Adolescent With Early Life Stress, Resilience
Conditions
Keywords
Early life stress, Adolescent, Mindfulness, Neurobiological, Stress, Resilience
Brief summary
Early life stress (ELS) is associated with a number of psychiatric and medical conditions later in life, thought to be caused by subsequent disruptions in biological processes involved in regulation of stress responses. Given that these alterations have long-lasting effects, there is a great need for effective preventative interventions. The long-term goal of this project is to identify early interventions that may most powerfully mitigate risk for psychiatric illness among adolescents with exposure to early life stress (ELS), with a focus on interventions that can be widely and effectively implemented, have the potential for long-lasting benefits, and can effectively engage targeted neurobiological processes and networks. The specific aims of the present study are to 1) examine how ELS impacts biological processes associated with regulation of stress, and 2) identify how MBI impacts affective symptoms and biological processes dysregulated by ELS. This study supports the efforts to reduce the effects of early adversity in children by testing an impact of an effective psychological intervention on disrupted biological processes caused by early adversity. Successful achievement of the proposed aims will contribute to a) the knowledge base needed to reduce the effects of trauma and stress in children and families and b) the development of easily implemented and disseminated preventative interventions. The proposed study will utilize a multi-method design to examine the effect of mindfulness on biological processes (i.e., stress responses) disrupted by exposure to ELS among adolescents age 13 to 15. Adolescents will first complete self-report measures of childhood adverse experiences, trauma, and neglect. Forty eligible adolescents will be next randomly assigned to either an eight session mindfulness-based stress reduction intervention for teens or no treatment. Pre- and post-intervention assessment will include (a) self-report measures of symptoms and emotion regulation, (b) a blood draw for assessment of inflammatory markers and gene expression, and (c) a stress task with saliva cortisol collected before and after this task.
Interventions
BEHAVIORALMindfulness
Mindfulness based stress reduction adapted for teens is a mindfulness intervention designed to aid adolescents in understanding stress, better coping with stress, and promoting resilience
Sponsors
Oklahoma State University
Laureate Institute for Brain Research, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Adolescents are randomly assigned to either a mindfulness intervention or no intervention.
Eligibility
Sex/Gender
ALL
Age
13 Years to 15 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 13.00 to 15.99 years at time of baseline assessment * Able to validly and safely complete baseline assessments * All genders * All races * Eligibility as a subject with early life stress will be determined by: * Scoring 4 or greater on Adverse Childhood Experiences (ACE) scale, with at least two experiences having occurred prior to age 10.
Exclusion criteria
* No biological parent or legal guardian identified to give permission for minor to participate * History of neurological disorders including seizure disorder, cerebral palsy, or other conditions requiring neurological or medical care, being managed for migraines (e.g., daily prophylactic medication, seeing a neurologist for migraines), or a diagnosis of Developmental Delay, including severe learning disorder, mental retardation, pervasive developmental disorder, or other conditions requiring repeated and persistent specialized education. * Current psychotic disorder, bipolar disorder, obsessive-compulsive and related disorders, substance use disorder, or conduct disorder. * Current active suicidal ideation. * Current use of medications with major effects on brain function or blood flow (e.g., antipsychotics, mood stabilizers); ADHD medications and SSRIs, that have been stable for at least 6 weeks, are not exclusionary since their use is associated with conditions that confer risk for monitored disorders that emerge in adolescence, and assessment of these individuals will provide useful data to the scientific community. Youth on ADHD medications and SSRIs will not be asked to go off their medications. * Not fluent in English * Non-correctable vision, hearing or sensorimotor impairments, as protocol elements may not be valid. * Youth planning to move to an area not within reasonable traveling distance of LIBR; knowledge at baseline that treatment completion / follow-up will not be possible. * Youth appears to be high/intoxicated, or withdrawing from the effects of alcohol or drugs at time of enrollment. * Youth / parent who are unable or unwilling to provide biological samples (i.e., blood draws or saliva collection). * Female youth who are pregnant * Youth who are currently in unsafe environments (e.g., currently living with an abusive parent)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cortisol Reactivity | Baseline (pre-intervention); Follow-up (post-intervention) at 6-8 weeks from baseline | Change in level of cortisol in saliva following a social stress test. Subjects completed the Trier Social Stress Test for Children (TSST-C) at baseline and follow-up. The TSST-C consists of public speaking and serial subtraction components in front of two research confederates. The test takes approximately 20 minutes to complete. Salivary cortisol was collected 20 minutes prior to TSST-C, and 20 minutes following the end of the TSST-C, such that the TSST-C task with data collection spanned approximately one hour. |
| Immune System Activity | Baseline (pre-intervention); Follow-up (post-intervention) at 6-8 weeks from baseline | Change in level of interleukin 6 (IL-6) and C-reactive protein (CRP) in blood |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mood and Feelings Questionnaire | Baseline (pre-intervention); Follow-up (post-intervention) at 6-8 weeks from baseline | Measure Description: We used the Mood and Feelings Questionnaire - Short Form (MFQ-sf) to characterize symptoms of anxiety and depression. The MFQ-sf is a 13-item questionnaire with a simple sum score for the entire scale. Minimum score = 0, maximum score = 26. Scores of 8 or more indicate moderate depression. Codings reflect whether the phrase was descriptive of the subject most of the time, sometimes, or not at all. Higher scores indicate greater symptoms of anxiety/depression, while lower scores indicate less anxiety/depression. |
Countries
United States
Participant flow
Recruitment details
Adolescents and their families were recruited from the community using flyers, radio advertisements, billboards, and a school-based messaging platform (e.g., PeachJar).
Participants by arm
| Arm | Count |
|---|---|
| Mindfulness Mindfulness: Eight sessions, twice per week over four weeks
Mindfulness: Mindfulness based stress reduction adapted for teens is a mindfulness intervention designed to aid adolescents in understanding stress, better coping with stress, and promoting resilience | 22 |
| Control Treatment as usual, inactive control group | 18 |
| Total | 40 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 5 | 5 |
| Overall Study | Withdrawal by Subject | 1 | 2 |
Baseline characteristics
| Characteristic | Total | Control | Mindfulness |
|---|---|---|---|
| Age, Continuous | 14.31 years STANDARD_DEVIATION 0.75 | 14.29 years STANDARD_DEVIATION 0.77 | 14.33 years STANDARD_DEVIATION 0.73 |
| Change in salivary cortisol baseline, post stress induction | 0.025 μg/dL STANDARD_DEVIATION 0.99 | 0.27 μg/dL STANDARD_DEVIATION 1.1 | -0.22 μg/dL STANDARD_DEVIATION 0.88 |
| Change in salivary cortisol baseline, pre stress induction | -0.02 μg/dL STANDARD_DEVIATION 1.02 | -0.16 μg/dL STANDARD_DEVIATION 1.15 | 0.12 μg/dL STANDARD_DEVIATION 0.89 |
| C-reactive protein | 1.775 mg/L STANDARD_DEVIATION 4.785 | 2.39 mg/L STANDARD_DEVIATION 5.75 | 1.16 mg/L STANDARD_DEVIATION 3.82 |
| Depression and Anxiety Symptoms | 8.1 units on a scale STANDARD_DEVIATION 5.53 | 9.39 units on a scale STANDARD_DEVIATION 6.54 | 6.81 units on a scale STANDARD_DEVIATION 4.53 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 3 Participants | 1 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 35 Participants | 16 Participants | 19 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Interleukin-6 | 0.65 pg/mL STANDARD_DEVIATION 0.835 | 0.83 pg/mL STANDARD_DEVIATION 1.19 | 0.47 pg/mL STANDARD_DEVIATION 0.48 |
| Race (NIH/OMB) American Indian or Alaska Native | 4 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 9 Participants | 5 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 5 Participants | 0 Participants | 5 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) White | 19 Participants | 9 Participants | 10 Participants |
| Sex: Female, Male Female | 15 Participants | 8 Participants | 7 Participants |
| Sex: Female, Male Male | 23 Participants | 9 Participants | 14 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 22 | 0 / 18 |
| other Total, other adverse events | 0 / 22 | 0 / 18 |
| serious Total, serious adverse events | 0 / 22 | 0 / 18 |
Outcome results
Primary
Cortisol Reactivity
Change in level of cortisol in saliva following a social stress test. Subjects completed the Trier Social Stress Test for Children (TSST-C) at baseline and follow-up. The TSST-C consists of public speaking and serial subtraction components in front of two research confederates. The test takes approximately 20 minutes to complete. Salivary cortisol was collected 20 minutes prior to TSST-C, and 20 minutes following the end of the TSST-C, such that the TSST-C task with data collection spanned approximately one hour.
Time frame: Baseline (pre-intervention); Follow-up (post-intervention) at 6-8 weeks from baseline
Population: Two subjects were removed from all analyses due to not having usable baseline data and withdrawing prior to intervention. One was removed from each group, such than N=22-1=21 analyzed for mindfulness and N=18-1=17 for control.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Mindfulness | Cortisol Reactivity | follow-up, pre stress induction | -0.21 μg/dL | Standard Deviation 1.05 |
| Mindfulness | Cortisol Reactivity | follow-up, post stress induction | 0.05 μg/dL | Standard Deviation 1.16 |
| Control | Cortisol Reactivity | follow-up, pre stress induction | 0.34 μg/dL | Standard Deviation 0.85 |
| Control | Cortisol Reactivity | follow-up, post stress induction | -0.08 μg/dL | Standard Deviation 0.76 |
p-value: <0.05Mixed Models Analysis
p-value: <0.05Mixed Models Analysis
p-value: 0.4Mixed Models Analysis
Primary
Immune System Activity
Change in level of interleukin 6 (IL-6) and C-reactive protein (CRP) in blood
Time frame: Baseline (pre-intervention); Follow-up (post-intervention) at 6-8 weeks from baseline
Population: Two subjects were removed from all analyses due to not having usable baseline data and withdrawing prior to intervention. One was removed from each group, such than N=22-1=21 analyzed for mindfulness and N=18-1=17 for control.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Mindfulness | Immune System Activity | CRP (followup) | 0.83 pg/mL; mg/L | Standard Deviation 1.45 |
| Mindfulness | Immune System Activity | I'll-6 (followup) | 0.46 pg/mL; mg/L | Standard Deviation 0.32 |
| Control | Immune System Activity | CRP (followup) | 0.99 pg/mL; mg/L | Standard Deviation 1.32 |
| Control | Immune System Activity | I'll-6 (followup) | 0.66 pg/mL; mg/L | Standard Deviation 0.65 |
Comparison: Comparing group differences (CRP biomarker) in mindfulness versus control at baseline versus follow-up timepoints.p-value: 0.39Mixed Models Analysis
Comparison: Comparing group differences (IL-6 biomarker) in mindfulness versus control at baseline versus follow-up timepoints.p-value: 0.95Mixed Models Analysis
Secondary
Mood and Feelings Questionnaire
Measure Description: We used the Mood and Feelings Questionnaire - Short Form (MFQ-sf) to characterize symptoms of anxiety and depression. The MFQ-sf is a 13-item questionnaire with a simple sum score for the entire scale. Minimum score = 0, maximum score = 26. Scores of 8 or more indicate moderate depression. Codings reflect whether the phrase was descriptive of the subject most of the time, sometimes, or not at all. Higher scores indicate greater symptoms of anxiety/depression, while lower scores indicate less anxiety/depression.
Time frame: Baseline (pre-intervention); Follow-up (post-intervention) at 6-8 weeks from baseline
Population: Two subjects were removed from all analyses due to not having usable baseline data and withdrawing prior to intervention. One was removed from each group, such than N=22-1=21 analyzed for mindfulness and N=18-1=17 for control.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Mindfulness | Mood and Feelings Questionnaire | 3.82 units on a scale | Standard Deviation 4.61 |
| Control | Mood and Feelings Questionnaire | 8.17 units on a scale | Standard Deviation 8.07 |
Comparison: Comparing group differences (symptoms of anxiety/depression) in mindfulness versus control at baseline versus follow-up timepoints.p-value: 0.08Mixed Models Analysis