Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes

参与自我调节目标以了解行为改变的机制并改善情绪和体重结果

• 批准号: 9339342
• 负责人: Jun Ma
• 金额: $ 9.52万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9339342
• 关键词: Adherence; Adult; Affect; Antidepressant adherence; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Biological; Biological Assay; Body Weight decreased; Brain; Cardiovascular Diseases; Cardiovascular system; Characteristics; Cognitive; Data Analyses; Depressed mood; Diabetes Mellitus; Diet; Diet Research; Disease; Disease remission; Early treatment; Educational workshop; Effectiveness; Emotional; Equilibrium; Funding; Health; Health behavior; Health behavior change; Health behavior outcomes; Human; Individual; Informal Social Control; Intervention; Intervention Studies; Life Style; Maintenance; Measures; Medical; Medicine; Mental Depression; Moods; Neurosciences; Obesity; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacotherapy; Phase; Physical activity; Physiological; Population; Primary Health Care; Process; Randomized; Randomized Controlled Trials; Regimen; Regulation; Research; Science; Series; Subgroup; Testing; Time; Training; Waiting Lists; Weight; Weight maintenance regimen; Woman; adverse outcome; base; behavior change; burden of illness; depressive symptoms; disability; evidence base; follow-up; good diet; health disparity; improved; insight; lifetime risk; men; multiple chronic conditions; obesity treatment; pilot trial; population health; problem solving therapy; programs; prototype; psychologic; relating to nervous system; research study; response; symposium; theories; treatment as usual; treatment response; virtual laboratory

 DESCRIPTION (provided by applicant): Background: Obesity affects 36% of US women and men and increases lifetime risk for diabetes and cardiovascular disease. Similarly, depression affects 20% of US women and 13% of men and is the leading cause of disability worldwide. Further, the 2 disorders have a bidirectional positive relationship. Proven behavioral interventions to treat obesity and depression exist; however, the underlying biological mechanisms remain unknown. This lack of understanding significantly hampers efforts to optimize the effectiveness of behavioral interventions and limits their dissemination and implementation into widespread practice to curtail the adverse consequences of obesity and depression and promote population health. Rapid advances in human neuroscience and behavioral science and integration of the two could provide unique opportunity to fill this gap. Objective: Leveraging a recently funded 2-year randomized controlled trial ("RAINBOW" target n=404; PI Dr. Jun Ma) of a first-ever integrated treatment for comorbid obesity and depression in primary care that uniquely combines 2 nationally recognized behavioral interventions, we propose a 2-phased project to identify, validate and refine a set of assays to measure self-regulation targets; and to engage these targets to optimize behavioral treatment of obesity and depression. Specific Aims: In the UH2 phase, we will (1) Conduct secondary data analysis and hold workshops and a symposium to finalize selection of self-regulation targets and assays for testing; (2) Leverage the RAINBOW intervention to engage identified targets; and (3) Verify target engagement across multiple domains (neural, physiological, behavioral, psychological), settings (laboratory, virtual, and naturalistic), and time points (0, 4 weeks, 6, 12 and 24 months) Transitional milestones are to (1) Establish assay(s) that reliably and accurately measure the identified targets; (2) Demonstrate malleability of the self-regulation target(s) in response to th RAINBOW integrated treatment; and (3) Identify self-regulation profile(s) that predict treatment response in health behaviors (medical regimen adherence, physical activity, diet) and outcomes (weight, depression). In the UH3 phase, we will conduct a pilot randomized controlled trial in which an additional 100 obese and depressed adults will be randomized to intervention or wait-list control and assessed at baseline, 4 weeks and 6 months. Intervention subjects will receive the first 4 weeks of the RAINBOW intervention, followed by target-guided tailoring of the intervention components in order to optimize target engagement and enhance behavioral change based on their individual self-regulation profile during the first 4 weeks. We will use the insights from intervention subjects to then further refine the tailoring strategies for the waitlis subjects. Implications: This research will provide a toolkit of well-validated assays of self-regulation targets important for health behavior change, as well as target- guided personalization of intervention strategies, in the treatment of comorbid obesity and depression. Impact: Given the widespread relevance of these disorders and the targeted health behaviors, this research will be a prototype for treating multiple chronic conditions with profound potential impacts on population health.

 描述（由申请人提供）： 背景：肥胖影响 36% 的美国女性和男性，并增加终生患糖尿病和心血管疾病的风险。同样，抑郁症影响着 20% 的美国女性和 13% 的男性，是全球残疾的主要原因。此外，这两种疾病具有双向正相关关系。已证实存在治疗肥胖和抑郁症的行为干预措施；然而，潜在的生物学机制仍然未知。这种缺乏了解极大地阻碍了优化行为干预措施有效性的努力，并限制了行为干预措施的传播和广泛实施，以减少肥胖和抑郁症的不利后果并促进人口健康。人类神经科学和行为科学的快速发展以及两者的整合可以为填补这一空白提供独特的机会。目的：利用最近资助的一项为期 2 年的随机对照试验（“RAINBOW”目标 n=404；PI Dr. Jun Ma）首次在初级保健中针对肥胖和抑郁症共病进行综合治疗，该试验独特地结合了 2 种全国认可的行为干预措施，我们提出了一个分两阶段的项目来识别、验证和完善一套测定自我调节目标的方法；并利用这些目标来优化肥胖和抑郁症的行为治疗。具体目标：在UH2阶段，我们将（1）进行二次数据分析并举办研讨会和座谈会，以最终确定自律目标和检测方法的选择； (2) 利用 RAINBOW 干预措施来吸引已确定的目标； (3) 跨多个领域（神经、生理、行为、心理）、环境（实验室、虚拟和自然）和时间点（0、4 周、6、12 和 24 个月）验证目标参与情况。 过渡里程碑是 (1) 建立可靠、准确测量已识别目标的测定方法； (2) 展示自我调节目标响应 RAINBOW 综合治疗的可塑性； (3) 确定自我调节概况，以预测健康行为（医疗方案依从性、体力活动、饮食）和结果（体重、抑郁）方面的治疗反应。在 UH3 阶段，我们将进行一项试点随机对照试验，其中另外 100 名肥胖和抑郁的成年人将被随机分配到干预组或候补名单控制组，并在基线、4 周和 6 个月时进行评估。干预对象将接受 RAINBOW 干预的前 4 周，然后根据前 4 周内的个人自我调节情况，对干预组件进行有针对性的定制，以优化目标参与度并增强行为改变。我们将利用干预受试者的见解，进一步完善针对 waitlis 受试者的定制策略。意义：这项研究将提供一个工具包，对对健康行为改变很重要的自我调节目标进行充分验证的分析，以及在肥胖和抑郁共病的治疗中以目标为导向的个性化干预策略。影响：鉴于这些疾病的广泛相关性和目标健康行为，这项研究将成为治疗多种慢性病的原型，对人口健康具有深远的潜在影响。