Exploratory Analysis of RR and MBSR for Stress Reduction

描述（由申请人提供）：在美国和世界各地的医疗机构中，有300多个独立的减压项目是模仿赫伯特·本森的放松反应（RR）计划或乔恩·卡巴金开发的正念减压（MBSR）计划的。虽然这两种治疗方法都是基于冥想，但每一种治疗方法所依据的科学哲学和冥想传统是不同的，这些差异反映在教给患者的指导和练习中。有大量已发表的证据支持每种方案的有效性，我们的初步数据表明，每种干预措施可能与不同的作用机制有关。我们的功能性MRI数据表明，每种冥想方式在区域激活上都有统计学上的显著差异；此外，每种形式的冥想都与呼吸变化的不同模式和幅度有关。

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.