Mindfulness-Based Cognitive Therapy for the chronic pain-depression co-morbidity among older Blacks in the community; The Quiet Focus study

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Research & Related Other Project Information Project Summary This K23 proposal details a comprehensive 5-year training program that will support the candidate’s transition towards becoming an independent investigator. The candidate (Dr. Tony V Pham), a first generation college student, underrepresented in medicine psychiatrist, will focus his career on developing and rigorously testing mind-body interventions with better access and relevance to underserved populations with chronic illnesses. In this application, the candidate proposes to address the chronic pain-depression co-morbidity in the older Black community by culturally adapting Mindfulness-Based Cognitive Therapy (MBCT). Among older Blacks, chronic pain co-occurs with depression, and this co-morbidity worsens physical and emotional function; however, Blacks face multiple barriers to evidence-based non-pharmacological pain and depression management including systemic racism, stigma, and the lack of culturally tailored care. A culturally tailored MBCT may be an effective and efficient solution to improve physical and emotional outcomes among this underserved population. This K23 will develop Quiet Focus, a cultural adaptation of MBCT for older Blacks with chronic musculoskeletal pain and co-occurring depression. My preliminary conversations with the community revealed strong interest in Quiet Focus, support for MBCT’s relevance to the community, and interest in participation only if the intervention is abbreviated and is delivered by a lay instructor from the Black community. In Aim 1, I will develop Quiet Focus using guidance from the older Black community with chronic pain and co-occurring depression. The starting point for Quiet Focus will be an abbreviated, evidence-based MBCT protocol (8 60-minute sessions) developed by co-mentor Shallcross. I will train lay instructors under the mentorship of co-mentor Joo and develop a fidelity protocol under the mentorship of primary mentor Vranceanu and co-mentor Shallcross. In Aim 2, I will train a Black lay individual to deliver Quiet Focus and assess preliminary feasibility and fidelity. In Aim 3, I will train a new Black lay individual to deliver Quiet Focus and another to deliver a time- and dose-matched control. I will then conduct a feasibility RCT of Quiet Focus and control and assess definitive feasibility benchmarks including fidelity. These proposed efforts will inform an efficacy trial through the R01 mechanism (primary outcome is physical function) as well as future studies aimed at generalizing this work to other underrepresented groups. These study aims are supported by 3 main training goals aimed at developing expertise in: (1) community engaged intervention development, (2) mixed methods research for intervention refinement, and (3) community-engaged clinical trials. These training goals are supported by (1) a team of expert mentors (Vranceanu, Jackson, Joo, and Shallcross), advisors (Mischoulon, Parker, Okereke), and a community advisory board (Jacqueline Hinton, Michael Kincade), (2) a rich institutional environment, and (3) targeted materials and meetings. For the past year, I have built the infrastructure for this proposal through formal and informal meetings with Black community leaders and groups of older Blacks with chronic pain and co-occurring depression. This K23 proposal is in line with NCCIH’s funding priorities to advance how Complementary and Integrative Health can improve pain outcomes, address the whole person, and increase diversity within the research workforce.