A positive psychology intervention to promote health behaviors in heart failure

 描述（由申请人提供）：塞拉诺博士是马萨诸塞州总医院（MGH）接受过临床培训的精神病学家和研究员。 他的研究主要与MGH的心脏精神病学研究项目合作，主要集中在促进心血管疾病和精神疾病患者的心理健康。 他曾担任多项心脏病患者研究的合作研究者，目前是一项旨在增强双相抑郁患者积极心理状态的试点研究的主要研究者。 他发表了18篇文章（7篇为第一作者），主要关注心脏病患者精神疾病的识别和管理。 他担任几个心脏病学期刊的临时评审员，并因其研究获得了地方和国家奖项。 由于他对心脏病患者的研究和临床经验，塞拉诺博士对促进健康行为（例如，体力活动、药物依从性）。 HF是一种慢性、使人衰弱和进行性疾病，影响近600万美国人，并导致严重损害， 功能，生活质量和生存。 健康行为与HF预后改善（包括生存率）相关，但HF患者通常难以坚持这些行为。 提高这一人群依从性的一种潜在方法是使用可以促进积极心理状态的干预措施，如乐观，感恩或幸福。这些状态与健康和医学疾病人群对健康行为的依从性改善有关，这表明在HF患者中提高这些状态的干预可能是促进这些行为并改善身心健康的有效方法。积极心理学，它使用系统的练习（例如，写一封感谢信，以新的方式使用个人力量）来获得积极的感受，可能是一种非常有希望的改善健康行为的方法。 在这个K23奖的建议，博士塞拉诺将获得所需的经验，成为一个独立的研究人员谁可以开发和实施心理干预，以增加健康的行为， HF患者。这将通过一个研究项目和正式的培训计划来实现，以提高他的能力：（1）创建、管理和分析定性访谈，（2）创建促进HF患者健康行为的积极心理学干预，（3）开发和完成单臂和对照干预试验，（4）测量和分析饮食和身体活动数据，（5）拓展生物统计学知识。 在他的研究项目中，塞拉诺博士将开发一种基于电话的积极心理干预，以增加纽约心脏协会II级或III级HF患者的健康行为，然后测试干预的可行性和初步疗效。首先，他将进行定性访谈，以确定积极心理状态（例如，乐观）和受损的健康行为完成。 然后，他将根据这些结果创建一个积极的心理干预。 接下来，他将进行一个小型的概念验证试验，以确保干预的初步可行性，并根据需要进行完善。 最后，他将进行一项随机、对照的试点试验，以收集有关干预的可行性、对乐观情绪的直接影响以及促进该队列健康行为的初步功效的信息。该项目的结果将构成未来R01应用的基础，以正式测试更大受试者群体中干预的有效性。 博士塞拉诺的研究试验将辅以正式的培训计划，以增加他对生物统计学，HF及其治疗，营养和体力活动测量，负责任的研究行为以及心脏病患者的心理干预的理解。 他的培训将包括哈佛公共卫生学院的生物统计学课程，临床和 与HF相关的研究会议，MGH行为医学计划的每周研讨会，定性研究和负责任的研究行为的正式培训，饮食和身体活动的结构化阅读计划，以及与导师和顾问的定期会议，他们在定性研究，积极心理学，HF，健康行为结果和行为干预方面具有专业知识。 博士塞拉诺的建议将为他提供进行定性研究、概念验证试验和对照试验的宝贵经验，并将增强他对HF、行为干预、健康行为测量和生物统计学的知识。 此外，这一经验将使塞拉诺博士成为一个独立的研究者在一个至关重要的领域，即促进健康行为的HF。由于HF患者难以坚持维持生命的健康行为，因此有效的心理干预可以增强积极的心理状态并促进这些行为，从而有可能改善这种毁灭性疾病患者的身心健康。

 DESCRIPTION (provided by applicant): Dr. Celano is a clinically trained psychiatrist and research fellow at the Massachusetts General Hospital (MGH). His research, performed primarily with the Cardiac Psychiatry Research Program at MGH, has centered on the promotion of psychological health in patients with cardiovascular disease and psychiatric illness. He has experience as a co-investigator on multiple studies in cardiac patients and currently is the principal investigator of a pilot study to enhance positive psychological states in patients with bipolar depression. He has published 18 articles (7 as first-author) that focus largely on the identification and management of psychiatric illness in cardiac patients. He serves as an ad hoc reviewer for several cardiology journals and has received local and national awards for his research. As a result of his research and clinical experience with cardiac patients, Dr. Celano has developed an increasing interest in the promotion of health behaviors (e.g., physical activity, medication adherence) in patients with heart failure (HF). HF is a chronic, debilitating, and progressive illness that affects nearly 6 million Americans and leads to significant impairments in functioning, quality of life, and survival. Health behaviors are associated with improved outcomes, including survival, in HF, but HF patients often have difficulty adhering to these behaviors. A potential way to improve adherence in this population is to use interventions that can boost positive psychological states, such as optimism, gratitude, or happiness. These states are associated with improved adherence to health behaviors in healthy and medically ill populations, suggesting that an intervention to boost them in HF patients may be an effective way to promote these behaviors and improve physical and mental health. Positive psychology, which uses systematic exercises (e.g., writing a letter of gratitude, using a personal strength in new way) to target positive feelings, may be a highly promising approach to improve health behaviors. In this K23 award proposal, Dr. Celano will obtain the experience needed to become an independent researcher who can develop and implement psychological interventions to increase healthy behavior in patients with HF. This will be accomplished through a research project and formal training plan to enhance his ability to: (1) create, administer, and analyze qualitative interviews, (2) create positive psychology interventions that promote health behaviors in HF patients, (3) develop and complete single-arm and controlled intervention trials, (4) measure and analyze diet and physical activity data, and (5) extend his knowledge of biostatistics. In his research project, Dr. Celano will develop a telephone-based positive psychology intervention to increase health behaviors in patients with New York Heart Association class II or III HF, then test the intervention's feasibility and preliminary efficacy. First, he will perform qualitative interviews to identify links between deficits in positive psychological states (e.g., optimism) and impaired health behavior completion. He will then create a positive psychology intervention based on these results. Next, he will perform a small, proof- of-concept trial to ensure initial feasibility of the intervention and to refine it as needed. Finally, he will perfor a randomized, controlled pilot trial to gather information about the intervention's feasibility, immediate impact on optimism, and preliminary efficacy at promoting health behaviors in this cohort. The results from this project will form the basis of a future R01 application to formally test the efficacy of the intervention in a larger group of subjects. Dr. Celano's research trial will be supplemented by a formal training plan to increase his understanding of biostatistics, HF and its treatment, nutrition and physical activity measurement, the responsible conduct of research, and psychological interventions for cardiac patients. His training will consist of biostatistics classes at the Harvard School of Public Health, clinical and research meetings related to HF, weekly seminars at MGH's Behavioral Medicine Program, formal training in qualitative research and the responsible conduct of research, structured reading programs in diet and physical activity, and regular meetings with mentors and consultants who have expertise in qualitative research, positive psychology, HF, health behavior outcomes, and behavioral interventions. Dr. Celano's proposal will provide him with invaluable experience in performing qualitative research, proof- of-concept trials, and controlled trials and will enhance his knowledge of HF, behavioral interventions, health behavior measurement, and biostatistics. Furthermore, this experience will enable Dr. Celano to become an independent investigator in a critically important area-namely, the promotion of health behaviors in HF. As patients with HF have trouble adhering to life-sustaining health behaviors, effective psychological interventions to enhance positive psychological states and promote these behaviors have the potential to improve mental and physical well-being in patients with this devastating illness.