Administration and Management Core

项目摘要 这个哥伦比亚罗伊巴尔无畏行为改变中心的目标是开发和测试新的 改善急性医疗事故痛苦幸存者的药物依从性和体力活动的干预措施 事件每年，数以百万计的中年和老年人经历心脏病发作，中风或诊断为 危及生命的疾病，如癌症。对一些人来说，这些事件是一个警钟，或“可教的 这些患者获得的健康行为有助于防止复发事件和减缓疾病 进展然而，许多经历这些高度痛苦事件的患者避免了继发风险- 减少药物和体力活动。我们已经证明，这些患者避免药物治疗，因为他们 是疾病风险的提醒，锻炼是因为生理变化（例如，心率）令人苦恼 提醒人们有可能发生复发性事件。因此，尽管高度痛苦的患者似乎 采取更健康的行为的动机，大多数人都没有。我们认为现有的行为改变 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Roybal中心将发展 针对恐惧机制的干预措施。 我们将首先关注急性心血管疾病（CVD）事件的幸存者，其中约1/3的人 患者对复发的恐惧、内感受性偏差或对提醒的心理生理反应升高， 它们的CVD事件（例如，侵入性想法、药物治疗、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， 使用基于安全的干预措施防止内感受性偏差。在未来的几年里，我们将进一步发展最 希望的干预措施，并征求与我们中心的主题一致的新方法的建议。我们将 在从住院到出院后第一个月的高危期进行直接干预， 从住院病人床边开始，使用标准的电子行为和机制评估设备， 跨研究。我们将优先考虑新飞行员的早期研究人员，并提供世界一流的研究 基础设施演进我们将首先关注心血管疾病，但我们将包括其他条件的专家，其中恐惧 起着重要的作用（例如，癌症和COPD）进行后续干预。 作为行为改变科学（SOBC）计划的领导者，我们是应用实验性 医学方法，以产生简单，有效，有效的行为改变干预，可能是 由利益相关者通过。因此，我们的罗伊巴尔中心拥有巨大的发展理论的希望- 可能对最脆弱人群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的患者。

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.