Joss Diane, Rosansky Joseph, Gardiner Paula, Edwards Robert R, Weiss Roger D, Napadow Vitaly, Schuman-Olivier Zev
Center for Mindfulness and Compassion, Cambridge Health Alliance, Malden, MA, United States.
Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
Front Psychol. 2025 Apr 30;16:1529106. doi: 10.3389/fpsyg.2025.1529106. eCollection 2025.
Adverse childhood experiences (ACE) are transdiagnostic developmental risk factors for various mental and physical health issues, including Opioid Use Disorder (OUD). Existing research demonstrated ACE not only affects the onset, severity, and comorbidity of disorders, but also affects treatment responses. To investigate whether and how ACE modulates treatment effects of Mindfulness Based Intervention (MBI), we conducted secondary analysis on the longitudinal data from a recent clinical trial on the effects of a MBI during outpatient buprenorphine treatment.
Using data from a RCT that randomized (1:1) a total of 196 patients with OUD into a live online group intervention with either a 24-week MBI or a matched recovery support control group, we conducted temporal path analysis with the following outcome measures: self-critical rumination, pain catastrophizing, pain interference, severity of depression and anxiety.
Both treatment arms had significant reduction of all symptom measures, but the MBI arm had a significant mechanistic path of ACE (baseline) ➔Self-Critical Rumination (week 8)➔Pain Catastrophizing (week 16) ➔ Pain Interference (week 24), which was not significant in the control arm. Only in the MBI arm, ACE severity was significantly correlated with score reductions of Self-Critical Rumination (week 8), which was not significant in the control arm.
ACE modulated treatment responses to MBI, through a mechanistic path in which symptom changes of Self-Critical Rumination was a mediator between ACE and psychological symptom changes of pain catastrophizing and pain interference, suggesting Self-Critical Rumination can be considered as a therapeutic target in future intervention development.
童年不良经历（ACE）是各种身心健康问题的跨诊断发展风险因素，包括阿片类物质使用障碍（OUD）。现有研究表明，ACE不仅影响疾病的发作、严重程度和共病情况，还会影响治疗反应。为了研究ACE是否以及如何调节基于正念的干预（MBI）的治疗效果，我们对最近一项关于门诊丁丙诺啡治疗期间MBI效果的临床试验的纵向数据进行了二次分析。
利用一项随机对照试验（RCT）的数据，该试验将总共196名OUD患者按1:1随机分为实时在线小组干预组，一组接受为期24周的MBI，另一组为匹配的康复支持对照组。我们采用时间路径分析，以以下指标作为结果测量：自我批判反刍、疼痛灾难化、疼痛干扰、抑郁和焦虑严重程度。
两个治疗组的所有症状指标均有显著降低，但MBI组有一条显著的ACE（基线）➔自我批判反刍（第8周）➔疼痛灾难化（第16周）➔疼痛干扰（第24周）的机制路径，而对照组没有此显著路径。仅在MBI组中，ACE严重程度与自我批判反刍（第8周）的得分降低显著相关，而对照组不显著。
ACE通过一种机制路径调节对MBI的治疗反应，其中自我批判反刍的症状变化是ACE与疼痛灾难化和疼痛干扰的心理症状变化之间的中介，这表明自我批判反刍可被视为未来干预发展中的一个治疗靶点。
