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，这突出了迫切需要严格评估练习的益处可能被授予的机制。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效果是否主要来自非特定的训练方面，还是来自特定的冥想练习；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。我们小组最近的一项横断面研究结果表明，与随机分配到积极对照条件的受试者相比，被随机分配到并练习慈悲冥想的年轻人表现出更少的炎症反应、更少的情绪困扰和对标准化实验室社会心理压力源（特里尔社会压力测试[TSST]）的自主反应。然而，由于横断面研究设计和缺乏冥想比较组，这些结果仅提供了对上述关键问题的部分见解，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，练习一种专门设计用于增强对他人的共情关怀的冥想程序（即同情冥想），将优化对社会心理压力的自主神经反应，从而减少外周炎症信号通路的激活，减少行为困扰。为了验证这一假设，我们提出了以下目标：目的1：使用纵向设计来确定练习时间有助于同情冥想对体内炎症和行为反应的影响；目的2：研究同情冥想对行为和对心理社会压力的炎症反应的影响是否特别来自于对他人产生共情关怀的训练，或者更普遍地来自于学习集中注意力和正念的基本冥想练习；目的3：研究冥想减轻应激性炎症的自主机制。为了实现这些目标，目前的研究将随机选择360名医学上健康的成年人，进行为期6周的慈悲冥想训练、正念注意力训练（控制注意力和正念的基本冥想练习）或健康教育讨论组（控制潜在的非特定因素，如群体支持）。在这些干预之前和完成后，所有受试者都将进行TSST测试，以评估对社会心理压力的炎症、自主神经和行为反应。与健康相关的行为和生活方式因素也将被评估，以评估它们对冥想对炎症的影响。鉴于有证据表明炎症途径是压力促进和/或恶化许多医学和精神疾病的重要机制，这项研究的长期健康影响可能会影响深远。公共卫生相关性：越来越多的人将冥想作为一种治疗各种压力相关疾病的方法，这凸显了确定冥想可以改善健康的机制对公共卫生的重要性，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佳应用的疾病状态。这项拟议的研究将验证这样一个假设，即冥想通过减少面对感知到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，这一假设对健康的长期影响可能是深远的，因为有证据表明，先天免疫炎症途径的激活是压力促进和/或恶化一系列严重的医学和精神疾病（即血管疾病、糖尿病、癌症、艾滋病毒、重度抑郁症）的重要机制，冥想正越来越多地作为一种干预手段应用于这些疾病。

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.