Mindfulness + tDCS to Reduce Situational Urgency Incontinence in Women

项目摘要 尿失禁(UUI)是一种非常普遍、病态和昂贵的疾病(每年高达830亿美元) 在老年妇女中，65岁以上的人中有高达36%的人患有这种疾病。其中一个常见的现象是 那些有尿失禁的人是对外部刺激的条件性膀胱反应，通常被标记为“情景性尿失禁”。 情景性尿失禁被患者描述为尿急和尿漏，当面对特定的 情境触发或提示，如走近前门/车库门时，会出现锁匙失禁，以及暴露在 流水如洗碗。研究发现，通常被归因于“膀胱痉挛”(逼尿肌过度活动)。 据透露，42%到80%的有尿失禁经历的女性会在情景中引发紧迫感， 其中约26%的人经历了情景触发的泄漏。我们最近的工作重点是 开发方法重新暴露在个人的情景紧急线索中，测试“紧急”的影响 以及自我报告紧迫感和实际渗漏情况的“安全”提示，最后评估膀胱控制的作用 大脑中对这些个人情景线索做出反应的机制。我们发现有情境感的女性 当暴露在个人的“紧急”而不是“安全”中时，UUI经历了更多的紧迫感和渗漏 他们日常生活中的摄影线索。此外，与注意和视觉空间处理相关的大脑区域 在接触到强烈但不安全的暗示时被激活。过去通过膀胱充盈模拟紧迫感的研究， 显示前额叶皮质，一个执行控制的位置，被激活，以帮助控制膀胱的激活。 然而，我们的研究发现，在接触视觉线索的女性中，PFC并没有被招募 情势紧迫性。因此，我们认为，能够在暴露期间增强PFC激活的干预措施 在紧急情况下，女性应该能够获得对线索的执行控制权，从而减少对线索的刺激 紧迫性和渗漏，以及整体尿路感染症状。使用我们现在经过充分测试的方法来个性化 我们的目标是测试这种方法的可行性、可接受性、 以及这些有希望的方法在减轻与紧急相关的反应性和减少UUI症状方面的依从性。 这些新方法包括：(1)专注于身体扫描和接受语言的短暂正念(MI)，(2) 经颅直流电刺激(TDC)应用于PFC背外侧，以及(3)MI+ Tdcs。60名患有情景性尿失禁的女性将被随机分成7个疗程的研究，并进行邮寄随访1- 训练后一周。所有参与者将接受4次紧急线索暴露培训，在此期间他们将 参与三种干预中的一种，以小组为基础。紧急程度的更改将通过开机自检前评估 训练差异：对个人冲动和安全线索的线索-反应时间，对尿Stroop任务的反应时间，自我 报告膀胱问题的严重程度，并在每日的膀胱日记中报告UUI发作和紧急程度。衰减 对情景紧急提示的反应将增加我们补充和增强UUI有效性的能力 治疗并减轻其许多患者的症状负担。

Project Summary Urinary urgency incontinence (UUI) is a highly prevalent, morbid and costly (up to $83 billion/year) disorder among older women, with up to 36% of those over 65 afflicted. One commonly experienced phenomenon among those with UUI is conditioned bladder responses to external triggers, often labeled “situational incontinence.” Situational incontinence is described by sufferers as urinary urgency and leakage when confronted with specific contextual triggers or cues, such as approaching the front/garage door ‘latch-key incontinence’, and exposure to running water such as doing dishes. Generally ascribed to 'bladder spasms' (detrusor overactivity), studies have revealed that anywhere between 42% and 80% of women with UUI experience situationally provoked urgency, with approximately 26% of those experiencing situationally triggered leakage. Our recent work has focused on developing methods to recreate exposure to individuals’ situational urgency cues, testing the impact of “urgency” and “safe” cues on self-report urgency and actual leakage, and finally assessing the role of bladder control mechanisms in the brain in response to these personal situational cues. We found that women with situational UUI experienced increased urgency and leakage when exposed to personal “urgency” versus “safe” photographic cues from their daily lives. Further, brain areas related to attentional and visuospatial processing were activated during exposure to urge, but not safe, cues. Past studies of urgency simulated by bladder filling, show that prefrontal cortex, a seat of executive control, is activated to aid in controlling bladder activation. However, our study found that the PFC was not recruited during exposure to visual cues among women with situational urgency. Thus, we propose that interventions capable of enhancing PFC activation during exposure to urgency situations should enable women to gain executive control over cues and result in less cue-provoked urgency and leakage, as well as overall UUI symptomatology. Using our now well-tested methods to personalize stimuli with photographs of urgency-provoking situational cues, our goal is to test the feasibility, acceptability, and compliance of these promising methods to attenuate urgency-related reactivity and reduce UUI symptoms. These novel methods include: (1) Brief mindfulness (MI) focused on body scan and acceptance language, (2) Transcranial direct current stimulation (tDCS) applied to the dorsolateral PFC, and (3) a combination of MI + tDCS. Sixty women with situational UUI will be randomized into a 7-session study, with a mail-in follow up 1- week post-training. All participants will undergo 4 urgency-cue exposure training sessions during which they will engage in one of the three interventions, based on group. Changes in urgency will be assessed via pre-post training differences in: Cue-reactivity to personal urge and safe cues, reaction time to a urinary Stroop task, self- report severity of bladder problems, and UUI episodes and urgency ratings on a daily bladder diary. Attenuating reactivity to situational urgency cues will increase our ability to complement and enhance the efficacy of UUI therapy and reduce symptom burden for its many sufferers.