Dismantling Mindfulness: Contributions of Attention vs. Acceptance

冥想，特别是正念冥想，是最受欢迎的补充和替代医学（CAM）疗法之一，用于缓解情绪压力，抑郁和焦虑，无论是原发性的，还是继发于另一种健康状况。虽然标准化的基于冥想的治疗包，如基于正念的减压（MBSR）和基于正念的认知疗法（MBCT）已经可靠地显示出情绪障碍和健康的持续改善，但它们包含如此多的不同成分和实践，以至于无法确定有效成分。正念包括：1）注意力调节成分，被认为是通过专注的意识练习培养的; 2）接受，非判断的心理立场，被认为是通过开放式监控练习培养的。该项目旨在为注意力和以接受为中心的冥想创建单独的实践标准，比较它们的临床疗效，并研究它们在具有临床显著水平的持续性负面影响和抑郁的个体中的单独作用机制。将通过一项为期8周的干预措施的三组随机对照试验，检查集中意识（FA）与开放监测（OM）与无治疗（等待名单）对照的临床获益和作用机制。结果变量包括负面影响（抑郁，焦虑，压力）和幸福感。假设的中介过程包括客观测量的注意力、情绪调节和它们所依赖的基本清醒。 除了研究应用外，培训计划还包括以下方面的正规教育：1）基于冥想的临床试验方法和情感障碍，2）注意力，情绪，睡眠倾向的心理生理测量，3）与治疗研究相关的生物统计方法。这项培训使我做好了准备，以实现我的长期目标，成为一名独立的、以病人为导向的研究人员。通过正式的教学指导和来自该领域领导者的经验丰富的研究人员的强有力的指导，我将开发必要的工具来阐明哪些冥想练习对情绪障碍最有帮助，以及认知和神经生理机制。 公共卫生相关性：这个应用程序解决了NCCAM的研究要求，调查身心疗法的神经心理学机制，以及精确的标准和更好地描绘冥想练习。通过从操作上定义组成“正念冥想”的两个组成部分和实践，该项目将有助于确定流行和成功的CAM疗法的有效成分。通过提供有关不同冥想练习的效果和益处的知识，该项目将帮助临床医生定制他们的治疗，以更好地满足不同患者的需求。

DESCRIPTION (provided by applicant): Meditation, particularly mindfulness meditation, is one of the most popular Complementary and Alternative Medicine (CAM) therapies for alleviating emotional stress, depression and anxiety that are either primary, or secondary to another health condition. While standardized meditation-based treatment packages like Mindfulness Based Stress Reduction (MBSR) and Mindfulness-based Cognitive Therapy (MBCT) have reliably shown sustained improvements in emotional disturbances and wellbeing, they contain so many different components and practices that the active ingredient cannot be ascertained. Mindfulness is comprised of 1) an attention regulation component, which is thought to be cultivated with focused awareness practice, and 2) an accepting, non-judgmental mental stance, which is thought to be cultivated through open-monitoring practice. This project aims to create separate practice criteria for attention and acceptance-focused meditations, compare their clinical efficacy and investigate their separate mechanisms of action in individuals with clinically significant levels of persistent negative affect and depression. The clinical benefit and mechanism of action of focused awareness (FA) vs open-monitoring (OM) vs a no-treatment (waitlist) control will be examined with a three- armed randomized control trial of these eight week interventions. Outcome variables include negative affect (depression, anxiety, stress) and wellbeing. Hypothesized mediating processes include objectively measured attention, emotion regulation and the basic wakefulness on which they depend. In addition to the research application, the training program includes formal education in 1) meditation-based clinical trials methodology and affective disorders, 2) psychophysiological measurement of attention, emotion, sleep propensity and 3) biostatistical methods related to treatment studies. This training prepares me to meet my long-term objective of becoming an independent patient- oriented researcher. Through formal didactic instruction and strong mentoring from experienced investigators who are leaders in the field, I will develop the requisite tools to shed light on which meditation practices are the most helpful for emotional disturbances and by what cognitive and neurophysiological mechanisms. PUBLIC HEALTH RELEVANCE: This application addresses NCCAM's request for research that investigates the neuropsychological mechanisms underlying mind-body therapies, and for precise criteria and better delineation of meditation practices. By operationally defining the two components and practices that comprise "mindfulness meditation", this project will help identify the active ingredients of a popular and successful CAM therapy. By providing knowledge about the effects and benefits of different meditation practices, this project will help clinicians tailor their treatment to better fit the needs of different patients.