Mindfulness + tDCS to Reduce Situational Urgency Incontinence in Women

项目摘要 尿急性尿失禁（UUI）是一种非常普遍、病态和昂贵（高达830亿美元/年）的疾病 在65岁以上的老年妇女中，高达36%的人患有这种疾病。一个常见的现象， UUI是膀胱对外界刺激的条件性反应，通常被称为“情境性尿失禁”。 情境性尿失禁被患者描述为尿急和尿漏， 背景触发或线索，如接近前门/车库门“锁钥匙失禁”，以及暴露于 流水，如洗碗。通常归因于“膀胱痉挛”（逼尿肌过度活动），研究表明， 显示，42%到80%的UUI女性经历了情境引发的紧迫感， 大约26%的人经历了情境触发的泄漏。我们最近的工作重点是 开发方法，以重现暴露于个人的情境紧迫性线索，测试“紧迫性”的影响 和“安全”的线索对自我报告的紧迫性和实际泄漏，并最终评估膀胱控制的作用 大脑中对这些个人情境线索做出反应的机制。我们发现， 当暴露于个人“紧急”与“安全”时，UUI的紧急性和泄漏增加 日常生活中的摄影线索。此外，与注意力和视觉空间处理相关的大脑区域 在暴露于刺激但不安全的线索时被激活。过去的研究表明，通过膀胱充盈来模拟尿急， 显示前额叶皮层，执行控制的座位，被激活，以帮助控制膀胱激活。 然而，我们的研究发现，在女性中，在暴露于视觉线索的过程中，PFC并没有被招募。 紧急情况因此，我们建议，干预能够提高PFC激活在暴露期间， 紧急情况应该使女性能够获得对线索的执行控制， 紧迫性和泄漏，以及整体UUI血管学。使用我们现在久经考验的方法来个性化 刺激与照片的紧迫性激发情景线索，我们的目标是测试的可行性，可接受性， 以及这些有希望的方法的依从性，以减弱尿急相关的反应性并减少UUI症状。 这些新方法包括：（1）专注于身体扫描和接受语言的短暂正念（MI），（2） 经颅直流电刺激（tDCS）应用于背外侧PFC，和（3）MI + tDCS。60名情境性UUI女性将被随机分配到一项7个疗程的研究中， 周后训练。所有参与者将接受4次紧急提示暴露培训，在此期间，他们将 参与三种干预措施之一，以小组为基础。紧急程度的变化将通过事前事后评估 训练差异：对个人冲动和安全线索的线索反应，对尿Stroop任务的反应时间，自我 报告膀胱问题的严重程度，以及每日膀胱日记上的UUI发作和紧迫性评级。衰减 对情境紧迫性线索的反应将增加我们补充和增强UUI功效的能力 治疗和减轻其众多患者的症状负担。

Project Summary Urinary urgency incontinence (UUI) is a highly prevalent, morbid and costly (up to $83 billion/year) disorder among older women, with up to 36% of those over 65 afflicted. One commonly experienced phenomenon among those with UUI is conditioned bladder responses to external triggers, often labeled “situational incontinence.” Situational incontinence is described by sufferers as urinary urgency and leakage when confronted with specific contextual triggers or cues, such as approaching the front/garage door ‘latch-key incontinence’, and exposure to running water such as doing dishes. Generally ascribed to 'bladder spasms' (detrusor overactivity), studies have revealed that anywhere between 42% and 80% of women with UUI experience situationally provoked urgency, with approximately 26% of those experiencing situationally triggered leakage. Our recent work has focused on developing methods to recreate exposure to individuals’ situational urgency cues, testing the impact of “urgency” and “safe” cues on self-report urgency and actual leakage, and finally assessing the role of bladder control mechanisms in the brain in response to these personal situational cues. We found that women with situational UUI experienced increased urgency and leakage when exposed to personal “urgency” versus “safe” photographic cues from their daily lives. Further, brain areas related to attentional and visuospatial processing were activated during exposure to urge, but not safe, cues. Past studies of urgency simulated by bladder filling, show that prefrontal cortex, a seat of executive control, is activated to aid in controlling bladder activation. However, our study found that the PFC was not recruited during exposure to visual cues among women with situational urgency. Thus, we propose that interventions capable of enhancing PFC activation during exposure to urgency situations should enable women to gain executive control over cues and result in less cue-provoked urgency and leakage, as well as overall UUI symptomatology. Using our now well-tested methods to personalize stimuli with photographs of urgency-provoking situational cues, our goal is to test the feasibility, acceptability, and compliance of these promising methods to attenuate urgency-related reactivity and reduce UUI symptoms. These novel methods include: (1) Brief mindfulness (MI) focused on body scan and acceptance language, (2) Transcranial direct current stimulation (tDCS) applied to the dorsolateral PFC, and (3) a combination of MI + tDCS. Sixty women with situational UUI will be randomized into a 7-session study, with a mail-in follow up 1- week post-training. All participants will undergo 4 urgency-cue exposure training sessions during which they will engage in one of the three interventions, based on group. Changes in urgency will be assessed via pre-post training differences in: Cue-reactivity to personal urge and safe cues, reaction time to a urinary Stroop task, self- report severity of bladder problems, and UUI episodes and urgency ratings on a daily bladder diary. Attenuating reactivity to situational urgency cues will increase our ability to complement and enhance the efficacy of UUI therapy and reduce symptom burden for its many sufferers.