Dismantling Mindfulness: Contributions of Attention vs. Acceptance

描述(申请人提供)：冥想，特别是正念冥想，是最受欢迎的补充和替代医学(CAM)疗法之一，用于缓解情绪压力、抑郁和焦虑，这些情绪压力、抑郁和焦虑要么是主要的，要么是其他健康状况的次要因素。虽然基于冥想的标准化治疗方案，如基于正念的压力减轻(MBSR)和基于正念的认知疗法(MBCT)可靠地显示出情绪障碍和幸福感的持续改善，但它们包含如此多不同的成分和实践，以至于无法确定有效成分。正念包括1)注意力调节成分，被认为是通过集中的意识练习来培养的；2)接受的，非评判的心理立场，被认为是通过开放监测练习来培养的。该项目旨在为注意力冥想和专注于接受的冥想创建不同的实践标准，比较它们的临床疗效，并研究它们在具有临床显著水平的持续性负面情绪和抑郁症的个体中的单独作用机制。聚焦意识(FA)与开放监测(OM)与非治疗(等待名单)对照的临床益处和作用机制将通过这八周干预措施的三臂随机对照试验来检验。结果变量包括负面情绪(抑郁、焦虑、压力)和幸福感。假设的中介过程包括客观测量的注意力、情绪调节和它们所依赖的基本觉醒。除了研究应用，培训计划还包括以下方面的正式教育：1)基于冥想的临床试验方法和情感障碍；2)注意力、情绪、睡眠倾向的心理生理学测量；3)与治疗研究相关的生物统计学方法。这次培训为我实现成为一名独立的、以患者为中心的研究人员的长期目标做好了准备。通过正式的教学指导和经验丰富的研究人员的强有力的指导，我将开发必要的工具，阐明哪些冥想练习对情绪障碍最有帮助，以及通过哪些认知和神经生理机制。 公共卫生相关性：此应用程序满足了NCCAM的要求，即研究心身疗法背后的神经心理机制，并对冥想实践进行准确的标准和更好的描述。通过操作定义组成“正念冥想”的两个组成部分和实践，这个项目将帮助确定流行和成功的CAM疗法的有效成分。通过提供不同冥想练习的效果和益处的知识，该项目将帮助临床医生定制他们的治疗方法，以更好地适应不同患者的需求。

DESCRIPTION (provided by applicant): Meditation, particularly mindfulness meditation, is one of the most popular Complementary and Alternative Medicine (CAM) therapies for alleviating emotional stress, depression and anxiety that are either primary, or secondary to another health condition. While standardized meditation-based treatment packages like Mindfulness Based Stress Reduction (MBSR) and Mindfulness-based Cognitive Therapy (MBCT) have reliably shown sustained improvements in emotional disturbances and wellbeing, they contain so many different components and practices that the active ingredient cannot be ascertained. Mindfulness is comprised of 1) an attention regulation component, which is thought to be cultivated with focused awareness practice, and 2) an accepting, non-judgmental mental stance, which is thought to be cultivated through open-monitoring practice. This project aims to create separate practice criteria for attention and acceptance-focused meditations, compare their clinical efficacy and investigate their separate mechanisms of action in individuals with clinically significant levels of persistent negative affect and depression. The clinical benefit and mechanism of action of focused awareness (FA) vs open-monitoring (OM) vs a no-treatment (waitlist) control will be examined with a three- armed randomized control trial of these eight week interventions. Outcome variables include negative affect (depression, anxiety, stress) and wellbeing. Hypothesized mediating processes include objectively measured attention, emotion regulation and the basic wakefulness on which they depend. In addition to the research application, the training program includes formal education in 1) meditation-based clinical trials methodology and affective disorders, 2) psychophysiological measurement of attention, emotion, sleep propensity and 3) biostatistical methods related to treatment studies. This training prepares me to meet my long-term objective of becoming an independent patient- oriented researcher. Through formal didactic instruction and strong mentoring from experienced investigators who are leaders in the field, I will develop the requisite tools to shed light on which meditation practices are the most helpful for emotional disturbances and by what cognitive and neurophysiological mechanisms. PUBLIC HEALTH RELEVANCE: This application addresses NCCAM's request for research that investigates the neuropsychological mechanisms underlying mind-body therapies, and for precise criteria and better delineation of meditation practices. By operationally defining the two components and practices that comprise "mindfulness meditation", this project will help identify the active ingredients of a popular and successful CAM therapy. By providing knowledge about the effects and benefits of different meditation practices, this project will help clinicians tailor their treatment to better fit the needs of different patients.