Early life adversity (ELA) is a major public health crisis that results in significant disruptions in neurobiological processes and long-term psychiatric and health consequences, yet very little is known about interventions that may prevent them and the optimal time to do so. ELA is characterized by chronic instances of emotional and physical abuse and neglect, sexual abuse, household dysfunction, and other events that repeatedly activate the body?s stress response. Not only is ELA associated with earlier onset and greater severity and comorbidity of depression, anxiety, and substance abuse, but these individuals also evidence significantly poorer responses to psychological and pharmacological interventions when treated for these conditions. An impressive body of research has documented the neurobiological injuries related to ELA exposure that lead to mental and physical health problems, including those in the endocrine and immune systems, gene expression, and brain development and function. However, whether these disruptions can be compensated for or altogether reversed with behavioral interventions, and what strategies may target these the disrupted underlying mechanisms to optimize outcomes has received very little attention. Mindfulness training promotes emotional awareness and regulation by enhancing the development of control over one?s thoughts, emotions, and behaviors, and is thus suited to target neural processes involved in psychological stress responses in ELA-exposed youth. With respect to its neural underpinnings, mindfulness practice downregulates the default mode network, and in particular the posterior cingulate cortex (PCC), which are also adversely affected by ELA-exposure. Although mindfulness practice has positive effects on both symptoms and brain function, it is unclear whether augmenting mindfulness training with PCC-targeted ?brain-training? (i.e., neurofeedback) acutely reverses the dysregulation associated with ELA exposure, and whether this change translates into state improvements in mindfulness and psychological functioning in ELA youth. To that end, the proposed project will first establish the augmented mindfulness training protocol (PCC-targeted neurofeedback during mindfulness practice) for use with healthy control and ELA-exposed youth. Next, we will randomly assign ELA-exposed to either complete the neurofeedback augmented mindfulness training or mindfulness training without neurofeedback. The proposed research does not only examine a novel approach for optimization of mindfulness training, but also, by directly targeting the disrupted neural circuitry, attempts to address the poorer treatment outcomes in this population. This will prompt new avenues of explanatory and preventive research in this population, and may lead to development and refinement of individualized treatment approaches. Given the high prevalence of ELA and its cost to society, improvement of ELA-related outcomes is among the most important challenges currently facing our communities.
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