A positive psychology intervention to promote health behaviors in heart failure

 简介(申请人提供)：塞拉诺博士是马萨诸塞州综合医院(MGH)一名受过临床训练的精神病学家和研究员。他的研究主要是与麻省理工学院的心脏精神病学研究计划一起进行的，重点是促进心血管疾病和精神疾病患者的心理健康。他在心脏病患者的多项研究中有合作研究的经验，目前是一项旨在增强双相抑郁患者积极心理状态的先导研究的首席研究员。他发表了18篇文章(第一作者为7篇)，主要关注心脏病患者的精神疾病的识别和处理。他担任几种心脏病学期刊的临时审稿人，并因其研究获得了地方和国家奖项。 由于他对心脏病患者的研究和临床经验，Celano博士对促进心力衰竭(HF)患者的健康行为(例如，体力活动、服药依从性)产生了越来越大的兴趣。心衰是一种慢性、衰弱和进行性疾病，影响着近600万美国人，并导致严重的 功能、生活质量和生存。健康行为与心力衰竭患者预后的改善相关，包括存活率，但心力衰竭患者往往难以坚持这些行为。在这一人群中提高依从性的一个潜在方法是使用可以促进积极心理状态的干预措施，如乐观、感激或幸福。这些状态与健康和内科疾病人群对健康行为的依从性提高有关，这表明对心力衰竭患者进行干预以促进健康行为可能是促进这些行为和改善身心健康的有效方式。积极心理学使用系统的练习(例如，写感谢信，以新的方式使用个人力量)来瞄准积极的情绪，这可能是一种非常有希望的改善健康行为的方法。 在这份K23奖项提案中，塞拉诺博士将获得成为一名独立研究员所需的经验，他可以开发和实施心理干预措施，以增加健康行为 心衰患者。这将通过一个研究项目和正式的培训计划来实现，以增强他的能力：(1)创建、管理和分析定性访谈，(2)创建促进心力衰竭患者健康行为的积极心理学干预措施，(3)开发和完成单臂和对照干预试验，(4)测量和分析饮食和体力活动数据，以及(5)扩展他的生物统计学知识。 在他的研究项目中，塞拉诺博士将开发一种基于电话的积极心理干预，以增加纽约心脏协会II级或III级心衰患者的健康行为，然后测试干预的可行性和初步效果。首先，他将进行定性访谈，以确定积极心理状态(例如乐观)的缺陷与受损的健康行为完成之间的联系。然后，他将根据这些结果创建积极的心理干预。接下来，他将进行一项小型的概念验证试验，以确保干预的初步可行性，并根据需要进行改进。最后，他将进行一项随机、对照的试点试验，以收集有关干预的可行性、对乐观情绪的直接影响以及在促进该队列中的健康行为方面的初步效果的信息。该项目的结果将成为未来R01应用的基础，以便在更大的受试者群体中正式测试干预的效果。 塞拉诺博士的研究试验将得到一项正式培训计划的补充，以增加他对生物统计学、心力衰竭及其治疗、营养和体力活动测量、负责任的研究行为以及心脏病患者心理干预的了解。他的培训将包括哈佛大学公共卫生学院的生物统计学课程，临床和 与心力衰竭相关的研究会议，麻省理工学院行为医学计划的每周研讨会，定性研究和负责任的研究进行的正式培训，饮食和体力活动方面的结构化阅读计划，以及与具有定性研究、积极心理学、心力衰竭、健康行为结果和行为干预专业知识的导师和顾问的定期会议。 塞拉诺博士的建议将为他提供在进行定性研究、概念验证试验和对照试验方面的宝贵经验，并将增强他对心力衰竭、行为干预、健康行为测量和生物统计学的知识。此外，这一经验将使塞拉诺博士成为一个极其重要的领域的独立研究员--即促进HF的健康行为。由于心力衰竭患者难以坚持维持生命的健康行为，有效的心理干预以增强积极的心理状态并促进这些行为具有改善这种毁灭性疾病患者的身心健康的潜力。

 DESCRIPTION (provided by applicant): Dr. Celano is a clinically trained psychiatrist and research fellow at the Massachusetts General Hospital (MGH). His research, performed primarily with the Cardiac Psychiatry Research Program at MGH, has centered on the promotion of psychological health in patients with cardiovascular disease and psychiatric illness. He has experience as a co-investigator on multiple studies in cardiac patients and currently is the principal investigator of a pilot study to enhance positive psychological states in patients with bipolar depression. He has published 18 articles (7 as first-author) that focus largely on the identification and management of psychiatric illness in cardiac patients. He serves as an ad hoc reviewer for several cardiology journals and has received local and national awards for his research. As a result of his research and clinical experience with cardiac patients, Dr. Celano has developed an increasing interest in the promotion of health behaviors (e.g., physical activity, medication adherence) in patients with heart failure (HF). HF is a chronic, debilitating, and progressive illness that affects nearly 6 million Americans and leads to significant impairments in functioning, quality of life, and survival. Health behaviors are associated with improved outcomes, including survival, in HF, but HF patients often have difficulty adhering to these behaviors. A potential way to improve adherence in this population is to use interventions that can boost positive psychological states, such as optimism, gratitude, or happiness. These states are associated with improved adherence to health behaviors in healthy and medically ill populations, suggesting that an intervention to boost them in HF patients may be an effective way to promote these behaviors and improve physical and mental health. Positive psychology, which uses systematic exercises (e.g., writing a letter of gratitude, using a personal strength in new way) to target positive feelings, may be a highly promising approach to improve health behaviors. In this K23 award proposal, Dr. Celano will obtain the experience needed to become an independent researcher who can develop and implement psychological interventions to increase healthy behavior in patients with HF. This will be accomplished through a research project and formal training plan to enhance his ability to: (1) create, administer, and analyze qualitative interviews, (2) create positive psychology interventions that promote health behaviors in HF patients, (3) develop and complete single-arm and controlled intervention trials, (4) measure and analyze diet and physical activity data, and (5) extend his knowledge of biostatistics. In his research project, Dr. Celano will develop a telephone-based positive psychology intervention to increase health behaviors in patients with New York Heart Association class II or III HF, then test the intervention's feasibility and preliminary efficacy. First, he will perform qualitative interviews to identify links between deficits in positive psychological states (e.g., optimism) and impaired health behavior completion. He will then create a positive psychology intervention based on these results. Next, he will perform a small, proof- of-concept trial to ensure initial feasibility of the intervention and to refine it as needed. Finally, he will perfor a randomized, controlled pilot trial to gather information about the intervention's feasibility, immediate impact on optimism, and preliminary efficacy at promoting health behaviors in this cohort. The results from this project will form the basis of a future R01 application to formally test the efficacy of the intervention in a larger group of subjects. Dr. Celano's research trial will be supplemented by a formal training plan to increase his understanding of biostatistics, HF and its treatment, nutrition and physical activity measurement, the responsible conduct of research, and psychological interventions for cardiac patients. His training will consist of biostatistics classes at the Harvard School of Public Health, clinical and research meetings related to HF, weekly seminars at MGH's Behavioral Medicine Program, formal training in qualitative research and the responsible conduct of research, structured reading programs in diet and physical activity, and regular meetings with mentors and consultants who have expertise in qualitative research, positive psychology, HF, health behavior outcomes, and behavioral interventions. Dr. Celano's proposal will provide him with invaluable experience in performing qualitative research, proof- of-concept trials, and controlled trials and will enhance his knowledge of HF, behavioral interventions, health behavior measurement, and biostatistics. Furthermore, this experience will enable Dr. Celano to become an independent investigator in a critically important area-namely, the promotion of health behaviors in HF. As patients with HF have trouble adhering to life-sustaining health behaviors, effective psychological interventions to enhance positive psychological states and promote these behaviors have the potential to improve mental and physical well-being in patients with this devastating illness.