Exploratory Analysis of RR and MBSR for Stress Reduction

描述(申请人提供)：美国和世界各地医疗机构的300多个独立的压力缓解计划是以赫伯特·本森的放松反应(RR)计划或Jon Kabat-Zinn开发的基于正念的压力减轻(MBSR)计划为蓝本。虽然这两种疗法都是基于冥想，但每种疗法的科学哲学和冥想传统都是不同的，这些差异反映在向患者传授的指导和练习中。有相当多的公开发表的证据支持每个方案的有效性，我们的初步数据表明，每个干预措施可能与不同的作用机制有关。我们的功能磁共振数据表明，每种冥想方式都与区域激活的统计上的显着差异有关；此外，每种冥想形式都与呼吸变化的不同模式和大小有关。 这是与每个干预的创始机构以及麻省理工学院马蒂诺斯生物医学成像中心的首次合作。在这项初步研究中，功能磁共振成像将与行为测量相结合，以确定放松反应的深度和正念的变化，以评估RR和MBSR干预措施的具体神经、生理和心理结果。从这些研究中获得的数据将提供第一个直接证据，证明这两种流行的减压干预措施的作用机制不同。这些目标符合NCCAM规定的研究重点，即资助旨在阐明有效、补充和替代医疗实践背后的作用机制的研究。 我们将对60名自报亚临床心理障碍的成年人进行临床试验。受试者将随机接受RR(n=30)或MBSR(n=30)计划。在接受其中一项干预之前和之后，所有受试者将参加GCRC和MRI扫描仪的数据收集会议，并完成心理问卷。临床结果的维持将在三个月的随访时间点进行评估。 公共卫生相关性：这项研究将确定两个成功的减压计划之间的不同作用机制：放松反应计划(RR)和基于正念的压力减轻计划(MBSR)。这两个计划都被证明在减轻压力方面是有效的，但它们似乎通过不同的机制运作，因此可能解决不同的潜在压力来源。如果成功，这项研究将提供关于以下方面的初步数据：(I)两种干预措施的作用机制，(Ii)最有可能从每种干预措施中受益的患者群体，以及(Iii)潜在的应激和减压的神经生理过程。

DESCRIPTION (provided by applicant): More than 300 independent stress reduction programs in medical facilities throughout the US and the world are modeled on either Herbert Benson's Relaxation Response (RR) program or the Mindfulness-Based Stress Reduction (MBSR) program developed by Jon Kabat-Zinn. Although both treatments are based on meditation, the scientific philosophies and meditative traditions upon which each is founded are different and these differences are reflected in the instructions and exercises taught to patients. There is considerable published evidence supporting the efficacy of each program and our preliminary data suggests that each intervention may be associated with differential mechanisms of action. Our functional MRI data suggests that each style of meditation is associated with statistically significant differences in regional activation; furthermore each form of meditation is associated with a differential pattern and magnitude of respiratory change. This is a first-time collaboration with the founding institutions of each intervention and the Martinos Center for Biomedical Imaging at the MGH. In this pilot study, functional MRI will be combined with behavioral measures for determining the depth of the relaxation response and changes in mindfulness to evaluate specific neurological, physiological and psychological outcomes of the RR and MBSR interventions. The data gained from these studies will provide the first direct evidence of differential mechanisms of action between these two popular stress reduction interventions. These aims are in accordance with NCCAM's stated research priority for the funding of studies geared to elucidating mechanisms of action underlying efficacious complementary and alternative medical practices. We will conduct a clinical trial of 60 adults with self-reported sub-clinical psychological distress. Subjects will be randomized to receiving the RR (n=30) or MBSR (n=30) program. Before and after receiving one of the interventions, all subjects will attend data collection sessions in the GCRC and MRI scanner, and complete psychological questionnaires. Maintenance of clinical outcome will be assessed at the three-month follow-up timepoint. Public Health Relevance: This study will identify differential mechanisms of action between two successful stress-reduction programs: the Relaxation Response program ("RR") and the Mindfulness-based Stress Reduction program ("MBSR"). Both of these programs have been shown to be effective at reducing stress, yet they appear to operate by distinct mechanisms and therefore may address different underlying sources of stress. If successful, this study would provide preliminary data regarding (i) the mechanisms of action at work in both interventions, (ii) patient populations that are most likely to benefit from each and (iii) the neurophysiologic processes underlying stress and stress-reduction.