Shapira Itamar, Richman Joshua, Pace Thaddeus W W, Lim Kelvin O, Polusny Melissa A, Hamner Mark B, Bremner J Douglas, Mumba Mercy N, Jacobs M Lindsey, Pilkinton Patricia, Davis Lori L
School of Medicine, UAB Heersink School of Medicine, 1670 University Blvd, Birmingham, AL 35233, USA.
Department of Surgery, UAB Heersink School of Medicine, Birmingham, AL, USA.
Mindfulness (N Y). 2022 Oct;13(10):2448-2460. doi: 10.1007/s12671-022-01969-6. Epub 2022 Sep 12.
This study evaluates the effects of treatment with mindfulness-based stress reduction (MBSR) compared to the active control, present-centered group therapy (PCGT), on morning plasma cortisol, interleukin-6 (IL-6), and C-reactive protein (CRP) in veterans diagnosed with post-traumatic stress disorder (PTSD).
In a post hoc exploratory analysis, we pooled biomarkers and clinical outcomes of mindfulness, PTSD, and depression from two randomized controlled trials comparing MBSR ( = 104) to PCGT ( = 106) in U.S. military veterans diagnosed with PTSD. Linear mixed-effects modeling was used to evaluate associations between changes in biomarkers and clinical outcomes from baseline to 9-week primary endpoint and 16-week follow-up endpoint.
Cortisol levels were inversely related to self-reported PTSD symptoms at baseline ( = 0.02). Cortisol increased from baseline to 9-week endpoint for both groups, but significantly less so in the MBSR group compared to PCGT group (mean difference 1.69 ± 0.8 SE; = 0.035). Changes in IL-6 and CRP did not differ between groups at either baseline or week 9. From baseline to week 9, increased mindfulness was significantly associated with increased cortisol ( = 0.02) and decreased PTSD and depression severity ( < 0.01). Increased IL-6 and CRP were significantly associated with decreased PTSD severity ( < 0.05), but not depression. Pooled analysis corroborated earlier findings that MBSR is significantly better than PCGT in improving clinical outcomes. Increased mindfulness was strongly associated with improved symptoms.
Increased mindfulness is associated with a recalibration of cortisol levels which may be indicative of therapeutic response, especially in patients with lower baseline cortisol. Furthermore, mindfulness-based practices improve symptoms of PTSD and depression in a significant correlation with self-reported levels of mindfulness.
NCT01532999 and NCT01548742.
本研究评估了基于正念减压疗法（MBSR）与积极对照的以当下为中心的团体治疗（PCGT）相比，对诊断为创伤后应激障碍（PTSD）的退伍军人早晨血浆皮质醇、白细胞介素-6（IL-6）和C反应蛋白（CRP）的影响。
在一项事后探索性分析中，我们汇总了两项随机对照试验中的生物标志物以及正念、PTSD和抑郁的临床结果，这两项试验比较了美国诊断为PTSD的退伍军人中MBSR组（n = 104）和PCGT组（n = 106）。线性混合效应模型用于评估从基线到9周主要终点和16周随访终点生物标志物变化与临床结果之间的关联。
皮质醇水平在基线时与自我报告的PTSD症状呈负相关（r = 0.02）。两组的皮质醇水平从基线到9周终点均升高，但MBSR组相比PCGT组升高幅度明显更小（平均差异1.69±0.8 SE；P = 0.035）。IL-6和CRP的变化在基线或第9周时两组之间没有差异。从基线到第9周，正念增强与皮质醇升高显著相关（r = 0.02），且PTSD和抑郁严重程度降低（P < 0.01）。IL-6和CRP升高与PTSD严重程度降低显著相关（P < 0.05），但与抑郁无关。汇总分析证实了早期的研究结果，即MBSR在改善临床结果方面明显优于PCGT。正念增强与症状改善密切相关。
正念增强与皮质醇水平的重新校准有关，这可能表明治疗反应，尤其是在基线皮质醇水平较低的患者中。此外，基于正念的练习可改善PTSD和抑郁症状，且与自我报告的正念水平显著相关。
ClinicalTrials.gov：NCT01532999和NCT01548742。
