Recovering Together after Cardiac Arrest: A dyadic mind-body intervention for emotional distress in cardiac arrest survivors and their informal caregivers

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PROJECT SUMMARY In this K23 proposal I detail a 5-year training plan that will launch my career as an independent investigator focused on developing and implementing mind-body interventions for cardiac arrest (CA) survivors and their families. Background: Experiencing a CA is continuously traumatic resulting in emotional distress in survivors (up to 61%) and their informal caregivers (up to 40%). Unlike other critically ill populations with established survivorship programs, CA survivor-caregiver dyads (pairs) are under-resourced and unprepared to manage survivorship, which exacerbates emotional distress. Untreated emotional distress post-CA becomes chronic and undermines clinical and quality of life outcomes. Addressing emotional distress early after CA by teaching mind-body skills and providing resources may prevent chronic emotional distress and improve quality of life. Specific aims: I plan to develop, refine, and test the feasibility and acceptability of a dyadic mind-body intervention for CA survivors with good neurologic recovery and their informal caregivers (“Recovering Together after Cardiac Arrest;” RT-CA). My aims are three-fold: 1) develop RT-CA through evidence-based frameworks (dyadic interdependence, response shift framework, family strength vulnerability model, resilience as a process) and evidence-based skills (from cognitive behavior therapy, dialectical behavior therapy, acceptance and commitment therapy, and mindfulness-based stress reduction), input from interviews with CA survivor-caregiver dyads (N=~12 dyads), and focus groups and interviews with CA medical stakeholders (N=16-24 stakeholders); 2) refine RT-CA through an open pilot (N=5 dyads) with exit interviews (for feedback) and pre-post assessments (for initial feasibility and acceptability); 3) test RT-CA for feasibility and acceptability (N=42 dyads) through a pilot randomized clinical trial (RCT) of RT-CA compared to a minimally enhanced usual control. Training: My research aims are supported by three training goals: 1) advanced qualitative methods for dyadic intervention development; 2) mixed methods for dyadic intervention refinement (integrating exit interview qualitative data with pre-post assessment quantitative data); 3) dyadic mind-body RCT methodology. My multi-disciplinary mentorship team is led by Dr. Ana-Maria Vranceanu, a clinical health psychologist and expert in developing and refining dyadic-mind body interventions, and Drs. Michael Donnino and Sarah Perman, emergency medicine physicians and experts in CA clinical trials and CA outcomes research respectively. My training goals are supported by 1) committed, multi-disciplinary mentors, 2) a rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and 3) targeted coursework, health equity and diversity trainings, seminars and workshops, scientific meetings, and experiential learning. My proposal is in line with the NCCIH priority of “supporting impactful clinical trials of complementary and integrative health approaches.” Impact: I am a clinical psychology fellow committed to improving CA survivorship. This K23 is my first step towards becoming an independently funded investigator in improving CA and eventually critical care survivorship. This K23 will pave the way for future trials of RT-CA, including adaptations for culturally diverse dyads, survivors without informal caregivers, bereaved caregivers, and caregivers of comatose CA survivors. RT-CA has the potential to create a new standard of care for CA by providing mind-body skills and resources to cope with survivorship challenges.