Administration and Management Core

项目摘要 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小说 改善急性医疗痛苦幸存者服药依从性和体力活动的干预措施 事件。每年，数以百万计的中老年人经历心脏病发作、中风或被诊断为 癌症等危及生命的疾病。对于一些人来说，这些事件起到了警钟的作用，或者说是可教的 这些患者养成了有助于预防复发和延缓疾病的健康行为 进步。然而，许多经历这些事件的高度痛苦的患者避免了二次风险- 减少服药和体力活动。我们已经证明，这类患者避免药物治疗是因为他们 是对疾病风险的提醒，以及锻炼，因为生理变化(如心率)令人痛苦 提醒人们有可能再次发生事件。因此，虽然高度痛苦的患者似乎有 采取更健康行为的动机，大多数人并非如此。我们假设现有的行为改变 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 在危及生命的医疗事件后普遍存在的行为。相应地，我们的罗伊巴尔中心将会发展 针对基于恐惧的机制的干预。 我们将首先关注急性心血管疾病(CVD)事件的幸存者，其中约三分之一 患者对复发的恐惧、感觉间的偏见或对以下提醒的心理生理反应增强 他们的心血管疾病事件(例如，侵入性想法、药物治疗、随访)。在第一年，我们会进行第一阶段 干预发展研究，测试和改进新的干预措施，以减少对复发和 使用以暴露为基础的干预措施防止相互感觉偏差。在未来的几年里，我们将进一步发展最 有希望的干预措施，并征求与我们中心主题一致的新方法的建议。我们会 在从住院到出院后第一个月的高危时期进行直接干预， 从住院患者床边开始，使用标准的电子行为和机制评估设备 不同的研究。我们将优先安排新飞行员的早期调查人员，提供世界一流的研究 基础设施。我们最初将重点放在心血管疾病上，但我们将包括其他恐惧情况下的专家 在以后的干预中起着重要的作用(如癌症和COPD)。 作为行为改变科学(SOBC)计划的领导者，我们是应用实验 医学方法，以产生简单、有效和有力的行为改变干预措施，很可能是 被利益相关者采纳。因此，我们的罗伊巴尔中心对发展理论有着巨大的希望- 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下来的患者。

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.