Columbia Roybal Center for Fearless Behavior Change

哥伦比亚皇家无所畏惧行为改变中心

• 批准号: 9810832
• 负责人: Donald Edmondson
• 金额: $ 61.56万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9810832
• 关键词: Accident and Emergency department; Acute; Address; Adherence; Adopted; Adult; Advisory Committees; Behavior; Behavior Therapy; Behavioral Mechanisms; Cardiac; Cardiovascular Diseases; Chronic Obstructive Airway Disease; Clinical Trials; Collaborations; Development; Devices; Diagnosis; Disease Progression; Distress; Education; Elderly; Enrollment; Ensure; Event; Exercise; Experimental Models; Fostering; Fright; Future; Goals; Health behavior; Heart Arrest; Heart Rate; Helping Behavior; Hospitalization; Hypersensitivity; Infrastructure; Inpatients; Intervention; Lead; Life; Malignant Neoplasms; Measurement; Medical; Medicine; Motivation; Myocardial Infarction; Patients; Perception; Pharmaceutical Preparations; Physical activity; Physiological; Pilot Projects; Play; Positioning Attribute; Productivity; Psychophysiology; Recurrence; Research; Research Infrastructure; Research Personnel; Risk; Role; Science; Signal Transduction; Standardization; Stimulus; Stroke; Survivors; Testing; Thinking; United States National Institutes of Health; Visit; Work; acute coronary syndrome; avoidance behavior; base; behavior change; cardiovascular disorder risk; clinical practice; compliance behavior; disorder risk; experience; follow-up; high risk; improved; innovation; medication compliance; middle age; novel; novel strategies; outcome forecast; prevent; programs; recruit; research and development; research study; response; role model; successful intervention; theories; therapy design; therapy development

Project Summary The goal of this Columbia Roybal Center for Fearless Behavior Change is to develop and test novel interventions for improving medicationadherence and physical activity in distressed survivors of acute medical events. Each year, millions of middle aged and older adults experience heart attacks, strokes, or diagnoses of life-threatening illnesses such as cancer. For some, these events serve as a wake-up calls, or “teachable moments,” and those patients acquire health behaviors that help to prevent recurrent events and slow disease progression. However, many patients who experience these events as highly distressingavoid secondary risk- reducing medications and physical activity. We have shown that such patients avoid medications because they are reminders of disease risk, and exercise because physiological changes (e.g., heart rate) are distressing reminders of the possibility of a recurrent event. As a result, while highly distressed patients seemingly have motivation to adopt more healthful behaviors, most do not. We posit that existing behavior change interventions have largely failed to improve health behaviors because they have not addressed fear/avoidance behaviors that are pervasive after a life-threatening medical event. Accordingly, our Roybal Center will develop interventions that target fear-based mechanisms. We will initially focus on survivors of acute cardiovascular disease (CVD) events, of whom approximately 1 in 3 patients have elevated fear of recurrence, interoceptive bias, or psychophysiological reactivity to reminders of their CVD events (e.g., intrusive thoughts, medications, follow-up visits). In Year 1, we will conduct stage I intervention development research, to test and refine novel interventions to reduce fear of recurrence and prevent interoceptive bias using exposure-based interventions. In later years, we will further develop the most promising interventions, and solicit proposals for new approaches consistent with our Center’s theme. We will direct interventions at the high risk period from hospitalization through the first month after discharge, beginning at the inpatient bedside, anduse standard electronic behavior and mechanism assessment devices across studies. We will prioritize early stage investigators for new pilots, and provide world-class research infrastructure. We will initially focus on CVD, but we will include experts in other conditions in which fear plays an important role (e.g., cancer and COPD) for later interventions. As leaders of the Science of Behavior Change (SOBC) program, we are experts in applying the experimental medicine approach to produce simple, efficient, and potent behavior change interventions that are likely to be adopted by stakeholders. Accordingly, our Roybal Center holds tremendous promise for developing theory- derived interventions that are likely to have a substantial impact on the health behaviors of the most vulnerable patients who survive acute medical events.

项目概要 哥伦比亚皇家无所畏惧行为改变中心的目标是开发和测试新颖的 改善急性医疗痛苦幸存者的药物依从性和身体活动的干预措施 事件。每年，数以百万计的中老年人经历心脏病、中风或诊断为 危及生命的疾病，例如癌症。对于一些人来说，这些事件是一个警钟，或者是“可教的” 时刻”，这些患者获得有助于预防事件复发和减缓疾病的健康行为 进展。然而，许多经历这些事件并感到非常痛苦的患者会避免次要风险—— 减少药物和体力活动。我们已经表明，此类患者会避免药物治疗，因为它们 提醒人们疾病风险和锻炼，因为生理变化（例如心率）令人痛苦 提醒人们重复发生事件的可能性。因此，虽然高度痛苦的患者似乎 大多数人没有采取更健康行为的动机。我们假设现有的行为会改变 干预措施在很大程度上未能改善健康行为，因为它们没有解决恐惧/回避问题 危及生命的医疗事件后普遍存在的行为。因此，我们的皇家中心将发展 针对基于恐惧的机制的干预措施。 我们首先将重点关注急性心血管疾病 (CVD) 事件的幸存者，其中大约三分之一 患者对复发、内感受偏差或对提醒的心理生理反应有更高的恐惧 他们的 CVD 事件（例如侵入性想法、药物、随访）。在第一年，我们将进行第一阶段 干预发展研究，测试和完善新的干预措施，以减少对复发的恐惧和 使用基于暴露的干预措施来防止内感受偏差。在接下来的几年里，我们将进一步开发最 有前景的干预措施，并征求符合我们中心主题的新方法的建议。我们将 从住院到出院后第一个月的高风险期进行直接干预， 从住院患者床边开始，使用标准电子行为和机制评估设备 跨研究。我们将优先考虑新试点的早期研究人员，并提供世界一流的研究 基础设施。我们最初将重点关注 CVD，但我们也会邀请其他领域的专家，在这些情况下，我们会担心 对后续干预发挥重要作用（例如癌症和慢性阻塞性肺病）。 作为行为改变科学 (SOBC) 计划的领导者，我们是应用实验方法的专家 医学方法来产生简单、有效和有效的行为改变干预措施，这些干预措施可能是 被利益相关者采纳。因此，我们的皇家中心在发展理论方面拥有巨大的希望—— 可能对最弱势群体的健康行为产生重大影响的衍生干预措施 在急性医疗事件中幸存下来的患者。