Stress Reduction in Therapeutic Community Treatment

描述(由申请人提供)： 有效治疗药物使用障碍是国家的优先事项。治疗社区(TCS)是一种重要的治疗方式，它提供了一个高度结构化的社会学习环境，鼓励行为、态度和自我形象的积极变化。TC治疗的成功结果与治疗时间相关；然而，TCS的流失率高得令人不安。我们认为，压力调节了TC的进步和保持，需要压力缓解策略来帮助客户管理TC固有的压力环境。许多研究证明了基于正念的压力减轻(MBSR)在减少各种临床和非临床人群的压力方面的前景。我们有初步数据表明，MBSR可以减轻TC患者的压力，这一点从唤醒的唾液皮质醇测量的减少中得到了证明。这项研究旨在将我们的MBSR发现转化为TCS的行为治疗，以提高客户的参与度和保留率。拟议的第1阶段行为发育研究将完善和测试第一个基于手册的MBSR计划，作为TC治疗的补充。本研究将：1)从操作上定义和标准化MBSR的原理和技术；2)在TC治疗中对MBSR进行中试和改进；3)测试假设，评估MBSR影响压力的潜力，并将其作为进展和保持的中介因子。压力将使用唾液皮质醇和感知压力量表进行测量。进步被概念化为重新进入社会的进步、全球自我改变和内化的自我改变。这些结果将分别通过设施计分系统、标准TC测量和压力描述的语言分析来衡量。留校率将通过设施的入学和辍学记录来衡量。将使用一般线性混合模型来分析数据，以处理随时间变化的问题，并使用标准分析方法来检查调解效果。

DESCRIPTION (provided by applicant): Effective treatment for substance use disorders is a national priority. Therapeutic communities (TCs), an important treatment modality, provide a highly structured social learning environment to encourage positive changes in behavior, attitudes, and self-image. Successful outcomes for TC treatment are correlated with time in treatment; yet, attrition from TCs is disturbingly high. We believe that stress mediates progress and retention in TCs and that stress reduction strategies are needed to assist clients to manage the inherently stressful environment of the TC. A number of studies document the promise of Mindfulness-Based Stress Reduction (MBSR) in reducing stress in a variety of clinical and non-clinical populations. We have preliminary data to demonstrate that MBSR decreases stress in TC clients as evidenced by a decrease in awakening salivary cortisol measurements. This study is designed to translate our MBSR findings into behavioral treatment for TCs to enhance engagement and retention of clients. The proposed Stage 1 Behavioral Development research will refine and test the first MBSR program based on a manual, as an adjunct to TC treatment. The study will: 1) operationally define and standardize principles and techniques of MBSR; 2) pilot test and refine MBSR in TC treatment; and 3) test hypotheses evaluating the potential of MBSR to influence stress, which is proposed as the mediator of progress and retention. Stress will be measured with salivary cortisol and the Perceived Stress Scale. Progress is conceptualized as progression toward re-entry to society, global self-change and internalized self-change. These outcomes will be measured with a facility point system, standard TC measures and linguistic analysis of stress descriptions, respectively. Retention will be measured with facility admission and dropout records. Data will be analyzed using general linear mixed models to address change over time and a standard analysis approach for examining mediation effects.