Mechanisms of Meditation

描述（由申请人提供）：越来越广泛地使用冥想来治疗与压力相关的情绪和医疗状况，这突显了迫切需要严格评估可能赋予练习益处的机制。这方面的主要挑战包括评估练习时间和结果之间的剂量反应关系；澄清冥想的生理和行为影响主要来自训练的非特定方面还是特定冥想练习的结果；并确定冥想可能影响与压力相关疾病相关的生理反应的分子机制。我们小组的一项横断面研究的最新结果表明，与随机分配到主动对照条件的受试者相比，随机分配并练习同情冥想的年轻人表现出炎症反应减少，情绪困扰减少，对标准化实验室心理社会压力源（特里尔社会压力测试[TSST]）的自主反应减少。然而，由于横断面研究设计和缺乏冥想比较臂，这些结果只能部分洞察上述关键问题，即特定冥想程序和/或练习时间在观察到的生理和行为结果中所起的作用。这项工作的主要假设是，练习专门为增强对他人的同理心关注而设计的冥想程序（即同情冥想）将优化自主神经对社会心理压力的反应，从而减少外周炎症信号通路的激活并减少行为困扰。为了检验这一假设，提出以下目标： 目标 1：使用纵向设计来明确确定练习时间有助于同情冥想对体内炎症和对心理社会压力的行为反应的影响；目标 2：检验慈悲冥想对社会心理压力的行为和炎症反应的影响是否特别源自对他人产生同理心关注的训练，或者更普遍地源自学习集中注意力和正念的基本冥想实践；目标 3：研究冥想可以减轻压力引起的炎症的自主神经机制。为了实现这些目标，当前的研究将随机将 360 名身体健康的成年人随机分配到为期 6 周的同情冥想训练、正念注意力训练（以控制接触注意力和正念的基本冥想练习）或健康教育讨论小组（以控制潜在的非特定因素，如团体支持）。在这些干预措施完成之前和完成后，所有受试者都将接受 TSST 测试，以评估对心理社会压力的炎症、自主和行为反应。还将评估与健康相关的行为和生活方式因素，以评估它们对冥想对炎症的影响的贡献。鉴于炎症途径是压力促进和/或恶化许多医疗和精神疾病的重要机制，这项研究的长期健康影响可能会产生深远的影响。公共卫生相关性：越来越多地使用冥想来治疗各种与压力相关的医疗状况，这突显了确定冥想可以改善健康的机制对公共卫生的重要性，这既可以确认这种广泛使用的干预措施的功效，也可以更好地确定冥想可能最适用的疾病状态。拟议的研究将检验这样的假设：冥想通过减少面对感知的社会心理压力时的自主神经激活来减少对社会心理压力的炎症反应。如果得到证实，这一假设的长期健康影响可能会深远，因为有证据表明，先天免疫炎症途径的激活是一种重要机制，压力通过该机制促进和/或恶化各种严重的医疗和精神疾病（即血管疾病、糖尿病、癌症、艾滋病毒、重度抑郁症），而冥想越来越多地应用于这些疾病的干预措施。

DESCRIPTION (provided by applicant): The increasingly widespread use of meditation for stress-related emotional and medical conditions highlights the urgent need to rigorously evaluate mechanisms through which the benefits of practice might be conferred. Primary challenges in this regard include evaluating dose response relationships between practice time and outcomes; clarifying whether physiological and behavioral effects of meditation derive primarily from non-specific aspects of training or result from specific meditation practices; and identifying molecular mechanisms by which meditation might affect physiological responses relevant to stress-related illness. Recent findings from a cross-sectional study by our group indicate that young adults who are randomized to, and practice, compassion meditation demonstrate reduced inflammatory responses, less emotional distress, and reduced autonomic responses to a standardized laboratory psychosocial stressor (Trier Social Stress Test [TSST]) when compared to subjects randomized to an active control condition. However, as a result of the cross-sectional study design and lack of a meditation comparator arm, these results provide only partial insight into key issues outlined above regarding the role played by specific meditation procedures and/or practice time in observed physiological and behavioral outcomes. The primary hypothesis of the proposed work is that practicing a meditation procedure specifically designed to enhance empathic concern for others (i.e. compassion meditation) will optimize autonomic reactivity to psychosocial stress in a manner that results in diminished activation of peripheral inflammatory signaling pathways and reduced behavioral distress. To test this hypothesis, the following aims are proposed: Aim 1: to use a longitudinal design to definitively establish that practice time contributes to the effect of compassion meditation on in vivo inflammatory and behavioral responses to psychosocial stress; Aim 2: To examine whether the effect of compassion meditation on behavioral and inflammatory responses to psychosocial stress results specifically from training in the generation of empathic concern for others or derives more generally from learning the basic meditative practices of focused attention and mindfulness; and Aim 3: to investigate autonomic mechanisms by which meditation may attenuate stress-induced inflammation. To accomplish these aims, the current study will randomize 360 medically healthy adults to 6 weeks of either compassion meditation training, Mindful Attention Training (to control for exposure to the basic meditation practices of attention and mindfulness) or a health education discussion group (to control for potential non-specific elements such as group support). Prior to, and upon completion of these interventions, all subjects will undergo TSST testing in order to assess inflammatory, autonomic and behavioral responses to psychosocial stress. Health-relevant behavioral and lifestyle factors will also be assessed to evaluate their contribution to the effect of meditation on inflammation. The long-term health implications of this study will likely be far reaching given evidence that inflammatory pathways represent an important mechanism by which stress promotes and/or worsens many medical and psychiatric conditions. PUBLIC HEALTH RELEVANCE: The increasing use of meditation as a treatment for a variety of stress-related medical conditions highlights the public health importance of identifying mechanisms by which meditation may improve health, both to confirm efficacy for this widely used intervention and to better identify disease states toward which meditation might be optimally applied. The proposed study will test the hypothesis that meditation reduces inflammatory responses to psychosocial stress via reductions in autonomic activation in the face of perceived psychosocial stress. If confirmed, the long-term health implications of this hypothesis would likely be far reaching, given evidence that activation of innate immune inflammatory pathways represents an important mechanism by which stress promotes and/or worsens a wide range of serious medical and psychiatric conditions (i.e. vascular disease, diabetes, cancer, HIV, major depression) to which meditation is being increasingly applied as an intervention.