefit most from MBIs, moving toward a personalized medicine approach.