The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study

Zsofia P Cohen, Kelly T Cosgrove, Elisabeth Akeman, Sara Coffey, Kent Teague, Jennifer Hays-Grudo, Martin P Paulus, Robin L Aupperle, Namik Kirlic, Zsofia P Cohen, Kelly T Cosgrove, Elisabeth Akeman, Sara Coffey, Kent Teague, Jennifer Hays-Grudo, Martin P Paulus, Robin L Aupperle, Namik Kirlic

Abstract

Background: Early life stress (ELS) has been linked to poor mental and physical health outcomes in adolescence and adulthood. Mindfulness reduces symptoms of depression and anxiety and improves cognitive and social outcomes in both youth and adults. However, little is known whether mindfulness can mitigate against the adverse neurobiological and psychological effects of ELS. This study aimed to examine the feasibility of conducting a group mindfulness intervention in adolescents with ELS and provide preliminary indication of potential effects on stress-related biomarkers and mental health symptoms.

Methods: Forty adolescents were randomized to receive either eight sessions of Mindfulness-Based Stress Reduction for Teens in group format (MBSR-T; n = 21) or Treatment as Usual Control group (CTRL; n = 17). Outcomes were assessed at baseline and follow-up and included measures associated with neurobiological functioning (immune and endocrine biomarkers) and self-reported mental health (depressive) symptoms. Linear mixed effects models were used to assess the effects of group and time on these outcome measures.

Results: Sixteen of the 21 adolescents completed the intervention, attending an average of 6.5 sessions. The model examining cortisol responses to stress induction revealed medium effects trending toward significance (Cohen's d = .56) for anticipatory cortisol levels in the MBSR-T relative to CTRL groups. No significant effects were found in models examining C-reactive protein or interleukin 6 inflammatory markers. The model examining depressive symptoms revealed a medium effect for symptom reduction (Cohen's d = .69) in the MBSR-T relative to CTRL groups.

Conclusions: This study demonstrated feasibility of conducting a group-based MBSR-T intervention for adolescents with ELS. There was some evidence for efficacy on a symptom level with potential subtle changes on a biological level. Future larger studies are needed to determine the efficacy of group-based mindfulness interventions in this population.

Trial registration: Identifier # NCT03633903 , registered 16/08/2018.

Keywords: Adolescence; Cortisol; Early life stress; Epigenetic; Inflammation; Mindfulness; Prevention; Resilience.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
CONSORT diagram. Figure shows the flow of adolescents through the phases of the study and the number that withdrew at each time point. Abbreviations: ACE, Adverse Childhood Experiences; CTRL, Control; MBSR-T, Mindfulness Based-Stress Reduction for Teens
Fig. 2
Fig. 2
a The trajectory of the self-reported mood scores before and after the Trier Social Stress Task for Children (TSST-C). Participants were asked to rate their mood on a 5-point Likert scale (1 = very calm, 5 = very anxious). Participants completing the mindfulness intervention evidenced reduced anxious arousal before and after the TSST-C when compared with participants assigned to treatment as usual. b The trajectory of cortisol response before and after the Trier Social Stress Test  for Children (TSST-C). Participants completing the mindfulness intervention evidenced reduced cortisol levels prior to the TSST-C commencing when compared with participants assigned to control group. Abbreviations: CTRL, Control; MBSR-T, Mindfulness Based-Stress Reduction for Teens
Fig. 3
Fig. 3
Change in depression by group over time. Shown here are interaction plots of (a) estimated marginal means based on the fitted linear mixed-effects model for depression from baseline to follow-up between groups and (b) means and standard deviations based on the fitted linear mixed-effects model for depression across treatment within the MBSR-T group. The MBSR-T group showed a significant decrease in depressive symptoms from baseline to follow-up, whereas the CTRL group did not. Further, a decreasing trend was observed over the course of treatment. Abbreviations: CTRL, Control group; MBSR-T, Mindfulness Based-Stress Reduction for Teens; MFQ, Mood and Feelings Questionnaire; S, Session

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