Targeting Stress Reactivity in Schizophrenia: Integrated Coping Awareness Therapy

针对精神分裂症的应激反应：综合应对意识疗法

• 批准号: 9461625
• 负责人: Piper S. Meyer
• 金额: $ 25.28万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-04 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9461625
• 关键词: Activities of Daily Living; Adolescence; Affect; Area; Awareness; Buffers; Chronic; Chronic stress; Clinical Trials; Data; Development; Disabled Persons; Disease; Distal; Economics; Emotions; Endocrine; Event; Felis catus; First Degree Relative; General Population; Generations; Goals; Immune; Impairment; Individual; Intervention; Lead; Life; Link; Literature; Manuals; Measures; Medical; Medical Care Costs; Mental disorders; Mission; Morbidity - disease rate; NIH Program Announcements; Outcome; Persons; Population; Psychology; Public Health; Quality of life; Randomized Controlled Trials; Recovery; Recovery of Function; Relapse; Research; Residual state; Resources; Risk; Risk Factors; Rogaine; Role; Schizophrenia; Severities; Social Security; Stress; Stressful Event; Supportive care; Symptoms; System; Testing; Therapeutic Intervention; Translational Research; United States National Institutes of Health; allostatic load; base; biological adaptation to stress; coping; cost; disability; disorder later incidence prevention; emerging adult; experience; first episode psychosis; first episode schizophrenia; functional disability; improved; improved functioning; indexing; innovation; mindfulness meditation; modifiable risk; novel; novel therapeutic intervention; prevent; psychologic; public health relevance; relapse risk; relating to nervous system; research and development; resilience; response; social; stress reactivity; stress symptom; success

DESCRIPTION (provided by applicant): Schizophrenia is one of the most devastating disorders that often results in a lack of functional recovery. Current treatments focused on remediating symptoms have shown only small successes in a return to functioning despite evidence of a dysregulated stress response. There is a fundamental gap in understanding the impact of allostatic overload in persons with schizophrenia that we theorize is associated with deficits in functioning and with an increased vulnerability and relapse risk. The long-term goal is to test an intervention aimed at improving stress reactivity. The objective in this application is o develop and test the feasibility of a novel therapeutic intervention combining strategies to improve stress reactivity and increase meaningful coping. The central hypothesis is that an intervention that improves stress reactivity as measured proximally by endocrine, immune, and autonomic indices will result in improved adaptive capacity, better role functioning, reduced risk of relapse, and decreased likelihood of disability for people in the early stages of schizophrenia. The rationale for the proposed research is that stress reactivity may be a modifiable risk factor underlying functional deficits in schizophrenia. The intervention integrates two treatment approaches. The first is based on research showing that mindfulness meditation practice is associated with alterations in the neural processing of stressful events and targets adaptive responses to stress. The second focuses on providing a buffer against stress by using the self-generation of adaptive emotions with a positive psychology intervention, which is potentially associated with building protective social resources. These complimentary interventions provide a comprehensive synergistic approach for this population that could lead to more adaptive coping responses and create a buffer against stress. Guided by strong preliminary data and support from the literature, this hypothesis will be tested by pursuing three specific aims: 1) To develop a novel intervention, I- CAT (Integrated Coping Awareness Therapy), aimed at reducing stress reactivity and improving functioning in persons with first episode psychosis (R21-Stage 1); 2) To pilot I-CAT and a range of possible proximal (e.g. autonomic, endocrine, immune indices of stress reactivity, symptom severity) and distal measures (function, relapse, quality of life) with six individuals with first episode psychosis (R21-Stage 2); and 3) To test the feasibiliy of a clinical trial implementing I-CAT for people with first episode psychosis in the context of a small randomized controlled trial with 40 individuals (20 assigned to I-CAT and 20 assigned to supportive therapy (ST) (R33-Stage 3)). The approach is innovative because it represents a departure from the status quo of the current array of treatments and targets functional recovery and relapse prevention through an intervention aimed at improving resilience to stress. The proposed research is significant, because it is expected to produce an intervention to ameliorate impaired stress reactivity that has the potential to change the trajectory of schizophrenia and reduce the likelihood of chronic disability and the associated medical morbidity.

描述（由申请人提供）：精神分裂症是最具破坏性的疾病之一，通常导致缺乏功能恢复。尽管有证据表明存在失调的应激反应，但目前专注于补救症状的治疗方法在恢复功能方面只取得了很小的成功。在理解精神分裂症患者适应负荷的影响方面存在根本性的差距，我们认为这与功能缺陷、易损性和复发风险增加有关。长期目标是