Neural Mechanisms of Mindfulness-Based Cognitive Therapy (MBCT) for Post-Traumatic Stress Disorder (PTSD)

抽象的。我们资助的R61是基于正念的认知疗法(MBCT)用于创伤后应激的RCT 精神障碍(PTSD)与匹配良好的比较器和后处理功能磁共振成像。我们正在检验一种假设，即MBCT 采用了一种新的治疗机制，包括提高元认知情绪调节能力 (“偏心”)，这是由于后扣带之间功能连接(FC)的增加。 皮质(PCC)和背外侧前额叶皮质(DLPFC)。我们假设，与母婴传播相关的增加 偏心将减少持续性负面思维(PNT)，这是一种常见于痛苦的跨诊断过程 精神错乱。然而，目前我们整个星球都陷入了一场全球性的新冠肺炎大流行，它已经 导致面对面研究暂停。近一半的美国成年人报告说，由于 对病毒、疾病和新冠肺炎大流行的社会负担的担忧和压力，以及压力 由此导致的经济低迷对心理健康产生了深远的影响。密歇根州(&gt；52K； 新冠肺炎病例/>5000人死亡)是美国受影响最大的“热点地区”之一。高收入的社区 低收入的非裔美国人受到的打击最大，而且首当其冲。 大流行。非裔美国人占密歇根州所有COVID病例的32%，占所有COVID相关病例的44% 然而，死亡人数只占密歇根州人口的14%。包括底特律市在内的韦恩县是 密歇根州疫情最严重的地区，有19K个病例和2K个死亡病例。非洲裔美国人也经常 暴露在日常种族歧视中，这是一种普遍和有害的心理压力形式，并有 身体健康障碍的比率更高，从而放大了COVID的风险。童年的逆境，创伤的暴露，以及 在非裔美国人和PNT中不成比例地增加的贫困，也可能大大增加风险 在COVID相关压力的背景下，用于焦虑、抑郁和SUD。需要心理健康治疗 对于受COVID影响的个人，特别是受到不成比例影响的低收入非裔美国人； 然而，社会疏远措施和日益严重的财政不安全造成了额外的障碍。充分地 为这些社区服务，我们现在迫切需要测试已经验证的、 在健康差距人群中远程提供压力管理计划。这样的远程传送 包括MBCT在内的干预措施是可行的，最近的数据表明，对 抑郁、焦虑、创伤后应激障碍和躯体功能障碍。基于这一证据，我们建议进行远程RCT 在服务不足、创伤暴露的健康差距人群中提供MBCT(N=30)和PMR(N=30) 密歇根州东南部受COVID影响不成比例。我们将测试有关药物疗效的假设 远程交付的压力管理，用于该人群中与COVID相关的压力、焦虑和抑郁，如 以及关于MBCT具体心理机制的假设，涉及更多的偏心/ 元认知情绪调节，以及这与PNT和相关痛苦的改善有何关系。

Abstract. Our funded R61 is an RCT of Mindfulness-based Cognitive Therapy (MBCT) for posttraumatic stress disorder (PTSD) vs a well-matched comparator and pre-post fMRI. We are testing the hypothesis that MBCT engages a novel therapeutic mechanism involving increased capacity for metacognitive emotion regulation (“decentering”), and this is underlain by increased functional connectivity (FC) between the posterior cingulate cortex (PCC) and the dorsolateral prefrontal cortex (DLPFC). We hypothesized that MBCT-linked increases in decentering would reduce perservative negative thinking (PNT), a transdiagnostic process common to distress disorders. However, at present our entire planet is caught in the grip of a global COVID-19 pandemic, which has led to suspension of in-person research. Nearly half of US adults report negative mental health impact due to worry and stress over the virus, and disease and social burdens of the COVID-19 pandemic, as well as stress from the resulting economic downturn are profoundly impacting mental health. The state of Michigan (>52K COVID-19 cases/>5K deaths) is among the most impacted “hot zones” in the US. Communities with high densities of low-income African Americans are the hardest hit and disproportionately bear the brunt of this pandemic. African Americans account for 32% of all Michigan COVID cases and 44% of all COVID-related deaths, yet are only 14% of the Michigan population. Wayne County, which includes the city of Detroit, is the single hardest hit location in Michigan, with >19K cases and >2K deaths. African Americans are also often exposed to everyday racial discrimination, a prevalent and pernicious form of psychological stress, and have higher rates of physical health disorders that amplify COVID risk. Childhood adversity, trauma exposures, and poverty, disproportionately elevated in African Americans, as well as PNT, likely also substantially increase risk for anxiety, depression, and SUD in the context of COVID-related stress. Mental health treatments are needed for COVID-impacted individuals, especially low income African Americans who are disproportionately impacted; however, social distancing measures and increased financial insecurity create additional barriers. To adequately serve these communities we now face an urgent need to test the feasibility and efficacy of already validated, remotely-delivered stress management programs in health disparity populations. Such remotely delivered interventions, including MBCT, are feasible and recent data suggest are highly efficient and efficacious for depression, anxiety, PTSD and SUD. Based on this evidence, we propose to conduct a RCT of remotely delivered MBCT (N=30) & PMR (N=30) in underserved, trauma-exposed health disparity populations disproportionately impacted by COVID in South East Michigan. We will test hypotheses about the efficacy of remotely-delivered stress management for COVID-related stress, anxiety and depression in this population, as well as hypotheses about the specific psychological mechanism of MBCT, involving increased decentering / metacognitive emotional regulation, and how this relates to improvement in PNT and related distress.