Mindfulness-Based Cognitive Therapy Delivered via Group Videoconferencing for Acute Coronary Syndrome Patients with Elevated Depression Symptoms

项目摘要 该K23奖项将支持候选人的培训和发展，以独立的临床研究职业生涯为重点，专注于基于正念的认知疗法（MBCT）的临床试验，以改善患有情感和医疗问题的患者的情感和身体健康。背景在急性冠状动脉综合征（ACS）患者中，抑郁症状是常见且致命的，需要可获得的身心治疗。MBCT是一种循证抑郁症治疗方法，可以通过电子健康（e-health）技术提供，以促进可及性，但没有研究将MBCT通过电子健康技术应用于有抑郁症状的ACS患者。具体目标。拟议的研究旨在：（1）确定ACS患者对电子健康MBCT干预的具体需求和偏好，以告知治疗适应和交付，（2）在开放试点试验中探索适应MBCT干预和研究程序的初步可行性和可接受性，并在必要时进行改进，以及（3）在试点RCT中建立MBCT和健康促进控制干预措施和研究程序的可行性和可接受性，和（3a）探索抑郁症状、潜在机制（炎症、情绪调节、亲社会性）和心脏结果（健康行为、身体功能）的组内变化。训练三个领域的培训将促进适应和测试MBCT在慢性病人群中的小组视频会议交付的功效和机制的专业知识：（1）MBCT交付的新型电子健康技术格式;（2）MBCT适应的定性研究;（3）压力生理学和炎症生物标志物研究。这些培训目标将得到以下人员的支持：（1）由专家导师、合作者和顾问组成的团队- Elyse R。Park博士，MPH（主要导师），格洛丽亚叶博士，MPH（共同导师），Jeff霍夫曼博士（共同导师），Bettina Hoeppner博士（合作者），大卫Victorson博士（顾问）;（2）资源丰富的机构环境;（3）有针对性的高级课程，研究研讨会和科学会议;以及（4）拟议的研究。冲击所获得的技能将促进一个独立的研究职业生涯，重点是针对MBCT的电子健康提供与共病的情感和医疗问题的患者，并进行MBCT的疗效和生理机制的严格研究。研究结果将为通过小组视频会议对具有不良结局风险的抑郁症状的ACS患者进行MBCT疗效试验的R 01应用提供可行性数据。根据该研究所的资助重点，这项工作将通过确定可行和可接受的干预措施来促进身心医学研究，以解决难以治疗的问题，并创新数据收集方法，为MBCT机制的理论模型提供信息。

PROJECT SUMMARY This K23 award will support the Candidate’s training and development toward an independent clinical research career focused on clinical trials of Mindfulness-Based Cognitive Therapy (MBCT) for emotional and physical health improvement in patients with comorbid emotional and medical problems. BACKGROUND. Among acute coronary syndrome (ACS) patients, depressive symptoms are common and deadly, and accessible mind-body treatments are needed. MBCT, an evidence-based depression treatment, can be delivered via electronic health (e-health) technologies to promote accessibility, but no research has applied MBCT via e-health technology to ACS patients with depressive symptoms. Specific Aims. The proposed study aims to: (1) identify ACS patients’ specific needs and preferences for an e-health MBCT intervention to inform treatment adaptation and delivery, (2) explore the initial feasibility and acceptability of the adapted MBCT intervention and research procedures in an open pilot trial and make refinements as necessary, and (3) establish the feasibility and acceptability of the MBCT and health enhancement control interventions and research procedures in a pilot RCT, and (3a) explore within-group changes in depression symptoms, potential mechanisms (inflammation, emotion regulation, pro-sociality), and cardiac outcomes (health behaviors, physical function). TRAINING. Training in three areas will promote expertise in adapting and testing the efficacy and mechanisms of MBCT for group videoconferencing delivery in chronic illness populations: (1) novel e-health technology formats for MBCT delivery; (2) qualitative research for MBCT adaptation; and (3) stress physiology and inflammatory biomarker research. These training goals will be supported by (1) a team of expert mentors, collaborators, and consultants – Elyse R. Park, PhD, MPH (primary mentor), Gloria Yeh, MD, MPH (co-mentor), Jeff Huffman, MD (co-mentor), Bettina Hoeppner, PhD (collaborator), David Victorson, PhD (consultant); (2) a resource-rich institutional environment; (3) targeted advanced coursework, research seminars, and scientific meetings; and (4) the proposed research studies. IMPACT. The skills gained will promote an independent research career focused on targeting MBCT for e-health delivery in patients with comorbid emotional and medical problems, and conducting rigorous studies of MBCT efficacy and physiological mechanisms. The results will provide feasibility data for an R01 application of an efficacy trial of MBCT via group videoconferencing for ACS patients with depressive symptoms at risk for poor outcomes. In line with the institute’s funding priorities, this work will advance mind-body medicine research by identifying feasible and acceptable interventions for difficult to treat problems, and innovative data collection methods to inform theoretical models of MBCT mechanisms.