2/2 MINDFULNESS-BASED STRESS REDUCTION AND COGNITIVE FUNCTION IN STRESS AND AGING

2/2 基于正念的减压以及压力和衰老中的认知功能

• 批准号: 8227359
• 负责人: Julie L Wetherell
• 金额: $ 17.02万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8227359
• 关键词: Address; Adherence; Adverse effects; Adverse event; Aging; Anxiety; Anxiety Disorders; Awareness; Basic Science; Biological; Chronic; Clinical; Clinical Trials; Cognition; Collaborations; Competence; Complementary and alternative medicine; Data; Depressed mood; Disease; Elderly; Functional disorder; Future; Guidelines; Health Care Costs; Health Priorities; Health education; Hydrocortisone; Hyperactive behavior; Impaired cognition; Impairment; Individual; Intervention; Investigation; Lead; Link; Major Depressive Disorder; Measurement; Mediator of activation protein; Meditation; Memory; Memory impairment; Mental Depression; Mental disorders; Methods; Moods; Movement; National Center for Complementary and Alternative Medicine; National Institute of Mental Health; Neuraxis; Neurocognition; Neurocognitive; Neurosecretory Systems; Outcome; Output; Phase; Pilot Projects; Procedures; Process; Production; Protocols documentation; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Research; Safety; Salivary; Severities; Site; Stress; Symptoms; Testing; Training; Translational Research; Validity and Reliability; base; biological adaptation to stress; cognitive function; compliance behavior; data management; depressive symptoms; efficacy testing; executive function; experience; hypothalamic-pituitary-adrenal axis; improved; inhibitor/antagonist; innovation; mindfulness; mindfulness-based stress reduction; minimal risk; novel; open label; psychologic; therapy development; treatment effect; treatment response; treatment strategy; young adult

DESCRIPTION (provided by applicant): This application responds to the collaborative R34 mechanism co-sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Mental Health (NIMH). We will evaluate the feasibility of adapting and testing Mindfulness-Based Stress Reduction (MBSR), a promising CAM treatment, for improving clinical outcomes and neurocognitive function in older adults with anxiety disorders or major depressive disorder (MDD) along with cognitive impairment. This project is important because these disorders are very common and cause cognitive impairment in older adults; together, these clinical and neurocognitive impairments are highly disabling and inadequately helped by existing treatments. Our treatment development proposal is based on well-known links in aging between a hyperactive hypothalamic-pituitary-adrenal (HPA) axis stress response and cognitive impairment. We have demonstrated that HPA axis hyperactivity is dependent on worry severity and is reversible with treatment, improving memory as well as clinical symptoms. These findings suggest that novel treatments that inhibit HPA axis hyperactivity in late-life mental disorders will remediate cognitive impairment. We have also shown that mindfulness-based interventions are acceptable, feasible, and reduce anxiety and depression in older adults. MBSR counteracts anxiety and depression by increasing mindfulness and decreasing worry and rumination; it also inhibits HPA axis hyperactivity, generating the hypothesis that MBSR can improve clinical symptoms and cognitive impairment in older adults with anxiety disorders and MDD via increased mindfulness, resulting in reduced worry/rumination and reducing the HPA axis stress response. We therefore propose to adapt and test MBSR for older adults with depression or anxiety and mood-related cognitive impairment. Phase 1 will pilot an MBSR protocol for depressed or anxious older adults with memory impairment or executive dysfunction, modify the intervention as needed, develop adherence and competency measurement, and test a control condition. Phase 2 (pilot RCT) will randomize 100 older adults to the MBSR protocol or a control condition and will examine feasibility. Anxiety and depressive symptoms and memory and executive function are outcomes; changes in mindfulness, worry/rumination, and cortisol are mediators. MBSR is a promising, novel treatment strategy for late-life anxiety disorders and MDD. We propose to develop the treatment while exploring putative psychological and biological mechanisms (mindfulness and neuroendocrine changes) underlying the treatment effect, giving this study clinical and scientific significance. PUBLIC HEALTH RELEVANCE: Chronic anxiety and depression lead to cognitive decline in older adults through the mechanism of HPA axis hyperactivity. This study proposes to use Mindfulness-Based Stress Reduction, a brief, easily implementable CAM intervention that is also a potent inhibitor of a hyperactive neuroendocrine stress response, to improve anxiety, depression, and cognition in older individuals.

描述（由申请人提供）：本申请响应由国家补充和替代医学中心 (NCCAM) 和国家心理健康研究所 (NIMH) 共同发起的协作 R34 机制。我们将评估采用和测试正念减压 (MBSR) 的可行性，这是一种很有前景的 CAM 治疗方法，可改善患有焦虑症或重度抑郁症 (MDD) 以及认知障碍的老年人的临床结果和神经认知功能。该项目很重要，因为这些疾病非常常见，会导致老年人认知障碍；总之，这些临床和神经认知障碍会造成严重的残疾，并且现有的治疗方法无法充分帮助他们。我们的治疗开发建议基于众所周知的衰老过程中下丘脑-垂体-肾上腺 (HPA) 轴应激反应过度活跃与认知障碍之间的联系。我们已经证明，HPA 轴过度活跃取决于忧虑的严重程度，并且可以通过治疗、改善记忆力和临床症状来逆转。这些发现表明，抑制晚年精神障碍中 HPA 轴过度活跃的新疗法将可以修复认知障碍。我们还表明，基于正念的干预措施是可接受的、可行的，并且可以减少老年人的焦虑和抑郁。 MBSR 通过增强正念、减少忧虑和沉思来对抗焦虑和抑郁；它还可以抑制 HPA 轴过度活跃，从而产生这样的假设：MBSR 可以通过增强正念来改善患有焦虑症和 MDD 的老年人的临床症状和认知障碍，从而减少担忧/沉思并减少 HPA 轴应激反应。因此，我们建议针对患有抑郁或焦虑以及与情绪相关的认知障碍的老年人进行调整和测试MBSR。第一阶段将为患有记忆障碍或执行功能障碍的抑郁或焦虑老年人试行MBSR方案，根据需要修改干预措施，制定依从性和能力测量，并测试控制条件。第 2 阶段（试点 RCT）将随机将 100 名老年人纳入 MBSR 方案或对照条件，并检查可行性。焦虑和抑郁症状以及记忆和执行功能是结果；正念、忧虑/沉思和皮质醇的变化是中介因素。 MBSR 是治疗晚年焦虑症和 MDD 的一种有前景的新型治疗策略。我们建议在开发治疗方法的同时探索治疗效果背后假定的心理和生物机制（正念和神经内分泌变化），赋予本研究临床和科学意义。 公共卫生相关性：慢性焦虑和抑郁通过 HPA 轴过度活跃的机制导致老年人认知能力下降。本研究建议使用基于正念的减压方法，这是一种简短、易于实施的 CAM 干预措施，也是过度活跃的神经内分泌应激反应的有效抑制剂，可改善老年人的焦虑、抑郁和认知。