Reducing stress with parenting-focused mindfulness to prevent youth substance use

描述(申请人提供)：青春期是物质使用障碍发展的关键时期。显然需要为青少年提供新的物质使用预防措施，特别是根植于基础科学发现的发展知情干预措施(NIDA，2010年)。重要的基础研究表明，父母压力是青少年使用药物和艾滋病毒危险行为的风险因素。这种风险在面临多种慢性压力的低收入家庭中可能会加剧。基于正念的压力减轻(MBSR)是一种经验性的治疗方法，可以减轻成年人的压力。然而，MBSR对父母压力和青少年结果的潜在强大影响尚未得到测试。这项拟议的研究的目标是开发和测试以育儿为重点的MBSR版本，以减轻父母的压力，防止低收入城市家庭使用青少年药物和艾滋病毒危险行为。我们假设，以养育为中心的MBSR(P-MBSR)将减少父母的压力，改善父母的养育行为和亲子关系，降低青少年的生物行为唤醒，防止药物使用和HIV危险行为的风险。在这个由职业早期研究人员发起的项目中，120名12-14岁的父母报告了高育儿压力，将在一家服务于低收入城市社区的儿童指导诊所招募。父母将被随机分配到诊所接受为期8周的P-MBSR干预(基于辛哈博士在耶鲁大学压力中心实施的MBSR干预)或接受育儿建议对照组。在干预前和干预后，将使用一种尖端的实验室范式来衡量适应性和专注性父母行为以及父母和青少年的生物行为应激反应，该范式模拟父母与青少年的互动以及青少年对互动的情感和生理反应(由卓别林博士，Pi；卓别林等人开发，2012年)。在干预前、干预后以及干预后6个月和1年，我们将收集关于父母压力、压力相关障碍、父母教养方式、亲子关系、青少年对使用药物和参与HIV危险行为(如无保护措施的性行为)的意图和期望的问卷调查、临床访谈和生物学测量。我们将使用HLM分析来检验干预效果。根据我们的初步研究发现，MBSR可以减少成年人的压力，我们预计P-MBSR将减少父母的压力，增加适应性和专注性父母的养育，密切亲子关系，减少青少年对父母互动的生理和情感反应，并防止青少年使用药物和危险的性行为。如果假设得到支持，这项研究将提供：1.P-MBSR的初步可行性和有效性数据，2.用于进行P-MBSR长期随机对照试验的R01应用的试点效果大小数据，3.P-MBSR在现实世界环境中的相关性和可接受性的证据，以及4.高危青少年药物使用的纵向数据。P-MBSR可能是一种成本效益高的策略，可以减少高危成年人的压力和压力相关障碍，同时防止他们的孩子使用药物和危险行为。

DESCRIPTION (provided by applicant): Adolescence is a critical period for the development of substance use disorders. There is a clear need for novel substance use preventions for youth, particularly developmentally-informed interventions rooted in basic science findings (NIDA, 2010). Significant basic research indicates parent stress as a risk factor for adolescent substance use and HIV risk behaviors. This risk may be exacerbated in low-income families who face multiple chronic stressors. Mindfulness-based stress reduction (MBSR) is an empirically-supported treatment that reduces stress in adults. However, the potentially powerful effects of MBSR on parenting stress and adolescent outcomes have not been tested. The goal of the proposed study is to develop and test a parenting-focused version of MBSR to reduce parent stress and prevent adolescent substance use and HIV risk behaviors in low-income urban families. We hypothesize that parenting-focused MBSR (P-MBSR) will decrease parent stress, improve parenting behavior and the parent-child relationship, decrease youth bio-behavioral arousal, and prevent risk for substance use and HIV risk behaviors. In this early-career investigator initiated project, 120 parents of 12-14 year olds reporting high parenting stress will be recruited at a child guidance clinic serving a low-income urban community. Parents will be randomly assigned to receive either an 8 week P-MBSR intervention at the clinic (based on the MBSR intervention implemented at the Yale Stress Center by Dr. Sinha, co-I) or to a parenting advice control group. At pre- and post-intervention, adaptive and mindful parenting behaviors and parent and youth bio-behavioral stress responses will be measured using a cutting-edge laboratory paradigm that models parent-adolescent interactions and youth emotional and physiological responses to interactions (developed by Dr. Chaplin, PI; Chaplin et al., 2012). Before, after, and at 6 months and 1 year post-intervention, we will collect questionnaire, clinical interview, and biological measures of parent stress, stress-related disorders, parenting, parent-child closeness, and adolescent intentions and expectancies for and engagement in substance use and HIV risk behaviors (e.g., unprotected sex). We will test intervention effects with HLM analyses. Based on our pilot finding that MBSR decreased stress in adults, we expect that P-MBSR will reduce parent stress, increase adaptive and mindful parenting and close parent-adolescent relationships, decrease adolescent physiological and emotional responses to parent interactions and prevent youth substance use and risky sex. If hypotheses are supported, the study will provide: 1. Initial feasibility and efficacy data for P-MBSR, 2. Pilot effect size data for a R01 application to conduct a longer-term RCT of P-MBSR, 3. Evidence of relevance and acceptability of P- MBSR in a real-world setting, and 4. Longitudinal data on substance use in at-risk youth. P-MBSR could be a cost-effective strategy to reduce stress and stress-related disorders in at-risk adults and at the same time prevent drug use and risk behavior in their children.