Rates of repeated exposure to trauma and levels of trauma-related psychiatric disorders in low-income, urban minority communities far exceed national averages. Despite this, inadequate access and substantial barriers to treatment in urban traumatized populations remain. Mindfulness-based interventions may target emotion dysregulation and dysfunction of the autonomic nervous system, mechanisms that contribute to trauma-related psychiatric outcomes like posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In line with the strategic goals of the NCCIH to improve care for hard-to-manage symptoms, the purpose of this study is to pilot a primary-care based mindfulness intervention for chronically traumatized African Americans screening positive for PTSD and MDD in primary care clinics within an urban public hospital. The study will utilize a randomized controlled trial (RCT) design along with a multi-method psychological and physiological assessment approach to establish the feasibility and acceptability of a [mindfulness-based cognitive therapy intervention for primary care (MBCT)] versus wait-list control in African Americans with chronic trauma exposure and comorbid PTSD and MDD. Also in line with the strategic goal of NCCIH to advance understanding of mechanisms underlying mind-body intervention approaches, preliminary mechanisms of action and change in outcomes associated with MBCT including emotion dysregulation, autonomic function, and PTSD and MDD symptoms will be evaluated. The data collection and [8-session] group intervention will take place in primary care clinics within an urban public hospital serving primarily low-income, minority individuals (>80% African American). Training activities will take place in an academic medical setting under the umbrella of a broader project aimed at understanding psychological and biological risk factors for PTSD. Training goals for this K23 project include 1) learning how to design, implement, and evaluate the outcomes of complementary and integrative behavioral health interventions, 2) [gaining enhanced training in mindfulness and integrated care], 3) learning longitudinal data analytic techniques, and 4) gathering and analyzing psychophysiological variables and integrating psychophysiological data into treatment research. Ultimately, career goals for the applicant include working to improve treatment for underserved civilian trauma populations in urban settings by taking a complementary integrative health perspective and enhance understanding of mechanisms of change in the context of trauma-related treatment. Bringing measures of objective physiological markers like autonomic function into primary care settings in the context of behavioral health treatments will also aid in our understanding of the biological mechanisms that may change as a result of these treatments and how those underlying biological mechanisms can positively impact health outcomes long term.
African Americans living in low-income, urban communities are at risk for repeated exposure to trauma and the development of posttraumatic stress disorder (PTSD) and depression, yet there remains inadequate access and substantial barriers to treatment for this at-risk population. This proposal will investigate the initial feasibility, acceptability, and preliminary mechanisms of action and outcomes of a mindfulness-based intervention in primary care for African Americans with chronic trauma exposure and PTSD and depression symptoms, with the goal of improving treatment for underserved civilian trauma populations in urban settings and enhancing understanding of mechanisms of change in the context of trauma-related treatment.
