正念减压疗法对早年受虐女性实验性疼痛敏感性和皮质醇反应的影响：一项随机对照试验。
Effects of Mindfulness-Based Stress Reduction on Experimental Pain Sensitivity and Cortisol Responses in Women With Early Life Abuse: A Randomized Controlled Trial.
机构信息
From the Department of Psychiatry (Andersen, Geiger, Schiller, Bluth, Xia, Tauseef, Leserman, Girdler), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychiatry and Behavioral Sciences (Watkins), Duke University, Durham; and Departments of Biostatistics (Zhang) and Physical Medicine and Rehabilitation (Gaylord), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
出版信息
Psychosom Med. 2021;83(6):515-527. doi: 10.1097/PSY.0000000000000889.
OBJECTIVE
Early life abuse (ELAb) initiates pathophysiological cascades resulting in long-term maladaptive stress responsivity, hyperalgesia, and an increased risk of psychopathology. Mindfulness-based stress reduction (MBSR) is effective in modifying psychological and somatic symptoms; thus, we predicted that MBSR would be particularly efficacious for women with ELAb.
METHOD
Medically healthy women (mean age = 31 years) with or without a history of early (≤13 years) physical or sexual abuse provided self-report measures and were tested in the laboratory before and after randomization to standard MBSR (n = 52) or social support (SSG) (n = 60) for 8 weeks. The laboratory procedure involved pain testing using the cold pressor and temporal summation of heat pain (indexing central sensitization) procedures, and exposure to the Trier Social Stress Test. Plasma cortisol in response to the experimental protocol was assessed as area under the curve (AUC).
RESULTS
The interventions differentially impacted pain sensitivity and cortisol AUC for women with ELAb, as MBSR increased the temporal summation of heat pain intensity ratings (p = .024) and reduced cortisol AUC (p = .004). For women without ELAb, MBSR decreased cold pressor tolerance (p = .045) and decreased the temporal summation of heat pain intensity ratings relative to SSG (p = .024). Both MBSR and SSG improved depression symptoms and emotion regulation abilities (p values < .001); however, MBSR was associated with greater benefits in describing emotions (p = .008) and impulse control (p = .017) for women with ELAb.
CONCLUSIONS
Women with ELAb benefited from MBSR-specific improvements in central sensitization, mindfulness skills, and emotion regulation abilities. This is the first study to examine the efficacy of MBSR in modifying affective and somatic symptoms based on ELAb status and provides evidence for considering ELAb in tailoring treatment approaches.Trial Registration: ClinicalTrials.gov Identifier: NCT01995916; https://clinicaltrials.gov/ct2/show/NCT01995916.
目的
早期生活虐待（ELAb）引发病理生理级联反应，导致长期适应不良的应激反应、痛觉过敏和精神病理学风险增加。基于正念减压（MBSR）在改变心理和躯体症状方面是有效的；因此，我们预测 MBSR 对有 ELAb 的女性特别有效。
方法
有或没有早期（≤13 岁）身体或性虐待史的医学健康女性（平均年龄=31 岁）提供自我报告的测量结果，并在随机分配到标准 MBSR（n=52）或社会支持（SSG）（n=60）之前和之后在实验室中进行测试，为期 8 周。实验室程序包括使用冷加压和热痛的时间总和（索引中枢敏化）程序进行疼痛测试，以及暴露于特里尔社会应激测试。通过评估实验方案的血浆皮质醇作为曲线下面积（AUC）。
结果
干预措施对有 ELAb 的女性的疼痛敏感性和皮质醇 AUC 产生了不同的影响，因为 MBSR 增加了热痛强度评分的时间总和（p=0.024）并降低了皮质醇 AUC（p=0.004）。对于没有 ELAb 的女性，MBSR 降低了冷加压耐受性（p=0.045），并且与 SSG 相比降低了热痛强度评分的时间总和（p=0.024）。MBSR 和 SSG 都改善了抑郁症状和情绪调节能力（p 值<.001）；然而，对于有 ELAb 的女性，MBSR 与描述情绪（p=0.008）和冲动控制（p=0.017）方面的更大益处相关。
结论
有 ELAb 的女性从 MBSR 特异性改善中枢敏化、正念技能和情绪调节能力中受益。这是第一项研究根据 ELAb 状态检查 MBSR 对调节情感和躯体症状的疗效的研究，并为考虑 ELAb 来调整治疗方法提供了证据。
试验注册
临床试验.gov 标识符：NCT01995916；https://clinicaltrials.gov/ct2/show/NCT01995916。
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