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。显然需要为青年提供新的药物使用预防措施，特别是基于基础科学发现的知情干预措施（NIDA，2010年）。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危险行为的危险因素。这种风险在面临多种慢性压力的低收入家庭中可能会加剧。基于正念的减压（MBSR）是一种治疗支持的治疗方法，可以减轻成年人的压力。然而，正念减压疗法对父母压力和青少年结果的潜在强大影响尚未得到验证。这项研究的目的是开发和测试一个以父母为中心的MBSR版本，以减少父母的压力，防止青少年物质使用和艾滋病毒的危险行为，在低收入的城市家庭。我们假设，父母为中心的MBSR（P-MBSR）将减少父母的压力，改善父母的行为和亲子关系，减少青年生物行为的觉醒，并防止风险的物质使用和艾滋病毒的危险行为。 在这个早期职业调查者发起的项目中，120名12-14奥尔兹的父母报告了高养育压力，他们将在一个为低收入城市社区服务的儿童指导诊所招募。父母将被随机分配到诊所接受为期8周的P-MBSR干预（基于Sinha博士在耶鲁压力中心实施的MBSR干预）或育儿建议对照组。在干预前和干预后，将使用先进的实验室范例来测量适应性和有意识的育儿行为以及父母和青少年的生物行为压力反应，该实验室范例模拟了父母-青少年的互动以及青少年对互动的情感和生理反应（由PI卓别林博士开发;卓别林等人，2012年）。在干预前、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、亲子亲密度、青少年对物质使用和HIV风险行为（例如，无保护的性行为）。我们将用HLM分析来检验干预效果。基于我们的试点发现，正念减压疗法降低了成年人的压力，我们预计P-MBSR将减少父母的压力，增加适应性和正念养育，密切父母与青少年的关系，减少青少年对父母互动的生理和情感反应，并防止青少年使用药物和危险性行为。如果假设得到支持，研究将提供：1。P-MBSR的初步可行性和有效性数据，2。进行P-MBSR长期RCT的R 01应用的中试效应量数据，3。P-MBSR在现实世界中的相关性和可接受性的证据，以及4。关于高危青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，可以减少处于风险中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.