Understanding and Reversing the Effects of Early Life Adversity on Midlife Health: Improving Daily Psychological Stress Responses using an Ecological Momentary Intervention

项目概要/摘要 早期生活逆境（ELA），如童年虐待，会给成年生活和以后留下“伤疤”， 心理健康问题和身体衰老疾病的风险增加。ELA也与生物学有关。 作为早期疾病可靠前兆的指标，如血压升高和C反应蛋白， 和缩短端粒长度的生物标志物，我将在这个建议中研究。确定持续的风险路径 ELA的中年健康可以为干预提供信息。在研究生物学机制的同时 我们对心理机制的理解已经扩散，这可以告知非药理学 干预措施已经落后。与国家老龄问题研究所关于 的ELA，拟议的项目旨在1）了解日常心理压力反应（例如，负面影响， 压力评估和持续认知）作为一个有前途的心理风险途径，并2）发展 以及3）试点测试改善对日常压力源的适应不良心理反应的干预。的 拟议的干预将使用日常正念为基础的做法，通过纳入日常生活， 移动的技术（生态瞬时干预）。为此，我首先会确定干预目标， 检查ELA、日常心理应激反应和健康结果（心理/身体）之间的关系 症状;生物标志物）在两个现有的中年研究与前瞻性和回顾性评估ELA。 接下来，我将开发一种基于生态瞬间正念的干预（EMMI）， 适应不良的日常心理压力反应使用一个小型的微型随机试验（n=20）。最后，我将 通过将ELA参与者随机分配至EMMI（n=35），对可接受性、可行性和依从性进行预试验，或 仅生态瞬时评估（n=35）。初步调查结果将为R级应用程序提供信息， 在充分把握度的研究中评价EMMI。这项研究将增进我们对中年的了解 与ELA相关的心理风险途径的可逆性。基于我作为一名临床和 K99/R 00健康心理学家，具有压力、心理神经内分泌学和心理健康方面的专业知识 独立之路奖解决了生态瞬时评估的关键培训需求， 干预，以机制为中心的干预开发和测试，基于正念的干预，以及 老化生物标志物的测量和解释。培训计划包括课程作业、会议、 阅读和学徒填补这些空白;研究提案提供了应用新的 知识我组建了一支由著名导师（Epel博士，Hecht博士，Almeida博士）组成的杰出团队， 在这些领域具有专门知识的专业顾问（Danese、Murphy、门德斯、Delucchi博士）。拟议 奖项将为我提供必要的经验，成为一个独立的，跨学科的， 翻译临床科学家致力于了解心理通路联系ELA和中年 健康和扭转风险途径使用正念和其他心理干预。

PROJECT SUMMARY/ABSTRACT Early life adversity (ELA), such as childhood maltreatment, can leave a “scar” into adult life and beyond, increasing risk for mental health problems and physical diseases of aging. ELA is also linked with biological indices that are reliable precursors to early disease, such as elevated blood pressure and C-reactive protein, and shortened telomere length–biomarkers I will study in this proposal. Identifying the persistent risk pathways by which ELA worsens midlife health can inform interventions. While research on the biological mechanisms has proliferated, our understanding of the psychological mechanisms, which can inform non-pharmacological interventions, has lagged behind. Congruent with the National Institute on Aging’s initiative on the reversibility of ELA, the proposed project aims to 1) understand daily psychological stress responses (e.g., negative affect, stress appraisals, and perseverative cognitions) as a promising psychological risk pathway, and to 2) develop and 3) pilot test an intervention that improves maladaptive psychological responses to daily stressors. The proposed intervention will use daily mindfulness-based practices that are incorporated into everyday life via mobile technology (Ecological Momentary Intervention). To this end, I will first identify intervention targets by examining relations between ELA, daily psychological stress responses, and health outcomes (mental/physical symptoms; biomarkers) in two existing midlife studies with prospective and retrospective assessments of ELA. Next, I will develop an Ecological Momentary Mindfulness-based Intervention (EMMI) that improves maladaptive daily psychological stress responses using a small micro-randomized trial (n=20). Lastly, I will pilot test acceptability, feasibility, and adherence by randomizing participants with ELA to EMMI (n=35) or Ecological Momentary Assessment-only (n=35). Preliminary findings will inform an R-level application to evaluate the EMMI in an adequately powered study. This research will advance our knowledge of the midlife reversibility of psychological risk pathways related to ELA. Building on my advanced training as a clinical and health psychologist with expertise in stress, psychoneuroendocrinology, and mental health, the K99/R00 Pathway to Independence Award addresses critical training needs in ecological momentary assessment and intervention, mechanism-focused intervention development and testing, mindfulness-based interventions, and measurement and interpretation of aging biomarkers. The training plan includes coursework, meetings, readings, and apprenticeships to fill these gaps; the research proposal provides opportunities to apply the new knowledge. I have assembled an outstanding team of renowned mentors (Drs. Epel, Hecht, Almeida) and specialized advisors (Drs. Danese, Murphy, Mendes, Delucchi) with expertise in these areas. The proposed award will provide me with the necessary experiences to become an independent, transdisciplinary, and translational clinical scientist dedicated to understanding the psychological pathways linking ELA and midlife health and to reversing risk pathways using mindfulness and other psychological interventions.