Optimizing a mindful intervention for urban minority youth via stress physiology

项目总结 拟议的R61/R33分阶段研究旨在阐明潜在的生理应激机制 针对易受外化、情感和创伤影响的青少年而设计的正念计划的效果 由于严重的环境劣势而导致的应激障碍。每一阶段的青少年将 从巴尔的摩市为高贫困社区服务的学校招聘，那里有逆境和经历 创伤和虐待是很常见的。干预措施目前正在巴尔的摩的几个地区实施 城市学校和其他环境，由整体生活基金会(HLF)提供，该公司是一个非营利性组织，拥有 提供以正念为基础的编程(呼吸训练和冥想)的漫长记录 贫困的青年。关于情绪调节显著变化的经验和轶事报道都有 已经报道了这种干预，但与大多数正念项目类似，效果机制还没有 但仍被描绘出来，特别是在处境不利的青年中。 我们感兴趣的主要机制是应激生理学，通过心率变异性(HRV)和 急性应激时的皮肤电导反应(SCR)，情绪调节和 与相关的临床症状有关(例如，外化行为、情感障碍)。 预测干预反应(适度)和应激相关途径的青年特征 通过取得积极成果(调解)，我们提议进行两次区域协调，最终 目的最大限度地改善高危青少年的外化行为以及情感和创伤障碍。在 R61，我们将集中测量正念计划的机械性影响，以确定其影响在 概念上合适的人口。巴尔的摩市4所高中的学生将随机接受治疗 和主动控制状况(N=160名学生)，并在基线、干预后和随访时进行评估。 将确定因干预而改善的应激生理特征。在R33，我们将 进行一个更大的RCT(8所学校，N=240)，分配给正念项目或 正念计划加上增强--HRV生物反馈--被证明对 压力反应。将在条件之间进行比较，然后将调解模型应用于 确定应激生理是否发生积极变化的最有效干预条件 解释在结果方面的改进。这一系列研究将描述参与者的特征，他们最大限度地 受正念的影响，并将区分治疗条件，导致更有效和 有效的目标定位和扩展。通过这样做，这项研究将在快速增长的 以青少年正念为基础的干预，通过确定共同作用的关键生理机制 正念练习。

PROJECT SUMMARY The proposed R61/R33 phased study aims to elucidate the physiological stress mechanisms underlying effects of a mindfulness program designed to target youth at risk for externalizing, affective and traumatic stress disorders by virtue of significant environmental disadvantage. Adolescents for each phase will be recruited from schools serving high poverty neighborhoods in Baltimore City where adversity and experiences of trauma and maltreatment are common. The intervention is currently being implemented in a few Baltimore City schools and other settings by the Holistic Life Foundation, Inc. (HLF), a non-profit organization with a lengthy track record of providing mindfulness-based programming (breath work and meditation) to impoverished youth. Both empirical and anecdotal reports of significant change in emotion regulation have been reported with this intervention, yet similar to most mindfulness programs, mechanisms of effects have not yet been delineated, particularly in disadvantaged youth. Our primary mechanism of interest is stress physiology, as measured by heart rate variability (HRV) and skin conductance response (SCR) during acute stress, a central component of emotion regulation and implicated in relevant clinical syndromes (e.g., externalizing behaviors, affective disorders).To identify the characteristics of youth that predict intervention response (moderation) and the stress-related pathways through which positive outcomes are achieved (mediation), we propose to conduct two RCTs with the ultimate goal to maximally improve externalizing behaviors and affective and traumatic disorders in at-risk youth. In the R61, we will intensively measure mechanistic effects of the mindfulness program to establish its effects in a conceptually appropriate population. Students in 4 Baltimore City High Schools will be randomized to treatment and active control conditions (N=160 students) and assessed at baseline, post-intervention and follow-up. Stress physiological profiles that improve in response to intervention will be identified. In the R33, we will conduct a larger RCT (8 schools, N=240) with assignment either to the mindfulness program or the mindfulness program plus an enhancement—HRV biofeedback—shown to independently exert effects on stress responses. Comparisons will be made between conditions and then a mediation model will be applied to the intervention condition exhibiting maximal effects to determine whether positive change in stress physiology explains improvements in outcomes. This sequence of studies will characterize participants who are maximally impacted by mindfulness and will differentiate between treatment conditions, leading to more efficient and effective targeting and scaling. In so doing, this research will break new ground in the rapidly growing field of youth mindfulness-based interventions by identifying key physiological mechanisms of effect for common mindfulness practices.