Reducing stress with parenting-focused mindfulness to prevent youth substance use

描述（由申请人提供）：青春期是物质使用障碍发展的关键时期。显然需要预防青少年使用新型物质，特别是基于基础科学发现的发育知情干预措施（NIDA, 2010）。重要的基础研究表明，父母压力是青少年药物使用和艾滋病毒风险行为的危险因素。在面临多重慢性压力源的低收入家庭中，这种风险可能会加剧。正念减压（MBSR）是一种经验支持的治疗方法，可以减轻成人的压力。然而，正念减压疗法对养育子女压力和青少年结果的潜在强大影响尚未得到测试。这项研究的目标是开发和测试一个以父母为中心的正念减压法，以减少父母的压力，防止低收入城市家庭中青少年使用药物和艾滋病毒风险行为。我们假设以父母为中心的MBSR （P-MBSR）可以减轻父母压力，改善父母行为和亲子关系，降低青少年生物行为唤醒，并预防药物使用风险和艾滋病毒风险行为。在这个早期职业研究者发起的项目中，120名12-14岁孩子的父母将被招募到一个服务于低收入城市社区的儿童指导诊所。父母将被随机分配，在诊所接受为期8周的p -正念减压干预（基于耶鲁压力中心Sinha博士的正念减压干预），或接受育儿建议对照组。在干预前和干预后，适应性和正心育儿行为以及父母和青少年的生物行为应激反应将使用尖端的实验室范式进行测量，该范式模拟父母-青少年互动以及青少年对互动的情感和生理反应（由卓别林博士，PI；卓别林等人，2012年开发）。在干预前、干预后、干预后6个月和干预后1年，我们将收集问卷、临床访谈和父母压力、压力相关障碍、养育方式、亲子亲密程度、青少年对药物使用和艾滋病毒风险行为（如无保护的性行为）的意图和期望以及参与的生物学测量。我们将用HLM分析来检验干预的效果。基于我们的试验发现，正念减压可以减轻成人的压力，我们期望p -正念减压可以减轻父母的压力，增加适应性和正念的养育以及亲密的亲子关系，减少青少年对父母互动的生理和情感反应，防止青少年使用药物和发生危险的性行为。如果假设得到支持，研究将提供：1。P-MBSR的初步可行性和疗效数据；进行P-MBSR长期RCT的R01应用的先导效应大小数据，3。3 . P- MBSR在现实环境中的相关性和可接受性的证据。高危青少年药物使用的纵向数据。P-MBSR可能是一种具有成本效益的策略，可以减少有风险的成年人的压力和压力相关疾病，同时防止他们的孩子吸毒和危险行为。

DESCRIPTION (provided by applicant): Adolescence is a critical period for the development of substance use disorders. There is a clear need for novel substance use preventions for youth, particularly developmentally-informed interventions rooted in basic science findings (NIDA, 2010). Significant basic research indicates parent stress as a risk factor for adolescent substance use and HIV risk behaviors. This risk may be exacerbated in low-income families who face multiple chronic stressors. Mindfulness-based stress reduction (MBSR) is an empirically-supported treatment that reduces stress in adults. However, the potentially powerful effects of MBSR on parenting stress and adolescent outcomes have not been tested. The goal of the proposed study is to develop and test a parenting-focused version of MBSR to reduce parent stress and prevent adolescent substance use and HIV risk behaviors in low-income urban families. We hypothesize that parenting-focused MBSR (P-MBSR) will decrease parent stress, improve parenting behavior and the parent-child relationship, decrease youth bio-behavioral arousal, and prevent risk for substance use and HIV risk behaviors. In this early-career investigator initiated project, 120 parents of 12-14 year olds reporting high parenting stress will be recruited at a child guidance clinic serving a low-income urban community. Parents will be randomly assigned to receive either an 8 week P-MBSR intervention at the clinic (based on the MBSR intervention implemented at the Yale Stress Center by Dr. Sinha, co-I) or to a parenting advice control group. At pre- and post-intervention, adaptive and mindful parenting behaviors and parent and youth bio-behavioral stress responses will be measured using a cutting-edge laboratory paradigm that models parent-adolescent interactions and youth emotional and physiological responses to interactions (developed by Dr. Chaplin, PI; Chaplin et al., 2012). Before, after, and at 6 months and 1 year post-intervention, we will collect questionnaire, clinical interview, and biological measures of parent stress, stress-related disorders, parenting, parent-child closeness, and adolescent intentions and expectancies for and engagement in substance use and HIV risk behaviors (e.g., unprotected sex). We will test intervention effects with HLM analyses. Based on our pilot finding that MBSR decreased stress in adults, we expect that P-MBSR will reduce parent stress, increase adaptive and mindful parenting and close parent-adolescent relationships, decrease adolescent physiological and emotional responses to parent interactions and prevent youth substance use and risky sex. If hypotheses are supported, the study will provide: 1. Initial feasibility and efficacy data for P-MBSR, 2. Pilot effect size data for a R01 application to conduct a longer-term RCT of P-MBSR, 3. Evidence of relevance and acceptability of P- MBSR in a real-world setting, and 4. Longitudinal data on substance use in at-risk youth. P-MBSR could be a cost-effective strategy to reduce stress and stress-related disorders in at-risk adults and at the same time prevent drug use and risk behavior in their children.