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

项目摘要/摘要 早期生活逆境(ELA)，如童年虐待，可能会在成年后和以后的生活中留下“伤疤”， 增加心理健康问题和衰老引起的身体疾病的风险。ELA也与生物学有关 是早期疾病的可靠前兆的指标，如高血压和C反应蛋白， 和缩短的端粒长度--我将在这项提案中研究的生物标记物。识别持续的风险路径 通过ELA恶化中年健康可以为干预提供信息。在研究其生物学机制的同时 已经激增，我们对心理机制的了解，可以告知非药理学 干预措施，已经落后。与国家老龄研究所关于可逆性的倡议一致 对于ELA，拟议的项目旨在1)了解日常心理压力反应(例如，负面情绪， 压力评估和持之以恒的认知)作为一种很有前途的心理风险途径，以及2)发展 以及3)试点测试，这是一种干预措施，可以改善人们对日常压力的不良心理反应。这个 建议的干预将使用基于日常正念的练习，这些练习通过 移动技术(生态瞬时干预)。为此，我将首先通过以下方式确定干预目标 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)在两项现有的对ELA进行前瞻性和回溯性评估的中年研究中。 接下来，我将开发一种基于生态瞬间正念的干预(EMMI)，它可以改善 使用小型微型随机试验(n=20)进行的日常心理应激反应不良。最后，我会 试点测试可接受性、可行性和依从性，随机选择ELA到EMMI的参与者(n=35)或 仅生态瞬时评估(n=35)。初步调查结果将通知R级申请 在一个有足够动力的研究中评估EMMI。这项研究将增进我们对中年的认识 与ELA相关的心理风险通路的可逆性。以我作为临床医生的高级培训为基础 在压力、心理神经内分泌学和心理健康方面有专长的健康心理学家，K99/R00 独立之路奖解决了生态瞬时评估和 干预、以机制为重点的干预开发和测试、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、 读物和学徒来填补这些空白；研究提案提供了应用新的 知识。我已经组建了一支由著名导师(埃佩尔博士、赫克特博士、阿尔梅达博士)和 拥有这些领域专业知识的专业顾问(丹尼斯博士、墨菲博士、门德斯博士、德鲁基博士)。建议数 该奖项将为我提供必要的经验，使我成为一名独立、跨学科和 致力于了解ELA和中年之间联系的心理途径的临床翻译科学家 并利用正念和其他心理干预手段扭转风险途径。

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.