Mind and health: developing a neural marker for mindfulness, a pathway to health

描述（由申请人提供）：NCCAM最近委托进行的一项审查得出结论，认为关于冥想练习的研究具有方法质量差的特点，在得出这些练习对改善健康和福祉的有效性的确切结论之前，需要更严格的科学。冥想的最佳研究形式是正念，最常见的是由麻省理工学院的研究小组成员开发的正念减压（MBSR）训练。拟议R34的直接目标是验证拟议的生物标志物对MBSR的影响。基于我们的初步数据，我们提出静息状态fMRI测量边缘应激反应网络中的功能连接（FC）将成为MBSR对情绪和应激反应影响的有价值的生物标志物，并将预测健康行为的持续改善。这种生物标记物将使未来大规模的随机试验成为可能，这些试验将关注正念减压疗法对长期健康行为改变的有效性，比如维持体重减轻。提出的生物标志物将允许未来的研究基于对有效成分和个体差异的更好理解来完善正念减压干预措施，减少对自我报告测量的依赖，并为识别最有可能受益的患者和那些可能需要量身定制干预的患者提供客观测量。我们的具体目标是：(1)验证功能连接作为对MBSR反应性的生物标志物；(2)在随访6个月时，探讨功能连接改变与健康行为改变的关系。我们的初步数据表明，杏仁核-眼窝额叶回路中的FC与特质正念密切相关，与情绪反应呈负相关，并且2)仅仅8周的正念减压训练就能增强这一回路。此外，正念减压训练在这一回路中产生了可量化的变化，与影响健康行为的心理特征的改善相对应。我们将随机抽取100名社区参与者进行正念减压或注意力控制。终点包括FC、健康行为（睡眠质量、身体活动、健康饮食）和相关心理结构（感知压力、抑郁、特质焦虑、特质愤怒和积极影响）的变化。终点将在基线、8周和12周进行测量，并在6个月时对健康行为和心理结果进行额外测量。我们假设干预组会比对照组经历更大的FC增加，并且FC的变化与健康行为和心理结构相关。我们还将考虑干预参与和预期。客观、定量地测量正念减压/正念对大脑的影响的能力是非常创新的。我们的跨学科研究团队包括正念减压疗法的开发人员、经验丰富的临床试验/行为治疗研究人员以及功能成像方法专家。

DESCRIPTION (provided by applicant): A recent review commissioned by NCCAM concluded that the research on meditation practices is characterized by poor methodological quality and that more rigorous science is needed before firm conclusions can be drawn on the effectiveness of these practices for improving health and well-being. The best studied form of meditation is mindfulness, which is most commonly taught by the Mindfulness-Based Stress Reduction (MBSR) training developed by members of our research team at UMass. The immediate goal of the proposed R34 is to validate a proposed biomarker for the effects of MBSR. Based on our preliminary data, we propose that resting-state fMRI measurement of functional connectivity (FC) in the limbic stress response network will be a valuable biomarker for the effect of MBSR on emotional and stress reactivity and will predict sustained improvements in health behaviors. This biomarker will enable future large-scale randomized trials that focus on the effectiveness of MBSR for long-term health behavior change, such as maintenance of weight loss. The proposed biomarker will allow future studies to refine MBSR interventions based on improved understanding of the effective components and individual differences, reduce reliance on self-reported measures, and provide an objective measure for identifying patients most likely to benefit and those who may need a tailored intervention. Our Specific Aims are to: (1) Validate functional connectivity as a biomarker for responsiveness to MBSR; (2) Investigate the association of functional connectivity change with changes in health behaviors at 6 month follow-up. Our preliminary data demonstrate that FC in the amygdala-orbitofrontal circuit is 1) strongly correlated with trait mindfulness and inversely correlated with emotional reactivity, and 2) enhanced by just 8 weeks of MBSR training Moreover, MBSR produces quantifiable changes in this circuit that correspond to improvements in psychological traits shown to impact health behaviors. We will randomize 100 community participants to MBSR or an attention control. Endpoints include changes in FC, health behavior (sleep quality, physical activity, healthy eating), and related psychological constructs (perceived stress, depression, trait anxiety, and trait anger, and positive affect). Endpoints will be measured at baseline, 8 weeks and 12 weeks, with an additional measurement at 6 months for health behavior and psychological outcomes. We hypothesize that the intervention group will experience a greater increase in FC than the comparison group and that changes in FC will correlate with health behavior and psychological constructs. We will also account for intervention engagement and expectancy. The ability to objectively and quantitatively measure the effects of MBSR/mindfulness on the brain is highly innovative. Our inter-disciplinary research team includes the developer of MBSR, experienced clinical trials / behavioral therapy researchers, and experts in functional imaging methods.