Columbia Roybal Center for Fearless Behavior Change

哥伦比亚皇家无所畏惧行为改变中心

基本信息

批准号：
10017831
负责人：
Ian Matthew Kronish
金额：
$ 60.63万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
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/10017831
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 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 outcome forecast prevent programs recruit research and development research study response role model successful intervention theories therapy design therapy development

项目摘要

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.

项目概要哥伦比亚皇家无所畏惧行为改变中心的目标是开发和测试新颖的改善急性医疗痛苦幸存者的药物依从性和身体活动的干预措施每年，数以百万计的中老年人经历心脏病、中风或诊断为心脏病。对于一些人来说，这些事件是一个警钟，或者是“可教育的”。时刻”，这些患者获得有助于预防事件复发和减缓疾病的健康行为然而，许多经历这些事件进展的患者都非常痛苦，他们会避免继发风险—— 我们已经表明，此类患者会避免药物治疗，因为它们会减少药物的使用。提醒人们疾病风险和锻炼，因为生理变化（例如心率）令人痛苦结果，虽然高度痛苦的患者似乎有再次发生事件的可能性。采取更健康行为的动机，但大多数人认为现有行为不会改变。干预措施在很大程度上未能改善健康行为，因为它们没有解决恐惧/回避问题相应地，我们的皇家中心将发展危及生命的医疗事件后普遍存在的行为。针对基于恐惧的机制的干预措施。我们首先将重点关注急性心血管疾病 (CVD) 事件的幸存者，其中大约三分之一患者对复发、内感受偏差或对提醒的心理生理反应有更高的恐惧他们的 CVD 事件（例如侵入性想法、药物、随访）在第一年，我们将进行第一阶段。干预发展研究，测试和完善新的干预措施，以减少对复发的恐惧和在接下来的几年中，我们将进一步开发基于暴露的干预措施来防止内感受偏差。干预措施，并征求符合我们中心主题的有希望的新方法的建议。从住院到出院后第一个月的高风险期进行直接干预，从住院患者床边开始，并使用标准电子行为和机制评估设备我们将优先考虑新试点的早期研究人员，并提供世界一流的研究。我们最初将重点关注CVD，但我们将包括其他令人担忧的情况的专家。对以后的干预发挥重要作用（例如癌症和慢性阻塞性肺病）。作为行为改变科学 (SOBC) 计划的领导者，我们是应用实验方法的专家医学方法来产生简单、有效和有效的行为改变干预措施，这些干预措施可能是因此，我们的皇家中心在发展理论方面有着巨大的前景—— 可能对最弱势群体的健康行为产生重大影响的衍生干预措施在急性医疗事件中幸存下来的患者。