Mechanic pathways of mindfulness meditation in post-traumatic stress disorder.

描述（由申请人提供）：拟议项目的总体目标是1)将Helane Wahbeh博士发展成为独立的补充和替代医师研究员；2)开展心身医学临床研究试验，评价作用机制。Wahbeh博士将通过指导培训在四个关键领域发展她的知识基础、经验和技能：1)随机对照试验的设计和实施；2)神经科学，收集和分析电生理数据；3)生物统计学；4)正念冥想。研究训练计划的长期目标是发现冥想疗法的作用机制，从而提高其有效利用。作为第一步，这项研究将作为一个模型研究，仔细分离冥想组成部分的机制途径。拟议研究的主要目的是评估冥想的两个常见部分，正念和呼吸减慢，并描述它们可能影响临床结果的机制。在一项随机对照试验中，100名患有创伤后应激障碍的退伍军人将被分为四组：1)正念冥想组，2)呼吸缓慢组，3)正念冥想和呼吸缓慢组，或4)静坐对照组。参与者每周将有一次20分钟的实验室课程，为期六周，课程之间每天有20分钟的家庭练习。将在干预期前后对措施进行评估。具体目的是通过观察各组在三个生理系统（自主神经系统、额叶皮层活动和下丘脑-垂体-肾上腺（HPA）轴）测量上的差异来评估冥想的作用机制。我们假设呼吸减缓会影响自主神经系统的测量，减少过度觉醒的症状，而正念冥想会通过额叶皮层的活动和减少侵入性的想法来影响认知功能。我们预测，呼吸减慢与正念成分的结合将显示自主神经和额叶皮层活动的影响，所有干预措施都将影响下丘脑轴活动的下游途径。

DESCRIPTION (provided by applicant): The overall goals of the proposed project are 1) to develop Dr. Helane Wahbeh into an independent complementary and alternative physician researcher; and 2) to conduct a clinical research trial in mind-body medicine evaluating mechanisms of action. Dr. Wahbeh will develop her knowledge base, experience and skill in four key areas through mentored training: 1) design and implementation of randomized controlled trials; 2) neuroscience and collecting and analyzing electrophysiological data, 3) biostatistics, and 4) mindfulness meditation. The long term goal of the research training plan is to discover the mechanism of action of meditation therapy and thus improve its effective use. As a first step, the study will serve as a model study to carefully separate the mechanistic pathways of meditation components. The primary objectives of the proposed study are to evaluate two common parts of meditation, mindfulness and slowed breathing, and to characterize the mechanism by which they may affect clinical outcomes. In a randomized controlled trial, 100 veterans with PTSD will be allocated one of four groups 1) mindfulness meditation, 2) slowed breathing, 3) mindfulness meditation and slowed breathing, or 4) a sitting quietly control group. The participants will have one 20 minute laboratory session each week for six weeks with 20 minutes of daily home practice between sessions. Measures will be assessed before and after the intervention period. The specific aims are to assess the mechanism of action of meditation by observing differences among groups on measures within three physiological systems: the autonomic nervous system, frontal cortex activity, and the hypothalamic-pituitary-adrenal (HPA) axis. We hypothesize that slowed breathing alone will affect autonomic nervous system measures and reduce hyper-arousal symptoms, whereas mindfulness meditation will influence cognitive function through frontal cortex activity and decreased intrusive thoughts. We predict that the combination of slowed breathing with the mindfulness component will show both autonomic and frontal cortex activity effects and that all interventions will influence the downstream pathway of HPA axis activity. PUBLIC HEALTH RELEVANCE: The study is important to public health because meditation is widely used without knowing exactly how it works. The study will help clinicians prescribe different types of meditation therapy to appropriate patient groups more effectively and adapt pieces of meditation therapy to match the illness being treated. Also, further clinical research is needed on treatments for veterans with PTSD, whom are a rapidly growing group.