Primary-Care Based Mindfulness Intervention for Chronically Traumatized Individuals

项目总结/摘要 低收入城市居民反复遭受创伤的比率和与创伤有关的精神障碍水平 少数民族社区远远超过全国平均水平。尽管如此，缺乏充分的机会和实质性障碍， 城市受创伤人口的治疗仍然存在。基于正念的干预可以针对情绪 自主神经系统的失调和功能障碍，导致创伤相关的机制， 精神疾病的结果，如创伤后应激障碍（PTSD）和重度抑郁症（MDD）。一致 NCCIH的战略目标是改善难以管理的症状的护理，本研究的目的是 是为长期遭受创伤的非裔美国人试行一项基于初级保健的正念干预， 在一家城市公立医院的初级保健诊所中筛查PTSD和MDD阳性。这项研究将 采用随机对照试验（RCT）设计，沿着多方法心理和生理学研究 建立正念认知疗法的可行性和可接受性的评估方法 非裔美国人慢性创伤患者初级保健干预（MBCT）]与等待名单对照 暴露和共病PTSD和MDD。也符合NCCIH推进 了解身心干预方法的基本机制， 与MBCT相关的结果的作用和变化，包括情绪失调，自主神经功能， 并评估创伤后应激障碍和抑郁症症状数据收集和[8节]小组干预将 在城市公立医院的初级保健诊所进行，主要服务于低收入、少数民族、 美国人（80%以上）。培训活动将在学术医疗环境中进行， 这是一个更广泛的项目，旨在了解创伤后应激障碍的心理和生物风险因素。 本K23项目的培训目标包括：1）学习如何设计、实施和评估 补充和综合行为健康干预，2）[获得加强正念训练 和综合护理]，3）学习纵向数据分析技术，以及4）收集和分析 心理生理变量和整合心理生理数据到治疗研究。最后， 申请人的职业目标包括致力于改善服务不足的平民创伤人群的治疗 在城市环境中，采取互补的综合健康观点， 创伤相关治疗背景下的变化机制。采取客观措施 在行为健康的背景下， 治疗也将有助于我们理解可能因这些而改变的生物机制。 治疗以及这些潜在的生物机制如何长期积极影响健康结果。

Project Summary/Abstract Rates of repeated exposure to trauma and levels of trauma-related psychiatric disorders in low-income, urban minority communities far exceed national averages. Despite this, inadequate access and substantial barriers to treatment in urban traumatized populations remain. Mindfulness-based interventions may target emotion dysregulation and dysfunction of the autonomic nervous system, mechanisms that contribute to trauma-related psychiatric outcomes like posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In line with the strategic goals of the NCCIH to improve care for hard-to-manage symptoms, the purpose of this study is to pilot a primary-care based mindfulness intervention for chronically traumatized African Americans screening positive for PTSD and MDD in primary care clinics within an urban public hospital. The study will utilize a randomized controlled trial (RCT) design along with a multi-method psychological and physiological assessment approach to establish the feasibility and acceptability of a [mindfulness-based cognitive therapy intervention for primary care (MBCT)] versus wait-list control in African Americans with chronic trauma exposure and comorbid PTSD and MDD. Also in line with the strategic goal of NCCIH to advance understanding of mechanisms underlying mind-body intervention approaches, preliminary mechanisms of action and change in outcomes associated with MBCT including emotion dysregulation, autonomic function, and PTSD and MDD symptoms will be evaluated. The data collection and [8-session] group intervention will take place in primary care clinics within an urban public hospital serving primarily low-income, minority individuals (>80% African American). Training activities will take place in an academic medical setting under the umbrella of a broader project aimed at understanding psychological and biological risk factors for PTSD. Training goals for this K23 project include 1) learning how to design, implement, and evaluate the outcomes of complementary and integrative behavioral health interventions, 2) [gaining enhanced training in mindfulness and integrated care], 3) learning longitudinal data analytic techniques, and 4) gathering and analyzing psychophysiological variables and integrating psychophysiological data into treatment research. Ultimately, career goals for the applicant include working to improve treatment for underserved civilian trauma populations in urban settings by taking a complementary integrative health perspective and enhance understanding of mechanisms of change in the context of trauma-related treatment. Bringing measures of objective physiological markers like autonomic function into primary care settings in the context of behavioral health treatments will also aid in our understanding of the biological mechanisms that may change as a result of these treatments and how those underlying biological mechanisms can positively impact health outcomes long term.