MBSR Intervention to reduce stress in AD caregivers

描述（由申请人提供）：正念减压（MBSR）是一种身心技术，结合了正念冥想、瑜伽和认知重新评估，目的是自我管理由压力、疼痛、癌症和其他疾病引起的心理和身体痛苦。尽管正念减压疗法已经存在了20年，并被纳入了许多临床环境，但很少有随机临床试验（rct）评估它对减轻压力的影响，或者正念减压疗法减轻压力的生理机制。照顾阿尔茨海默病（AD）患者的人会经历高水平的压力、抑郁症状和不利的身体健康结果，这可能是慢性压力的结果。然而，对阿尔茨海默病护理人员的心理教育干预对自我报告的压力只有适度的好处，可能是因为他们教授处理当前护理问题的技术，随着护理对象疾病的进展，这些技术变得不那么有用了。相比之下，正念减压是一种概念上有效的减压方法，因为它具有压力管理和适应各种压力情况的通用方法。

DESCRIPTION (provided by applicant): Mindfulness-Based Stress Reduction (MBSR) is a mind-body technique that incorporates mindfulness meditation, yoga, and cognitive reappraisal with the goal of self-managing the psychological and physical distress resulting from stress, as well as pain, cancer and other illnesses. Although MBSR has been in existence for 20 years and has been incorporated into numerous clinical settings, few randomized clinical trials (RCTs) have evaluated its effects on stress reduction, or the physiological mechanism by which MBSR reduces stress. Caregivers to persons with Alzheimer's Disease (AD) experience high levels of stress, depressive symptoms, and adverse physical health outcomes, likely as a result of chronic stress. However, psycho-educational interventions for AD caregivers have shown only modest benefits on self-reported stress, probably because they teach techniques to deal with current caregiving problems which become less useful as the care recipient's disease progresses. In contrast, MBSR presents a conceptually effective stress reduction method for AD caregivers because of its generic approach to stress management and adaptability to various stressful situations. This revised proposed R21 study is guided by psychoneuoimmunology (PNI) theory. It aims to design and pilot-test an RCT of an 8-week MBSR intervention for older adult AD caregivers to reduce perceived stress, depressive symptoms, and improve two biological markers of PNI mechanisms: dihydroepiandrosterone-sulfate (DHEA-S) and interleukin-6 (IL-6). This study has two phases. The first phase is a development phase in which a team of MBSR experts will design the curriculum and training materials for an 8-week MBSR program adapted for elderly caregivers, and an 8-week social contact program to be used for comparison purposes. The second phase will be a pilot test of an RCT comparing this MBSR program to a social contact control group on short-term (pre-post intervention) and 6-month change in perceived stress, depressive symptoms, and biological markers among 72 elderly AD caregivers, recruited from the Boston University (BU) Alzheimer's Disease Center. Data collection will take place at the BU General Clinical Research Center. The results will provide information on rates of eligibility, participation, compliance and attrition; respondents' willingness to provide biological specimens; and the overall protocol for the future RCT. Mixed effects models will be used to test hypotheses comparing the MBSR group to the control group on changes in perceived stress, depressive symptoms, and DHEA-S and IL-6. The results will guide the design of a larger RCT of the effects of MBSR on reducing stress, and will provide insight into the physiological mechanisms of MBSR.