Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes

 描述(申请人提供)：背景：肥胖影响36%的美国女性和男性，并增加糖尿病和心血管疾病的终生风险。同样，抑郁症影响了20%的美国女性和13%的男性，是全球残疾的主要原因。此外，这两种疾病之间存在双向正相关关系。治疗肥胖症和抑郁症的行为干预措施已得到证实；然而，其潜在的生物学机制仍不清楚。这种缺乏了解大大阻碍了优化行为干预措施有效性的努力，并限制了这些干预措施的传播和实施成为广泛的做法，以减少肥胖症和抑郁症的不良后果，促进人口健康。人类神经科学和行为科学的快速发展以及两者的结合可能为填补这一空白提供独特的机会。目的：利用最近资助的一项为期两年的随机对照试验(彩虹目标n=404；Pi Dr.Jun Ma)，该试验首次在初级保健中整合治疗肥胖和抑郁，独特地结合了两种国家认可的行为干预措施，我们提出了一个分两个阶段的项目，以确定、验证和完善一套衡量自我调节目标的测试；并利用这些目标来优化肥胖和抑郁的行为治疗。具体目标：在UH2阶段，我们将(1)进行二次数据分析并举办研讨会和研讨会，以最终确定用于测试的自我调节目标和分析；(2)利用彩虹干预来参与确定的目标；以及(3)验证跨多个领域(神经、生理、行为、心理)、环境(实验室、虚拟和自然)和时间点(0、4周、6、12和24个月)的目标参与度过渡里程碑是：(1)建立可靠和准确地测量确定的目标的分析(S)；(2)证明自我调节目标(S)在彩虹综合治疗中的延展性；以及(3)确定自我调节特征(S)，预测健康行为(坚持医疗方案、体力活动、饮食)和结果(体重、抑郁)的治疗反应。在UH3阶段，我们将进行一项试点随机对照试验，在该试验中，另外100名肥胖和抑郁成年人将被随机分配到干预或等待名单对照中，并在基线、4周和6个月进行评估。干预对象将接受彩虹干预的前4周，随后是干预组件的目标指导定制，以便在前4周根据他们的个人自我调节情况优化目标参与并增强行为变化。我们将利用来自干预对象的见解，进一步完善为等待对象量身定做的策略。影响：这项研究将提供一套经过充分验证的自我调节目标分析工具包，这些目标对健康行为改变非常重要，以及在治疗同时患有肥胖症和抑郁症的患者中，以目标为导向的个性化干预策略。影响：鉴于这些疾病与目标健康行为的广泛相关性，这项研究将成为治疗多种慢性病的原型，对人群健康具有深远的潜在影响。

 DESCRIPTION (provided by applicant): Background: Obesity affects 36% of US women and men and increases lifetime risk for diabetes and cardiovascular disease. Similarly, depression affects 20% of US women and 13% of men and is the leading cause of disability worldwide. Further, the 2 disorders have a bidirectional positive relationship. Proven behavioral interventions to treat obesity and depression exist; however, the underlying biological mechanisms remain unknown. This lack of understanding significantly hampers efforts to optimize the effectiveness of behavioral interventions and limits their dissemination and implementation into widespread practice to curtail the adverse consequences of obesity and depression and promote population health. Rapid advances in human neuroscience and behavioral science and integration of the two could provide unique opportunity to fill this gap. Objective: Leveraging a recently funded 2-year randomized controlled trial ("RAINBOW" target n=404; PI Dr. Jun Ma) of a first-ever integrated treatment for comorbid obesity and depression in primary care that uniquely combines 2 nationally recognized behavioral interventions, we propose a 2-phased project to identify, validate and refine a set of assays to measure self-regulation targets; and to engage these targets to optimize behavioral treatment of obesity and depression. Specific Aims: In the UH2 phase, we will (1) Conduct secondary data analysis and hold workshops and a symposium to finalize selection of self-regulation targets and assays for testing; (2) Leverage the RAINBOW intervention to engage identified targets; and (3) Verify target engagement across multiple domains (neural, physiological, behavioral, psychological), settings (laboratory, virtual, and naturalistic), and time points (0, 4 weeks, 6, 12 and 24 months) Transitional milestones are to (1) Establish assay(s) that reliably and accurately measure the identified targets; (2) Demonstrate malleability of the self-regulation target(s) in response to th RAINBOW integrated treatment; and (3) Identify self-regulation profile(s) that predict treatment response in health behaviors (medical regimen adherence, physical activity, diet) and outcomes (weight, depression). In the UH3 phase, we will conduct a pilot randomized controlled trial in which an additional 100 obese and depressed adults will be randomized to intervention or wait-list control and assessed at baseline, 4 weeks and 6 months. Intervention subjects will receive the first 4 weeks of the RAINBOW intervention, followed by target-guided tailoring of the intervention components in order to optimize target engagement and enhance behavioral change based on their individual self-regulation profile during the first 4 weeks. We will use the insights from intervention subjects to then further refine the tailoring strategies for the waitlis subjects. Implications: This research will provide a toolkit of well-validated assays of self-regulation targets important for health behavior change, as well as target- guided personalization of intervention strategies, in the treatment of comorbid obesity and depression. Impact: Given the widespread relevance of these disorders and the targeted health behaviors, this research will be a prototype for treating multiple chronic conditions with profound potential impacts on population health.