Mindfulness-Based Cognitive Therapy for the chronic pain-depression co-morbidity among older Blacks in the community; The Quiet Focus study

研究及相关其他项目信息 项目摘要 这份K23提案详细说明了一项全面的5年培训计划，该计划将支持候选人过渡到 成为一名独立的调查员。候选人(Tony V Pham博士)是第一代大学生， 在医学精神病学家中的代表性不足，他的职业生涯将专注于开发和严格测试心身 对慢性病服务不足的人群提供更好的机会和相关性的干预措施。在此应用程序中， 候选人建议从文化上解决老年黑人社区慢性疼痛和抑郁并存的问题 适应正念认知疗法(MBCT)。在年长的黑人中，慢性疼痛与抑郁并存， 这种共同的发病率恶化了身体和情感功能；然而，黑人在循证方面面临着多重障碍 非药物性疼痛和抑郁治疗，包括系统性种族主义、耻辱和文化上的缺乏 量身定做的护理。根据文化定制的MBCT可能是改善身体和情绪的有效和高效的解决方案 在这些服务不足的人群中取得的成果。这款K23将开发安静的焦点，这是MBCT的文化改编 患有慢性肌肉骨骼疼痛和共生抑郁症的老年黑人。我和他的初步对话 社区对安静的焦点表现出强烈的兴趣，支持MBCT与社区的相关性，并对 只有在干预被缩短并由黑人社区的非专业指导员提供的情况下才能参与。在AIM 1，我将根据患有慢性疼痛和共生疾病的老年黑人社区的指导，培养安静的注意力 抑郁症。安静聚焦的起点将是一项简短的、以证据为基础的MBCT方案(8 60分钟 会议)由共同导师Shallcross开发。我将在联合导师Joo和Joo的指导下培训非专业教师 在主要导师Vranceanu和共同导师Shallcross的指导下制定忠诚度协议。在《目标2》中，我会 培训一名黑道员工，使其能够安静地集中注意力，评估初步的可行性和保真度。在目标3中，我将训练一名 新的Black提供个人提供安静的焦点，另一种提供时间和剂量匹配的控制。那我会的 进行静默聚焦和控制的可行性RCT，并评估最终的可行性基准，包括保真度。 这些拟议的努力将通过R01机制(主要结果是身体功能)为疗效试验提供信息 以及旨在将这项工作推广到其他代表性不足群体的未来研究。这些研究目标都得到了支持 3个主要培训目标，旨在发展以下方面的专门知识：(1)社区参与干预发展，(2)混合 方法干预改进研究；(3)社区参与临床试验。这些培训目标是 由(1)专家导师(Vranceanu、Jackson、Joo和Shallcross)、顾问(Mischoulon、Parker、 Okereke)和社区顾问委员会(Jacqueline Hinton，Michael Kincade)，(2)丰富的制度环境， (3)有针对性的材料和会议。在过去的一年里，我通过正式 以及与黑人社区领袖和患有慢性疼痛并伴发的老年黑人团体的非正式会议 抑郁症。这项K23提案与NCCIH的资金优先事项保持一致，以促进互补性和综合性 健康可以改善疼痛结果，解决整个人的问题，并增加研究人员的多样性。

Research & Related Other Project Information Project Summary This K23 proposal details a comprehensive 5-year training program that will support the candidate’s transition towards becoming an independent investigator. The candidate (Dr. Tony V Pham), a first generation college student, underrepresented in medicine psychiatrist, will focus his career on developing and rigorously testing mind-body interventions with better access and relevance to underserved populations with chronic illnesses. In this application, the candidate proposes to address the chronic pain-depression co-morbidity in the older Black community by culturally adapting Mindfulness-Based Cognitive Therapy (MBCT). Among older Blacks, chronic pain co-occurs with depression, and this co-morbidity worsens physical and emotional function; however, Blacks face multiple barriers to evidence-based non-pharmacological pain and depression management including systemic racism, stigma, and the lack of culturally tailored care. A culturally tailored MBCT may be an effective and efficient solution to improve physical and emotional outcomes among this underserved population. This K23 will develop Quiet Focus, a cultural adaptation of MBCT for older Blacks with chronic musculoskeletal pain and co-occurring depression. My preliminary conversations with the community revealed strong interest in Quiet Focus, support for MBCT’s relevance to the community, and interest in participation only if the intervention is abbreviated and is delivered by a lay instructor from the Black community. In Aim 1, I will develop Quiet Focus using guidance from the older Black community with chronic pain and co-occurring depression. The starting point for Quiet Focus will be an abbreviated, evidence-based MBCT protocol (8 60-minute sessions) developed by co-mentor Shallcross. I will train lay instructors under the mentorship of co-mentor Joo and develop a fidelity protocol under the mentorship of primary mentor Vranceanu and co-mentor Shallcross. In Aim 2, I will train a Black lay individual to deliver Quiet Focus and assess preliminary feasibility and fidelity. In Aim 3, I will train a new Black lay individual to deliver Quiet Focus and another to deliver a time- and dose-matched control. I will then conduct a feasibility RCT of Quiet Focus and control and assess definitive feasibility benchmarks including fidelity. These proposed efforts will inform an efficacy trial through the R01 mechanism (primary outcome is physical function) as well as future studies aimed at generalizing this work to other underrepresented groups. These study aims are supported by 3 main training goals aimed at developing expertise in: (1) community engaged intervention development, (2) mixed methods research for intervention refinement, and (3) community-engaged clinical trials. These training goals are supported by (1) a team of expert mentors (Vranceanu, Jackson, Joo, and Shallcross), advisors (Mischoulon, Parker, Okereke), and a community advisory board (Jacqueline Hinton, Michael Kincade), (2) a rich institutional environment, and (3) targeted materials and meetings. For the past year, I have built the infrastructure for this proposal through formal and informal meetings with Black community leaders and groups of older Blacks with chronic pain and co-occurring depression. This K23 proposal is in line with NCCIH’s funding priorities to advance how Complementary and Integrative Health can improve pain outcomes, address the whole person, and increase diversity within the research workforce.