Moving 2 Mindful (M2M) study protocol: testing a mindfulness group plus ecological momentary intervention to decrease stress and anxiety in adolescents from high-conflict homes with a mixed-method longitudinal design.

INTRODUCTION: Interparental conflict exposure places adolescents at risk for problems with stress and anxiety; existing prevention/intervention strategies focus on reducing interparental conflict. Mindfulness-based programmes may be a promising treatment strategy for this population, but studies have not yet tested whether they are effective in this high-conflict context. In addition, evidence suggests that extensions to traditional treatments, such as delivering components in daily life that are tailored to moments of need, can increase treatment efficacy, particularly when combined with in-person treatments and particularly for adolescents. However, there are no such extensions to mindfulness interventions available. The Moving 2 Mindful study aims to (1) develop an ecological momentary intervention (EMI) supplement to Learning to BREATHE (L2B), an evidence-based mindfulness intervention for adolescents; (2) refine the EMI programme and determine the best delivery plan; (3) examine the feasibility and acceptability of L2B Plus (L2B plus the developed supplement) and (4) examine the potential for L2B Plus to reduce stress and anxiety for adolescents from high-conflict homes. METHODS AND ANALYSIS: The Moving 2 Mindful study proposes a mixed-methods approach to developing and refining a multimethod adaptive supplement to L2B. Feasibility, acceptability and potential effectiveness will be tested in a sample of 38 families, who will be randomly assigned to receive L2B Plus or an active health and wellness control condition and followed until 3 months postintervention. A range of psychosocial and physiological factors will be assessed at multiple time points. This study is registered with clinicaltrials.gov (ID NCT03869749; pre-results). ETHICS AND DISSEMINATION: The Institutional Review Board at Colorado State University has approved this study. Findings will be disseminated in scientific journals and conferences, whether they are positive, negative or inconclusive.

Unraveling current and future adolescent depressive symptoms: The role of stress reactivity across physiological systems.

Neurobiological processes are highlighted in animal and theoretical models of the development of depression, but there is mixed empirical evidence about associations between stress physiology and depressive symptoms. Adolescence has been highlighted as a period during which coordination across physiological stress response systems may be particularly important. However, most studies have focused on depressive symptoms and physiological reactivity in isolated systems. The goal of this study was to examine associations of hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS; i.e., sympathetic and parasympathetic nervous system [SNS and PNS, respectively]) reactivity with depressive systems, as well as the interrelatedness of reactivity across systems. Participants were adolescents (n = 153, 10-17 years) from diverse backgrounds, recruited from the community. Adolescents experienced a stressor, during which cortisol (HPA axis), skin conductance level (SCL; SNS), and respiratory sinus arrhythmia (RSA; PNS) were measured; youth also reported depressive symptoms. Some youth (n = 60) reported depressive symptoms again 1 year later as part of another study. Results from latent growth analysis embedded in a structural equation model (SEM) indicated that concurrent depressive symptoms were predicted by an interaction between cortisol reactivity and baseline RSA levels, with fewer symptoms for adolescents who had lower baseline RSA and greater cortisol reactivity. Controlling for concurrent depressive symptoms, prolonged cortisol recovery (above and beyond cortisol or ANS reactivity), was related to prospective depressive symptoms. Results support and extend theoretical arguments about the role of dysregulated stress physiology in the development of depressive symptoms, and the importance of multisystem approaches to understanding the role of stress physiology in risk and resilience. (PsycINFO Database Record

Autonomic nervous system coordination moderates links of negative interparental conflict with adolescent externalizing behaviors.

Although negative interparental conflict predicts elevated externalizing problems for children, there are individual differences in this association. Theoretically, children's abilities to coordinate physiological stress across response systems moderate the effects of interparental conflict on developmental outcomes. Past cross-sectional research has demonstrated that poor coordination of sympathetic (SNS) and parasympathetic (PNS) nervous systems puts children at a greater risk for externalizing behaviors in the context of interparental conflict. Our goal was to examine whether this same pattern is evident in adolescents and provide the first longitudinal test of this theoretical pathway. Participants were families with adolescents (10-17 years) from diverse ethnic and socioeconomic backgrounds. Parents reported conflict, were observed during a conflict discussion, and reported adolescent externalizing behaviors; parents again reported externalizing behaviors 1 year later. Adolescents experienced a stressor while skin conductance level (SCL; SNS) and respiratory sinus arrhythmia (RSA; PNS) were measured. Similar to past research with children, there were 3-way interactions between negative interparental conflict, SCL reactivity, and RSA reactivity in relation to adolescent externalizing behaviors, concurrently and prospectively. The overall pattern suggested that adolescents who displayed poorly coordinated responding displayed a positive association between interparental conflict and externalizing behaviors, whereas adolescents who showed well-coordinated responding displayed a nonsignificant or negative association. Coinhibition of the SNS and PNS may put adolescents particularly at risk for prospective externalizing behaviors. Autonomic nervous system coordination-particularly activation of the SNS and inhibition of the PNS during stress-may protect adolescents from experiencing adjustment problems in the context of interparental conflict. (PsycINFO Database Record

Is cortisol production in response to an acute stressor associated with diurnal cortisol production during adolescence?

The goal of the current study was to examine the extent to which cortisol responding to an acute stressor is related to diurnal cortisol patterns during adolescence. Participants were 105 adolescents (10-17 years of age) who experienced a robust social-evaluative stressor and provided saliva samples (before and immediately after, as well as 10, 20, and 30 min after the stressor) to assess both cortisol reactivity and recovery and also provided saliva samples (at wake-up, 30 min after wake-up, 4 pm, and at bedtime) on two consecutive days to measure diurnal cortisol production. Dual process latent growth curve models, one for cortisol reactivity and one for diurnal cortisol, indicated that dampened cortisol reactivity and prolonged cortisol recovery (i.e., less cortisol produced during reactivity but more cortisol produced during recovery) were associated with dampened decreases in cortisol production across the day, suggesting that adolescents are likely to show attenuation in multiple components of HPA axis functioning.