Mindfulness-based Stress Reduction for Multiple Sclerosis: Feasibility, Durability, and Clinical Outcomes

这个K23指导职业发展奖的总体目标是促进候选人向神经疾病的压力和压力管理的独立研究人员的过渡。心理应激可对多发性硬化症(MS)产生不利影响，并与神经症状恶化、MRI病变负担增加和生活质量下降有关。基于正念的压力减轻(MBSR)在各种情况下改善了健康结果，但关于多发性硬化症或神经功能障碍患者的MBSR数据有限。此外，一旦干预完成，关于MBSR效果随时间的可持续性存在相互矛盾的证据：一些研究表明效果保持，而另一些研究发现效果减弱超过12个月。为此，拟议研究的具体目的是：1)确定MBSR对MS患者的可行性，2)探索MBSR改善生活质量和MS症状的能力，3)评估MBSR结果在12个月的随访中的持久性。候选人将进行MBSR与教育对照的随机对照试验(n=60)。对于可行性，具体的招聘、采用和遵守标准将决定成功与否。对于初步的健康结果，MBSR和对照组参与者将在8周时比较感知压力、生活质量和常见多发性硬化症症状的有效测量。对于持久性，干预后将对健康结果进行12个月的跟踪。在研究结束时，对参与者的深入访谈将探索加强或阻止压力管理维持的行动、心理前景、环境因素和资源。定性数据将为定量结果提供背景，这些结果将共同描述MBSR的稳定性和干预后行为变化的轨迹。为了确保她的成功，候选人设计了一个全面的指导研究、教学培训和专业发展计划，重点放在四个具体的培训目标上：1)获得心身行为干预试验的专业知识，2)提高混合方法和行为变化研究的高级知识，3)通过公共卫生硕士提高统计知识和能力，4)继续作为CAM研究的讲演者、导师和领导者进行专业发展。这一奖项将为候选人提供一个独特的机会，与美国两家领先的CAM和传统医学学术研究机构合作。由MS、心身医学、压力结果和定性方法等领域的专家组成的跨学科团队将指导应聘者的研究和高级培训。这项研究有可能改善MBSR的临床应用，进一步阐明从行为起始到长期行为改变的转变，并显著提高MS患者的生活质量。研究结果可能不仅适用于MS，还可能作为其他有身体限制或神经损害的疾病的模型。重要的是，这个有指导的K23职业发展奖将为候选人成为一名成功的、独立资助的神经疾病压力和压力管理研究人员做好准备。

The overall goal of this K23 Mentored Career Development Award is to enhance the candidate's transition to an independent investigator of stress and stress-management for neurological conditions. Psychological stress can have detrimental effects in multiple sclerosis (MS) and is associated with worsening neurological symptoms, increased lesion burden on MRI, and decreased quality of life. Mindfulness-based stress reduction (MBSR) has improved health outcomes across a variety of conditions yet there is limited data regarding MBSR for people with MS or neurological disabilities in general. Furthermore, once the intervention is complete there is conflicting evidence as to the sustainability of MBSR effects over time: some studies show maintenance of effects while others find attenuation over 12 months. To this end, the specific aims of the proposed research are to: 1) Determine the feasibility of MBSR for people with MS, 2) Explore the ability of MBSR to improve quality of life and MS symptoms, and 3) Evaluate the durability of MBSR outcomes over a 12-month follow up. The candidate will conduct a randomized controlled trial of MBSR vs. education control (n=60). For feasibility, specific recruitment, adoption, and adherence criteria will determine success. For preliminary health outcomes, validated measures of perceived stress, quality of life, and common MS symptoms will be compared between MBSR and control participants at eight weeks. For durability, health outcomes will be tracked for 12 months post-intervention. At the close of the study, in-depth interviews with participants will explore actions, psychological outlook, environmental factors, and resources that enhance or deter stress-management maintenance. Qualitative data will provide context for quantitative outcomes and together these results will depict the stability of MBSR and the trajectory of behavior change post-intervention. To ensure her success, the candidate has devised a comprehensive program of mentored research, didactic training, and professional development that focuses on four specific training goals: 1) Gain expertise in mind-body behavioral intervention trials, 2) Advance knowledge in mixed methods and behavior change research, 3) Enhance statistical knowledge and abilities with a Master in Public Health, 4) Continue professional development as a presenter, mentor, and leader in CAM research. This award will provide a unique opportunity for the candidate to work collaboratively with two of the nation’s leading academic research institutions in CAM and conventional medicine. A cross-disciplinary team of experts in MS, mind-body medicine, stress outcomes, and qualitative methods will guide the candidate’s research and advanced training. The proposed research has the potential to improve the clinical application of MBSR, further elucidate the transition from behavior initiation to long-term behavior change, and substantially improve quality of life for people with MS. Findings may not only be applicable to MS but may serve as a model for other conditions with physical limitations or neurological impairments, as well. Importantly, this mentored K23 Career Development Award will prepare the candidate to become a successful, independently funded investigator in stress and stress-management for neurological conditions.