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: 10252886
• 负责人: Ian Matthew Kronish
• 金额: $ 59.57万
• 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/10252886
• 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; Prognosis; 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; prevent; programs; recruit; research and development; research study; response; role model; 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.

项目总结