Optimizing a mindful intervention for urban minority youth via stress physiology

项目摘要 拟议的R61/R33阶段研究旨在阐明生理应激机制， 正念计划的效果，旨在针对有外化、情感和创伤风险的青少年 由于明显的环境不利而导致的应激障碍。每个阶段的青少年将 从服务于巴尔的摩市高贫困社区的学校招募， 精神创伤和虐待是很常见的干预措施目前正在实施的几个巴尔的摩 城市学校和其他环境的整体生活基金会，公司。(HLF)，一个非营利组织， 提供基于正念的编程（呼吸工作和冥想）的长期记录， 贫困的年轻人无论是经验性的还是轶事性的关于情绪调节的显著变化的报道， 据报道，这种干预措施，但类似于大多数正念计划，影响机制还没有 尤其是在弱势青年中。 我们感兴趣的主要机制是应激生理学，如通过心率变异性（HRV）和心率变异性（HRV）测量的。 皮肤电传导反应（SCR）在急性应激，情绪调节的核心组成部分， 涉及相关临床综合征（例如，外化行为，情感障碍）。 预测干预反应（适度）和压力相关途径的青年特征 我们建议进行两项随机对照试验， 目标是最大限度地改善高危青少年的外化行为、情感障碍和创伤性障碍。在 R61，我们将集中测量正念计划的机械效果，以确定其在一个 在概念上是合适的人口。4所巴尔的摩城市高中的学生将被随机分配接受治疗 和积极控制条件（N=160名学生），并在基线，干预后和随访时进行评估。 将确定响应于干预而改善的应激生理特征。在R33中， 进行更大规模的RCT（8所学校，N=240），分配给正念课程或 正念程序加上增强-HRV生物反馈-显示独立地对 应激反应将在条件之间进行比较，然后将调解模型应用于 干预条件表现出最大的影响，以确定是否积极的变化，在应激生理 解释结果的改善。这一系列研究将描述最大限度地 受正念的影响，并将区分治疗条件，从而更有效， 有效的定位和扩展。通过这样做，这项研究将在快速发展的领域开辟新的天地， 青年正念为基础的干预措施，通过确定关键的生理机制的影响， 正念练习

PROJECT SUMMARY The proposed R61/R33 phased study aims to elucidate the physiological stress mechanisms underlying effects of a mindfulness program designed to target youth at risk for externalizing, affective and traumatic stress disorders by virtue of significant environmental disadvantage. Adolescents for each phase will be recruited from schools serving high poverty neighborhoods in Baltimore City where adversity and experiences of trauma and maltreatment are common. The intervention is currently being implemented in a few Baltimore City schools and other settings by the Holistic Life Foundation, Inc. (HLF), a non-profit organization with a lengthy track record of providing mindfulness-based programming (breath work and meditation) to impoverished youth. Both empirical and anecdotal reports of significant change in emotion regulation have been reported with this intervention, yet similar to most mindfulness programs, mechanisms of effects have not yet been delineated, particularly in disadvantaged youth. Our primary mechanism of interest is stress physiology, as measured by heart rate variability (HRV) and skin conductance response (SCR) during acute stress, a central component of emotion regulation and implicated in relevant clinical syndromes (e.g., externalizing behaviors, affective disorders).To identify the characteristics of youth that predict intervention response (moderation) and the stress-related pathways through which positive outcomes are achieved (mediation), we propose to conduct two RCTs with the ultimate goal to maximally improve externalizing behaviors and affective and traumatic disorders in at-risk youth. In the R61, we will intensively measure mechanistic effects of the mindfulness program to establish its effects in a conceptually appropriate population. Students in 4 Baltimore City High Schools will be randomized to treatment and active control conditions (N=160 students) and assessed at baseline, post-intervention and follow-up. Stress physiological profiles that improve in response to intervention will be identified. In the R33, we will conduct a larger RCT (8 schools, N=240) with assignment either to the mindfulness program or the mindfulness program plus an enhancement—HRV biofeedback—shown to independently exert effects on stress responses. Comparisons will be made between conditions and then a mediation model will be applied to the intervention condition exhibiting maximal effects to determine whether positive change in stress physiology explains improvements in outcomes. This sequence of studies will characterize participants who are maximally impacted by mindfulness and will differentiate between treatment conditions, leading to more efficient and effective targeting and scaling. In so doing, this research will break new ground in the rapidly growing field of youth mindfulness-based interventions by identifying key physiological mechanisms of effect for common mindfulness practices.