目的:这项研究的主要目的是进行一项开放的试点临床试验,对军人轻度创伤性脑损伤后出现的持续脑震荡症状进行简短的基于正念的干预。对于许多服务成员来说,操作节奏和其他时间限制可能会阻止他们完成基于正念的标准减压课程。因此,这项研究试图检查一种名为基于正念的压力的五节干预的有效性,疼痛,情感,和注意力调节(MSPEAR)。
方法:参与者是有轻度创伤性脑损伤(TBI)和持续脑震荡后症状的现役军人,所有这些人都是从军事治疗机构的门诊TBI康复计划中招募的.在最初注册的38名服务成员中,25完成了为期5次的MSPEAR干预,20人返回进行为期5周的随访评估。问卷评估感知压力,积极的影响,疼痛干扰和灾难,睡眠障碍,感知行为和注意力调节,在干预前进行自我效能感和生活满意度,干预后,和5周的随访间隔。干预前和5周随访时的神经心理学测试包括绩效效度测量,注意,工作记忆,和执行功能措施。进行T检验以比较干预前(时间1)和干预后(时间2)的问卷测量。在时间1,时间2和时间3(5周随访)进行了重复的方差分析,以比较问卷和神经心理学措施。
结果:感知压力的改善,积极的影响,行为调节,元认知,睡眠障碍,自我效能感,在MSPEAR干预后立即发现生活满意度,并在5周随访时维持.将干预前与5周随访进行比较时,疼痛灾难化的放大和无助方面得到了改善。不同研究评估时间的疼痛干扰没有显著差异。神经心理学测试显示持续注意力的改善,工作记忆,认知灵活性,和抑制控制时,将干预前与5周随访评估进行比较。
结论:MSPEAR干预似乎有望作为军事人员轻度创伤性脑损伤后特定脑震荡后症状的简短有效治疗方法。MSPEAR的每个组成部分包括应力,痛苦的灾难,情绪和注意力调节在这项研究中显示出改善,并进行更大规模的调查,在轻度创伤性脑损伤后出现持续症状的现役军人中,优选随机对照试验。
OBJECTIVE: The primary aim of this study was to conduct an open pilot clinical trial of a brief mindfulness-based intervention for persistent postconcussion symptoms that occur after mild traumatic brain injury in military service members. For many service members, operational tempo and other time constraints may prevent them from completing a standard mindfulness-based stress reduction course. Thus, this study sought to examine the effectiveness of a five-session intervention called mindfulness-based stress, pain, emotion, and attention regulation (MSPEAR).
METHODS: Participants were active duty service members with a history of mild traumatic brain injury (TBI) and persisting postconcussion symptoms, all of whom were recruited from an outpatient TBI rehabilitation program at a military treatment facility. Of the 38 service members that were initially enrolled, 25 completed the 5-session MSPEAR intervention, and 20 returned for a 5-week follow-up evaluation. Questionnaires assessing perceived stress, positive affect, pain interference and catastrophizing, sleep disturbances, perceived behavioral and attention regulation, self-efficacy and satisfaction with life were administered at preintervention, postintervention, and at 5-week follow-up intervals. Neuropsychological testing at preintervention and 5-week follow-up included performance validity measures, attention, working memory, and executive function measures. T-tests were run to compare for questionnaire measures at preintervention (Time 1) to postintervention (Time 2). Repeated analysis of variances were conducted to compare questionnaire and neuropsychological measures at Time 1, Time 2, and at Time 3 which is the 5-week follow-up.
RESULTS: Improvements in perceived stress, positive affect, behavioral regulation, metacognition, sleep disturbance, self-efficacy, and satisfaction with life were found immediately after the MSPEAR intervention and were maintained at the 5-week follow-up. Magnification and helplessness aspects of pain catastrophizing improved when comparing preintervention to the 5-week follow-up. Pain interference was not significantly different across study assessment times. Neuropsychological testing revealed improvements in sustained attention, working memory, cognitive flexibility, and inhibitory control when comparing preintervention to the 5-week follow-up assessment.
CONCLUSIONS: The MSPEAR intervention appears to show promise as a brief and effective therapy for specific postconcussion symptoms after mild traumatic brain injury in military service members. Each of the components of MSPEAR including stress, pain catastrophizing, emotion and attention regulation showed improvements in this study, and bears further investigation in a larger scale, preferably randomized controlled trial in those active duty military service members who experience persisting symptoms after a mild traumatic brain injury.