正念减压训练和心理弹性变化轨迹对癌症存活者心理适应状况的影响： HPA轴表观遗传机制

Resilience refers to the dynamic process or personality of adapting well in the face of adversity, which indicated that the individual with higher level of resilience usually has better psychosocial adaptation after experiencing the stress. Resilience is regulated dynamically by genetic × environmental factors, and epigenetic changes occurred during gene transcription on HPA axis are regarded as the key molecular mechanism of this interaction in stress reaction. Additionally, mindfulness-based stress reduction(MBSR) training, for its role in promoting resilience and positive psychological adjustment, has also been accepted and applied in stress management. However, when facing the continuous and major life events such as cancer diagnosis and treatment, could resilience still influence on psychosocial adaptation outcome through epigenetic changes on HPA axis among cancer survivors? And how does MBSR improve the levels of resilience and psychological adaptation in cancer survivors? These questions are yet to be clarified and need to be validated. In this study, we will recruit cancer survivors as participants, take cross-sectional and longitudinal design, and use questionnaire survey and molecular biological techniques to solve the following issues: (1) resilience level and psychological status at baseline and how they will change and interact each other as disease progresses; (2) the characteristic and varying patterns of epigenetic modifications on HPA axis in terms of the level and interaction of resilience；(3) the effect and mechanism of MBSR on resilience and emotion among cancer survivors. By this exploration, we hope to provide new insight to promote the psychosocial rehabilitation of cancer survivors from the perspective of positive psychology and accurate medicine.

心理弹性是个体成功应对逆境的特质或过程，与个体面对应激后较好的身心适应密切相关。心理弹性受到遗传×环境交互作用的动态调控，发生于HPA轴上相关基因转录水平的表观遗传调节被认为是这种交互作用的关键分子机制。正念减压训练因能提高心理弹性而在应激管理中得到广泛应用。面对癌症诊断、治疗等持续而重大的生活事件，癌症存活者的心理弹性是否还能通过HPA轴表观修饰调控其心理适应结局？正念训练是如何影响该群体的心理弹性水平？这些问题均有待阐明和验证。本研究以癌症存活者为研究对象，采用横向和纵向的研究方法，借助问卷调查和分子生物实验手段，拟探讨以下问题：（1）癌症存活者心理弹性变化轨迹与心理适应状况的关系；（2）HPA轴表观遗传修饰特点及与心理弹性的动态变化关系；（3）正念训练提高心理弹性及促进心理适应的效果及机制。本研究为从积极心理学和精准医学视角促进癌症患者的心理社会康复提供新思路。

本项目的总体目标是从积极心理学视角，探讨促进癌症存活者心理康复的因素及潜在机制。基于此目标，本项目以癌症存活者为被试，非癌症人群（健康人群为主）为对照，采用横断面、纵向研究设计，聚焦探讨以下三个方面的内容：（1）心理弹性与心理适应状况的关系；（2）以正念为核心的积极心理干预方案的构建及效果验证；（3）正念干预及心理弹性对癌症存活者心理适应状况影响的生理及心理机制。主要研究结果：（1）在重大应激状态下，如癌症诊断和治疗，癌症存活者除了经受症状困扰（焦虑、抑郁和失眠等）外，还会表现出积极改变（如创伤后成长，生命意义感等）。心理弹性是疾病适应过程的关键因素，不仅缓解心理症状（癌症复发恐惧、心理困扰等）和躯体症状（癌因性疲乏、失眠等），还与积极心理品质（如希望、乐观、正念等）和积极情感（如积极情绪、幸福感、生命意义感）有关，进而促进个体良好的身心适应，提高生活质量。（2）构建了人群特异性（胃肠癌患者、肺癌患者和对照人群等）、干预形式（面对面或线上自助式）及干预时长（2周或4周等）多样化的正念干预方案，并在临床人群中进行验证，发现其能够有效提高个体正念及心理弹性水平，改善失眠、压力、疲乏等身心症状，降低患者对癌症的消极认知，提高疾病接受度等，具有一定的适用性；（3）通过初步分析HPA轴上相关的基因多态性、表观遗传修饰（DNA甲基化）、炎症因子及皮质醇等生理指标与心理适应的关系发现，多巴胺受体基因(DRD2)的DNA甲基化和积极情绪是心理弹性提高个体身心适应的潜在机制；糖皮质激素受体基因（NR3C1）的DNA甲基化和心理弹性是正念干预对身心适应发挥作用的可能机制。本项目促进了积极心理学在癌症患者心理社会康复中的应用，是对传统病理心理学的有益补充；构建了适用于不同人群的积极心理干预方案，有待于推广应用；从生理和心理层面分析了心理弹性和积极心理干预发挥作用的机制，为精准干预提供思路。