Mindfulness-Based Cognitive Therapy Delivered via Group Videoconferencing for Acute Coronary Syndrome Patients with Elevated Depression Symptoms

项目总结 这一K23奖项将支持候选人的培训和发展，使其走向独立的临床研究生涯，专注于基于正念的认知疗法(MBCT)的临床试验，以改善患有情绪和医疗问题的患者的情绪和身体健康。背景资料。在急性冠脉综合征(ACS)患者中，抑郁症状是常见的且致命的，需要可获得的心身治疗。MBCT是一种循证的抑郁症治疗方法，可以通过电子健康(e-Health)技术提供，以促进可获得性，但尚未有研究通过电子健康技术将MBCT应用于有抑郁症状的ACS患者。明确的目标。这项拟议的研究旨在：(1)确定ACS患者对电子健康MBCT干预的特定需求和偏好，以告知治疗适应和提供信息，(2)在开放的试点试验中探索调整后的MBCT干预和研究程序的初步可行性和可接受性，并根据需要进行改进，(3)在试点随机对照试验中建立MBCT和健康增强控制程序的可行性和可接受性，以及(3a)探索抑郁症状、潜在机制(炎症、情绪调节、亲社会)和心脏结果(健康行为、身体功能)的组内变化。训练。三个领域的培训将促进在适应和测试MBCT在慢性病人群中进行团体视频会议交付的有效性和机制方面的专门知识：(1)用于MBCT交付的新的电子健康技术形式；(2)MBCT适应的定性研究；(3)应激生理学和炎症生物标记物研究。这些培训目标将得到(1)专家导师、合作者和顾问团队的支持--Elyse R.Park博士、公共卫生硕士(主要导师)、Gloria Yeh医学博士、公共卫生硕士(共同导师)、Jeff Huffman医学博士(联合导师)、Bettina Hoeppner博士(合作者)、David Victorson博士(顾问)；(2)资源丰富的机构环境；(3)有针对性的高级课程作业、研究研讨会和科学会议；以及(4)拟议的研究研究。冲击力。所获得的技能将促进独立的研究生涯，专注于将MBCT用于为患有共同情感和医疗问题的患者提供电子健康服务，并对MBCT的疗效和生理机制进行严格的研究。这一结果将为R01通过小组视频会议对有抑郁症状的ACS患者应用MBCT疗效试验提供可行性数据。根据该研究所的资金优先事项，这项工作将通过确定针对难以治疗的问题的可行和可接受的干预措施，以及创新的数据收集方法来为MBCT机制的理论模型提供信息，从而推动心身医学研究。

PROJECT SUMMARY This K23 award will support the Candidate’s training and development toward an independent clinical research career focused on clinical trials of Mindfulness-Based Cognitive Therapy (MBCT) for emotional and physical health improvement in patients with comorbid emotional and medical problems. BACKGROUND. Among acute coronary syndrome (ACS) patients, depressive symptoms are common and deadly, and accessible mind-body treatments are needed. MBCT, an evidence-based depression treatment, can be delivered via electronic health (e-health) technologies to promote accessibility, but no research has applied MBCT via e-health technology to ACS patients with depressive symptoms. Specific Aims. The proposed study aims to: (1) identify ACS patients’ specific needs and preferences for an e-health MBCT intervention to inform treatment adaptation and delivery, (2) explore the initial feasibility and acceptability of the adapted MBCT intervention and research procedures in an open pilot trial and make refinements as necessary, and (3) establish the feasibility and acceptability of the MBCT and health enhancement control interventions and research procedures in a pilot RCT, and (3a) explore within-group changes in depression symptoms, potential mechanisms (inflammation, emotion regulation, pro-sociality), and cardiac outcomes (health behaviors, physical function). TRAINING. Training in three areas will promote expertise in adapting and testing the efficacy and mechanisms of MBCT for group videoconferencing delivery in chronic illness populations: (1) novel e-health technology formats for MBCT delivery; (2) qualitative research for MBCT adaptation; and (3) stress physiology and inflammatory biomarker research. These training goals will be supported by (1) a team of expert mentors, collaborators, and consultants – Elyse R. Park, PhD, MPH (primary mentor), Gloria Yeh, MD, MPH (co-mentor), Jeff Huffman, MD (co-mentor), Bettina Hoeppner, PhD (collaborator), David Victorson, PhD (consultant); (2) a resource-rich institutional environment; (3) targeted advanced coursework, research seminars, and scientific meetings; and (4) the proposed research studies. IMPACT. The skills gained will promote an independent research career focused on targeting MBCT for e-health delivery in patients with comorbid emotional and medical problems, and conducting rigorous studies of MBCT efficacy and physiological mechanisms. The results will provide feasibility data for an R01 application of an efficacy trial of MBCT via group videoconferencing for ACS patients with depressive symptoms at risk for poor outcomes. In line with the institute’s funding priorities, this work will advance mind-body medicine research by identifying feasible and acceptable interventions for difficult to treat problems, and innovative data collection methods to inform theoretical models of MBCT mechanisms.