BUTLER HOSPITAL

COBRE CENTER FOR NEUROMODULATION (CCN)

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

OPTIMIZATION OF A BEHAVIORAL INTERVENTION TO INCREASE PHYSICAL ACTIVITY IN OLDER ADULTS LIVING WITH HIV - INCREASING NUMBERS OF PERSONS LIVING WITH HIV (PLWH) ARE LIVING TO OLDER AGES. OLDER PLWH ARE AT INCREASED RISK FOR A WIDE SPECTRUM OF CO-MORBID CONDITIONS SUCH AS CARDIOVASCULAR DISEASE, FRAILTY PHENOTYPE, AND MENTAL HEALTH DISORDERS. PRACTICAL PRIMARY CARE-BASED INTERVENTIONS ARE NEEDED FOR OLDER PLWH THAT TARGET LIFESTYLE FACTORS TO REDUCE COMPLICATIONS OF AGING AND IMPROVE HEALTHSPAN. MOST PLWH ENGAGE IN LESS PHYSICAL ACTIVITY (PA) THAN IS RECOMMENDED BY PUBLIC HEALTH GUIDELINES. THUS, INCREASING PA CAN LEAD TO NUMEROUS MENTAL AND PHYSICAL HEALTH BENEFITS AMONG PLWH. CURRENT STUDIES IN PLWH TYPICALLY FOCUS ON THE IMPACT OF SUPERVISED EXERCISE. HOWEVER, THERE ARE MANY BARRIERS TO THIS TYPE OF PA. LIFESTYLE PHYSICAL ACTIVITY (LPA) PROGRAMS THAT FOCUS ON INTEGRATING PA, ESPECIALLY WALKING, INTO EVERYDAY LIFE, MAY BE MORE SUCCESSFUL IN PRODUCING A SUSTAINED INCREASE IN PA. THE LONG-TERM GOAL OF THIS RESEARCH IS TO DEVELOP AN EFFECTIVE AND EFFICIENT PRIMARY CARE INTERVENTION THAT INCREASES LPA AMONG OLDER PLWH. WE LEVERAGE THE MULTIPHASE OPTIMIZATION STRATEGY (MOST) AS A FRAMEWORK FOR DEVELOPING, OPTIMIZING, AND EVALUATING A MULTICOMPONENT BEHAVIORAL INTERVENTION. MOST IS COMPRISED OF THREE PHASES. FIRST, IN THE PREPARATION PHASE, AN EMPIRICAL AND THEORY-DRIVEN CONCEPTUAL MODEL IS DEVELOPED THAT IDENTIFIES DIFFERENTIABLE INTERVENTION COMPONENTS AND SPECIFIES OPTIMIZATION CRITERIA (I.E., GOAL OF INTERVENTION DEVELOPMENT). WE HAVE COMPLETED THIS PHASE. SECOND, IN THE OPTIMIZATION PHASE, THE IMPACT OF EACH INTERVENTION COMPONENT ON THE DESIRED OUTCOME IS EMPIRICALLY EXAMINED. THE GOAL IS TO DETERMINE WHICH COMPONENTS TO INCLUDE IN A FINAL INTERVENTION PACKAGE THAT IS OPTIMIZED FOR EFFICACY AND EFFICIENCY. THE PROPOSED STUDY REFLECTS THE SECOND PHASE, OR AN OPTIMIZATION TRIAL. FINALLY, IN THE EVALUATION PHASE, THE OPTIMIZED INTERVENTION PACKAGE IS EVALUATED FOR EFFICACY IN A TRADITIONAL RCT; THIS WILL BE THE NEXT STEP IN THIS LINE OF RESEARCH FOLLOWING THE CURRENTLY PROPOSED PROJECT. IN THIS PROJECT, WE WILL TEST THE IMPACT OF THREE SEPARABLE INTERVENTION COMPONENTS ON STEPS PER DAY AFTER 4 MONTHS OF INTERVENTION. WE WILL RECRUIT 208 PLWH OF AGE =50 YEAR CLASSIFIED AS LOW-ACTIVE. ALL PARTICIPANTS RECEIVE COMPONENT ‘0’: BRIEF ADVICE TO EXERCISE AND A FITBIT ACTIVITY TRACKER. WE THEN TEST 3 ADDITIONAL COMPONENTS IN A FACTORIAL DESIGN: 1) PA COACHING— FOCUSED ON GOAL-SETTING AND SELF-MONITORING; 2) COGNITIVE-BEHAVIORAL INTERVENTION FOR PA (CB-PA)—FOCUSED ON IDENTIFYING VALUES AND ADDRESSING INTERNAL BARRIERS TO PA SUCH AS PAIN, DEPRESSION, OR FATIGUE; 3) SOCIAL SUPPORT FOR PA (SS-PA)—A COMPONENT WHICH LEVERAGES THE SOCIAL FUNCTIONALITY OF THE FITBIT APP, PROMOTING SOCIAL SUPPORT AND FRIENDLY COMPETITION. THE PRIMARY OUTCOME WILL BE STEPS PER DAY DURING MONTH 4. THE OBSERVED MAIN AND INTERACTION EFFECTS FOR THE 3 CANDIDATE COMPONENTS WILL GUIDE SELECTION OF COMPONENTS TO BE INCLUDED IN AN OPTIMIZED INTERVENTION THAT WILL BE TESTED IN A FUTURE RCT. WE WILL ALSO EXAMINE POTENTIAL MEDIATORS FOR EACH INTERVENTION COMPONENT, AS WELL AS SECONDARY OUTCOMES INCLUDING PERCEIVED PHYSICAL HEALTH, MENTAL HEALTH, CARDIOVASCULAR DISEASE RISK, AND THE FRAILTY PHENOTYPE.

TESTING THE EFFICACY OF A TECHNOLOGY-SUPPORTED LIFESTYLE PHYSICAL ACTIVITY INTERVENTION AMONG WOMEN WITH DEPRESSION IN ALCOHOL TREATMENT

OPTIMIZATION AND MULTI-SITE FEASIBILITY OF YOGA FOR CHRONIC PAIN IN PEOPLE IN TREATMENT FOR OPIOID USE DISORDER - CHRONIC PAIN IS A SIGNIFICANT PROBLEM FOR AT LEAST HALF OF ALL PERSONS RECEIVING OPIOID AGONIST THERAPY (OAT) FOR OPIOID USE DISORDER – I.E., BUPRENORPHINE/ NALOXONE (BUP) OR METHADONE MAINTENANCE TREATMENT (MMT). PHARMACOTHERAPEUTIC PAIN MANAGEMENT IS CHALLENGING IN OAT PATIENTS, AND OTHER BEHAVIORAL OPTIONS FOR MANAGING CHRONIC PAIN ARE NEEDED. HATHA YOGA MAY BE A USEFUL ADJUNCTIVE APPROACH FOR DECREASING PAIN- RELATED DISABILITY AND PAIN SEVERITY, AND PREVENTING OPIOID MISUSE DURING OAT. THERE IS EVIDENCE SUPPORTING ITS EFFICACY IN OTHER CHRONIC PAIN POPULATIONS, AND YOGA MAY TARGET CRAVINGS AND OTHER RISK FACTORS FOR OPIOID RELAPSE. WITH NCCIH R34 FUNDING, WE CONDUCTED A PILOT RCT OF A 12-WEEK HATHA YOGA CLASS VS. A HEALTH EDUCATION CLASS (HE; A CONTROL CONDITION) FOR PEOPLE WITH CHRONIC PAIN RECEIVING MMT (N=20) OR BUP (N=20) FOR OPIOID USE DISORDER. THE PRIMARY TARGET OF THE YOGA INTERVENTION WAS DECREASED LIFE INTERFERENCE DUE TO PAIN. IN THIS STUDY, WE MEASURED MULTIPLE INDICES OF FEASIBILITY AND ACCEPTABILITY OF THE MANUALIZED INTERVENTIONS. ALTHOUGH WE MET A PRIORI BENCHMARKS ON MANY OF THESE FEASIBILITY INDICES, WE DID FIND THAT, CONSISTENT WITH LITERATURE ON BEHAVIORAL INTERVENTIONS IN OAT PATIENTS, SOME PARTICIPANTS ATTENDED ONLY VERY FEW CLASSES. THUS, AS A NEXT STEP IN THIS RESEARCH, THE PURPOSE OF THE CURRENT PROJECT IS TO DEVELOP AN OPTIMIZED YOGA INTERVENTION PACKAGE THAT INCLUDES KEY COMPONENTS THAT INCREASE YOGA DOSAGE RECEIVED, DEFINED AS TIME IN CLASS (A FUNCTION OF NUMBER OF CLASSES ATTENDED) PLUS HOME YOGA PRACTICE TIME. WE PLAN TO USE THE MULTIPHASE OPTIMIZATION STRATEGY (MOST) TO DO THIS. WE WILL EVALUATE FOUR INTERVENTION COMPONENTS, ALL OF WHICH WILL BE ADDED TO OUR STANDARD GROUP YOGA CLASSES, TO DETERMINE THEIR IMPACT ON TOTAL YOGA DOSAGE RECEIVED. THESE COMPONENTS ARE: A) TWO ADDED 1:1 MEETINGS WITH THE YOGA TEACHERS; B) PROVISION OF STUDY TEACHER-LED HOME PRACTICE VIDEOS; C) MONETARY INCENTIVES FOR CLASS ATTENDANCE; AND D) TEXT MESSAGES DESIGNED TO INCREASE INTRINSIC MOTIVATION FOR YOGA PRACTICE. AS A SECONDARY GOAL, IN KEEPING WITH THE U01 PROGRAM ANNOUNCEMENT, WE WILL ALSO DEMONSTRATE THAT WE CAN CONDUCT THIS RESEARCH IN TWO SITES DISTINCT FROM EACH OTHER AND FROM OUR PREVIOUS SITE. IN THIS STUDY, AFTER CONDUCTING PILOT WORK (PHASE 1), WE PLAN TO CONDUCT A FULLY-POWERED FACTORIAL EXPERIMENT THAT WILL ALLOW US TO EVALUATE THE IMPACT OF EACH OF THE 4 INTERVENTION COMPONENTS ON YOGA DOSAGE RECEIVED. ALL PARTICIPANTS WILL RECEIVE THE CORE YOGA INTERVENTION, WITH RANDOM ASSIGNMENT TO RECEIVE OR NOT RECEIVE EACH OF THE FOUR INTERVENTION COMPONENTS OUTLINED ABOVE. RESULTS FROM PHASE 2 WILL ALLOW US TO CHOOSE AN EFFICIENT COMBINATION OF INTERVENTION COMPONENTS THAT, TOGETHER WITH STANDARD YOGA CLASSES, MAXIMIZES YOGA DOSAGE. WE WILL ALSO BE ABLE TO EXAMINE MECHANISMS BY WHICH INTERVENTION COMPONENTS ARE HYPOTHESIZED TO WORK. THIS PROJECT WILL PREPARE US FOR THE NEXT STEP IN THIS RESEARCH, I.E., A FULLY-POWERED, MULTI-SITE RCT TESTING THE OPTIMIZED YOGA INTERVENTION (VS. A CONTROL CONDITION), WITH A PRIMARY OUTCOME OF REDUCED PAIN INTERFERENCE.

EFFECTIVENESS OF A MULTI-COMPONENT MHEALTH INTERVENTION TO IMPROVE POST-HOSPITAL TRANSITIONS OF CARE FOR PATIENTS WITH SMI - PROJECT SUMMARY/ABSTRACT THE PERIOD IMMEDIATELY FOLLOWING DISCHARGE FROM ACUTE PSYCHIATRIC HOSPITALIZATION IS A TIME FRAUGHT WITH GAPS AND DISCONTINUITIES IN CARE FOR MANY PATIENTS. DESPITE THIS TIME OF ELEVATED RISK, PATIENTS OFTEN LACK SUFFICIENT TRANSITIONAL SUPPORTS AND RELATED RESOURCES FOR RETURNING TO THE COMMUNITY AND RESUMING LONG-TERM OUTPATIENT TREATMENT. THE LONG-TERM GOAL IS TO IMPROVE THE CONTINUITY OF CARE FOR PATIENTS WITH SERIOUS MENTAL ILLNESS (SMI) BY SUPPORTING A SAFER AND MORE EFFICIENT BRIDGE FROM HOSPITAL TO OUTPATIENT CARE. THE OBJECTIVE OF THIS PROPOSAL IS TO TEST THE EFFECTIVENESS OF OUR EMPIRICALLY-SUPPORTED, MULTI-COMPONENT MHEALTH INTERVENTION CALLED TFOCUS IN COMPARISON TO ENHANCED ASSESSMENT AND MONITORING TO ENSURE SAFETY AND AN ADEQUATE STANDARD OF CARE (“SAFE”). TFOCUS WILL BE DEPLOYED DURING THE HIGH-RISK PERIOD DIRECTLY FROM HOSPITAL TO OUTPATIENT CARE AND PROVIDE REAL-TIME ASSESSMENT AND INTERVENTION TO PATIENTS VIA A MOBILE APP, PLUS USER ENGAGEMENT AND CLINICAL STATUS UPDATES TO CLINICIANS VIA A WEB-BASED “DASHBOARD.” TO SPEED THE TRANSLATION OF FINDINGS TO CLINICAL PRACTICE, WE WILL RIGOROUSLY TEST THE EFFECTIVENESS OF TFOCUS IN A FULLY-POWERED HYBRID TYPE 1 EFFECTIVENESS-IMPLEMENTATION TRIAL, WHILE COLLECTING INFORMATION ON IMPLEMENTATION BARRIERS/FACILITATORS TO PROMOTE UPTAKE IN REAL WORLD SETTINGS. THE CENTRAL HYPOTHESIS IS THAT TFOCUS WILL IMPROVE ILLNESS SELF-COPING AND TREATMENT ATTITUDES, WHICH WILL LEAD TO REDUCED: PSYCHIATRIC SYMPTOMS, REHOSPITALIZATIONS, AND SUICIDAL IDEATION/BEHAVIORS. TFOCUS WILL ALSO LEAD TO IMPROVED POST-DISCHARGE TREATMENT ENGAGEMENT AND ILLNESS RECOVERY. THE AIMS OF THIS PROPOSAL ARE: (1) TO CONDUCT A FULLY-POWERED, RCT (N=180) TO TEST THE EFFECTIVENESS OF TREATMENT-AS-USUAL (TAU) + TFOCUS VS TAU + SAFE; (2) TO EXAMINE POTENTIAL MEDIATORS AND MODERATORS OF TREATMENT EFFECTS; AND, (3) TO IDENTIFY PATIENT, STAFF, AND ORGANIZATIONAL/SYSTEM-LEVEL FACTORS THAT MAY FACILITATE/HINDER TFOCUS IMPLEMENTATION. THE PRIMARY OUTCOME WILL BE OVERALL PSYCHIATRIC SYMPTOMS. THE APPROACH IS INNOVATIVE BECAUSE IT IS ONE OF THE FIRST RANDOMIZED CONTROLLED TRIALS CONDUCTED IN THE U.S. SPECIFICALLY EVALUATING AN MHEALTH AFTERCARE SUPPORT PROGRAM FOR PATIENTS WITH SMI DIRECTLY MOVING FROM HOSPITAL TO OUTPATIENT CARE. ALSO, THIS STUDY IS UNIQUE IN THAT IT WILL COLLECT DATA TO GENERATE HYPOTHESES ABOUT IMPLEMENTATION STRATEGIES VIA A MULTI-PRONGED APPROACH INVOLVING KEY STAKEHOLDERS AND ADDITIONAL IMPLEMENTATION ATA. UPON SUCCESSFUL COMPLETION OF THE PROPOSED R01 RESEARCH, THIS STUDY WILL CONTRIBUTE SIGNIFICANT ACTIONABLE DATA THAT WILL LAY THE GROUNDWORK FOR A LARGE-SCALE HYBRID TYPE 3 TRIAL OF TFOCUS IN DIVERSE HOSPITAL SETTINGS.

ECOLOGICAL ASSESSMENT OF PROXIMAL RISK FACTORS FOR SUICIDE DURING CARE TRANSITIONS - PROJECT SUMMARY/ABSTRACT SUICIDAL IDEATION AND BEHAVIOR ARE GROWING PUBLIC HEALTH PROBLEMS IN THE UNITED STATES. THIS IS PARTICULARLY CONCERNING DURING THE HIGH-RISK PERIOD FOLLOWING DISCHARGE FROM PSYCHIATRIC HOSPITALIZATION WHEN RISK FOR SUICIDE IS AMONG THE HIGHEST RATES OBSERVED. UNFORTUNATELY, OUR CURRENT ABILITY TO PREDICT SUICIDE IS ONLY SLIGHTLY ABOVE CHANCE. THIS POOR PREDICTIVE ABILITY MAY BE DUE TO AN OVERRELIANCE ON DISTAL/CROSS-SECTIONAL SUICIDE RISK FACTORS ALONE, RATHER THAN AN EMPHASIS ON PROXIMAL RISK FACTORS (THE DYNAMIC COGNITIVE, AFFECTIVE, AND BEHAVIORAL EXPERIENCES OCCURRING IN THE DAYS, HOURS, AND MINUTES PRIOR TO SUICIDE). THE PROPOSED STUDY BUILDS UPON OUR TEAM'S EXISTING INFRASTRUCTURE AND EXPERTISE IN DIGITAL PHENOTYPING AND ECOLOGICALLY VALID MODELS OF SUICIDE RISK. WE WILL EXAMINE HOW AFFECTIVE (E.G., NEGATIVE AFFECT) AND CONTEXTUAL (E.G., SOCIAL INTERACTIONS, COGNITIONS, & SLEEP DISRUPTION) PROXIMAL RISK FACTORS INTERACT TO INFLUENCE SUICIDAL IDEATION AND CONFER RISK FOR SUICIDAL BEHAVIOR, PARTICULARLY DURING THE HIGH-RISK PERIOD FOLLOWING HOSPITALIZATION. WE WILL RECRUIT AND FOLLOW-UP WITH 240 PSYCHIATRIC INPATIENTS HOSPITALIZED FOR SUICIDAL IDEATION OR BEHAVIOR OVER A FIVE-YEAR STUDY PERIOD. PARTICIPANTS WILL COMPLETE BASELINE ASSESSMENTS INCLUDING CLINICAL INTERVIEWS, LABORATORY-BASED BEHAVIORAL ASSESSMENTS, AND SELF-REPORTS OF DISTAL RISK FACTORS ASSOCIATED WITH SUICIDE. DURING HOSPITALIZATION, PARTICIPANTS WILL BEGIN COMPLETING ECOLOGICAL MOMENTARY ASSESSMENTS (EMAS) OF AFFECT, COGNITION, BEHAVIOR, AND SOCIAL/ENVIRONMENTAL CONTEXT. FOLLOWING DISCHARGE, PARTICIPANTS WILL CONTINUE EMA MONITORING FOR 4-WEEKS AT BASELINE AND AGAIN FOR TWO 3-WEEK EMA “BURSTS” AT 3- AND 6-MONTH FOLLOW-UP ASSESSMENTS. DURING EACH EMA MONITORING PERIOD, WE WILL COLLECT DIGITAL PHENOTYPING DATA (E.G., SLEEP, LOCATION, ACTIVITY LEVEL/MOVEMENT) USING WEARABLES AND SMARTPHONE SENSORS. WE WILL CONDUCT 3- AND 6-MONTH FOLLOW-UP ASSESSMENTS IN OUR LAB TO RE-ADMINISTER LAB-BASED BEHAVIORAL ASSESSMENTS AND COLLECT OUTCOME DATA INCLUDING SUICIDAL IDEATION, SUICIDAL BEHAVIOR, AND RE-HOSPITALIZATION. THE PROPOSED STUDY AIMS TO IDENTIFY PROXIMAL RISK FACTORS FOR SUICIDE AND USE INTENSIVE LONGITUDINAL METHODS TO CHARACTERIZE THE RELATIONSHIPS AMONG AFFECTIVE AND CONTEXTUAL PROXIMAL RISK FACTORS WHILE ALSO EXAMINING HOW DISTAL RISK FACTORS MODERATE THE RELATIONSHIPS AMONG PROXIMAL RISK FACTORS AND BETWEEN PROXIMAL RISK FACTORS AND SUICIDAL IDEATION AND BEHAVIOR. WE WILL EXAMINE THESE RELATIONSHIPS BOTH BEFORE AND AFTER DISCHARGE FROM PSYCHIATRIC HOSPITALIZATION. THE RESULTS OF THIS STUDY HAVE THE POTENTIAL TO SUBSTANTIALLY ENHANCE OUR UNDERSTANDING OF SUICIDE PHENOMENOLOGY AS IT EXISTS IN THE REAL WORLD, PARTICULARLY ACROSS THE HIGH-RISK PERIOD FOLLOWING PSYCHIATRIC HOSPITALIZATION, WITH THE POTENTIAL TO IMPROVE OUR ABILITY TO PREDICT, PREVENT, AND ULTIMATELY TREAT SUICIDAL THOUGHTS AND BEHAVIORS USING TRADITIONAL AND TECHNOLOGY-ENHANCED INTERVENTIONS.

A LONGITUDINAL EMA STUDY EXAMINING THE ROLE OF MATERNAL MOOD AND PHYSICAL SYMPTOMS ON WOMEN'S CANNABIS USE ACROSS THE PERINATAL PERIOD - ABSTRACT CANNABIS IS THE MOST WIDELY USED DRUG AMONG PREGNANT WOMEN, AND RATES OF USE ARE INCREASING DRAMATICALLY. REASONS FOR THE SHARP INCREASE IN CANNABIS USE (CU) AMONG IN PERINATAL WOMEN ARE NOT CLEAR. CHANGES IN CANNABIS LEGALIZATION, INCREASED ACCESS AND ACCEPTABILITY OF THE DRUG, AND A PERCEPTION OF LOW HEALTH RISK OR THERAPEUTIC BENEFIT ARE POSSIBLE EXPLANATIONS. INCREASED CU FOR MEDICINAL REASONS IN THE GENERAL POPULATION MAY PROMPT WOMEN TO CONSIDER CU FOR PREGNANCY SYMPTOMS, SUCH AS NAUSEA. FURTHER, SYMPTOMS OF ANXIETY AND DEPRESSION ARE COMMON DURING THE PERINATAL PERIOD, AND SOME WOMEN MAY TURN TO CANNABIS IF IT IS PERCEIVED TO BE LESS RISKY, OR MORE ACCEPTABLE, THAN STANDARD PSYCHOPHARMACOLOGIC TREATMENTS. YET ADVERSE OUTCOMES HAVE BEEN DOCUMENTED, INCLUDING HIGHER INCIDENCE OF LOW BIRTH WEIGHT, GREATER NEED FOR NEONATAL INTENSIVE CARE ADMISSION, AND A 3-FOLD RISK OF NEONATAL MORBIDITY. MOTHERS WHO USE CANNABIS PRENATALLY EXPERIENCE HIGHER RATES OF DEPRESSION; AMONG POSTPARTUM USERS, THERE IS ALSO A GREATER RISK FOR DEPRESSION AND AS WELL AS LOWER LIKELIHOOD OF BREASTFEEDING. NOT ALL WOMEN WHO USE CANNABIS PRIOR TO PREGNANCY CONTINUE DURING THE PERINATAL PERIOD. SOME DATA SUGGEST THAT 2/3 OF WOMEN DISCONTINUE CU UPON LEARNING OF PREGNANCY, WITH UP TO 1/3 CONTINUING USE. OUR DATA SHOW THAT MANY WOMEN WHO CONTINUE CU EXPRESS CONFLICTED FEELINGS ABOUT THEIR USE. AMONG THOSE WHO QUIT, RELAPSE IS NOT UNCOMMON, ESPECIALLY AFTER DELIVERY. REASONS FOR CONTINUED CU DURING THE PERINATAL PERIOD, AND MOTIVATIONS FOR CESSATION, ARE RELATIVELY UNKNOWN. IN LIGHT OF THE WIDESPREAD CU DURING THE PERINATAL PERIOD, A CRITICAL NEED EXISTS TO DEVELOP TAILORED INTERVENTIONS, SERVICES, AND EDUCATIONAL MATERIALS, PARTICULARLY ADDRESSING THE NEEDS OF PREGNANT WOMEN WITH HIGH LEVELS OF MOOD AND PHYSICAL SYMPTOMS. HOWEVER, BEFORE INTERVENTIONS AND SERVICES CAN BE DEVELOPED, IT IS CRUCIAL TO ELUCIDATE PREGNANT WOMEN’S MOTIVES FOR CU, PREDICTORS OF USE AND CESSATION, THE EXTENT TO WHICH MOOD AND PHYSICAL SYMPTOMS DRIVE PATTERNS OF USE, AS WELL AS THE SALIENCE OF CONTEXTUAL FACTORS (E.G., ACCESS TO CANNABIS). UTILIZING A FRAMEWORK BASED ON SOCIOECOLOGICAL MODELS OF HEALTH BEHAVIOR, WE PROPOSE TO EXAMINE FACTORS THAT CONTRIBUTE TO WOMEN’S CU BEHAVIOR IN THE PERINATAL PERIOD. IN THIS 5-YEAR STUDY, WE WILL RECRUIT 200 PREGNANT WOMEN WHO REPORT REGULAR CU IMMEDIATELY PRIOR AND/OR DURING PREGNANCY AND FOLLOW THEM FROM THE FIRST TRIMESTER OF PREGNANCY TO 12 WEEKS POSTPARTUM. WE INCLUDE 4, 10-DAY BURSTS OF ECOLOGICAL MOMENTARY ASSESSMENT (EMA) DURING THE PERINATAL PERIOD TO TRACK ASSOCIATIONS BETWEEN MATERNAL MOOD AND PHYSICAL SYMPTOMS, CU, AND CANNABIS CRAVINGS. FURTHER, WE WILL CONDUCT QUALITATIVE INTERVIEWS WITH WOMEN TO ELICIT FEEDBACK REGARDING IDEAL CONTENT AND MODALITY OF FUTURE SERVICES AND INTERVENTIONS. QUANTITATIVE AND QUALITATIVE RESULTS WILL BE INTEGRATED TO YIELD COHESIVE FINDINGS TO GUIDE FUTURE RESEARCH AND SERVICE DEVELOPMENT. TAILORED SUPPORT FOR WOMEN MAY REDUCE DELETERIOUS OUTCOMES ASSOCIATED WITH CU DURING THE PERINATAL PERIOD.

RCT TO IMPROVE POST-HOSPITAL TREATMENT ADHERENCE FOR COMORBID SUBSTANCE USE AND BIPOLAR DISORDERS

DYNAMIC IMPACTS OF SLEEP DISRUPTION ON ECOLOGICALLY ASSESSED AFFECTIVE, BEHAVIORAL, AND COGNITIVE RISK FACTORS FOR SUICIDE - PROJECT SUMMARY/ABSTRACT SUICIDAL IDEATION AND BEHAVIOR ARE GROWING PUBLIC HEALTH PROBLEMS IN THE UNITED STATES. UNFORTUNATELY, OUR CURRENT ABILITY TO PREDICT SUICIDE IS ONLY SLIGHTLY ABOVE CHANCE, WHICH MAY BE ATTRIBUTABLE TO AN OVERRELIANCE ON DISTAL/CROSS-SECTIONAL RISK FACTORS THAT ARE WEAK PROXIMAL PREDICTORS OF SUICIDE RISK. MODELING THE COMPLEX PROCESS BY WHICH ATYPICAL SLEEP IMPACTS DAILY FUNCTIONING IN CONJUNCTION WITH ESTABLISHED PROXIMAL RISK FACTORS CAN AID IN IDENTIFYING CONTEXTS AND TIME PERIODS OF GREATEST SUICIDAL RISK, MODELED AT THE INDIVIDUAL LEVEL. THE PROPOSED STUDY BUILDS UPON OUR TEAM’S EXTENSIVE EXPERTISE IN SLEEP/WAKE CYCLES, PSYCHOPHYSIOLOGY, DEEP PHENOTYPING, AND MULTI-METHOD, MULTIVARIATE, ECOLOGICALLY VALID MODELS OF SUICIDE VULNERABILITY IN HIGH-RISK PSYCHIATRIC POPULATIONS. WE WILL EXAMINE HOW A HOLISTIC MODEL OF ATYPICAL SLEEP RELATES TO KNOWN TRAIT (BASELINE NEUROCOGNITIVE PERFORMANCE; E.G., GREATER IMPULSIVE TENDENCIES, HIGHER LOSS SENSITIVITY, REDUCED ABILITY TO REGULATE EMOTIONS) AND STATE (TIME-VARYING, OCCURRING HOURS TO DAYS BEFORE SI/SB; E.G., MOMENTARY FLUCTUATIONS IN EMOTIONAL REACTIVITY, IMPULSIVITY; GREATER EMOTIONAL LABILITY; GREATER ISOLATIVE TENDENCIES), RISK FACTORS FOR SUICIDE, AND EXAMINE HOW THESE FACTORS TOGETHER PROXIMALLY INFLUENCE SUICIDAL IDEATION AND CONFER RISK FOR FUTURE SUICIDAL BEHAVIOR. WE WILL RECRUIT 200 PSYCHIATRIC INPATIENTS AT HIGH RISK FOR SUICIDE AND CONDUCT A BASELINE ASSESSMENT OF SLEEP/WAKE FUNCTIONING AND TRAIT RISK FACTORS AND USE LABORATORY-BASED TASKS COUPLED WITH PSYCHOPHYSIOLOGY (I.E., EVENT- RELATED POTENTIALS, HEART RATE VARIABILITY, AND ELECTRODERMAL ACTIVITY) TO PHENOTYPE RISK PROCESSES LINKED TO AROUSAL AND COGNITIVE SYSTEMS. THIS BASELINE ASSESSMENT WILL BE FOLLOWED BY FOUR WEEKS OF EMA AND DIGITAL PHENOTYPING COUPLED WITH SAFTE-DERIVED ACTIGRAPHY TO CHARACTERIZE KEY STATE RISK FACTORS. WE WILL CONDUCT FOLLOW-UP ASSESSMENTS AT 1-, 3-, AND 6-MONTHS POST HOSPITAL DISCHARGE TO DETERMINE HOW OUR PROXIMAL MODEL OF RISK PROSPECTIVELY PREDICTS SI AND SB. THE PROPOSED STUDY AIMS TO CHARACTERIZE PROXIMAL RISK FOR SUICIDE USING INTENSIVE LONGITUDINAL METHODS AND TO IDENTIFY “WINDOWS” OF GREATEST RISK FOR SUICIDE, WHICH MAY VARY FROM PERSON TO PERSON, THAT SERVE AS MARKERS FOR INTENSIVE INTERVENTION. FINALLY, WE WILL LEVERAGE THIS EXTENSIVE DATASET TO DEVELOP A MODEL OF THE SLEEP-SUICIDE RELATIONSHIP EMPHASIZING THE CONTRIBUTION OF TRAIT AND STATE FACTORS. THE RESULTS OF THIS STUDY HAVE THE POTENTIAL TO GREATLY ENHANCE OUR UNDERSTANDING OF THE PHENOMENOLOGY OF SUICIDE RISK AS IT EXISTS IN THE REAL WORLD, WITH THE POTENTIAL TO IMPROVE OUR ABILITY TO PREDICT, PREVENT, AND INTERVENE USING BOTH TRADITIONAL AND TECHNOLOGY-ENHANCED PSYCHOTHERAPIES.

TDCS TO DECREASE OPIOID RELAPSE - BUPRENORPHINE HAS EMERGED AS A LEADING TREATMENT FOR OPIOID USE DISORDER (OUD), BUT RECIPIENTS HAVE HIGH EARLY RELAPSE RATES LIKELY DUE TO VARYING DEGREES OF DYSFUNCTION WITHIN CRAVING AND COGNITIVE CONTROL NEURONAL NETWORKS. TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) MAY HAVE PROMISE AS ADJUVANT TREATMENT FOR BUPRENORPHINE INITIATORS BECAUSE CONSIDERABLE WORK ON ADDICTIVE SUBSTANCES SUGGESTS TREATMENT TARGETED AT THE DORSOLATERAL PREFRONTAL CORTEX (DLPFC; REGION INVOLVED IN SELF-REGULATION) MAY REDUCE CRAVING AND DRUG CONSUMPTION. WE WILL MEASURE BEHAVIORAL AND BRAIN RESPONSES FOLLOWING TDCS STIMULATION TO THE DLPFC DELIVERED DURING COGNITIVE CONTROL NETWORK (CCN) PRIMING. PARTICIPANTS IN THEIR FIRST WEEK OF PRESCRIBED BUPRENORPHINE WILL BE ASSESSED TWICE USING FMRI, ONCE PRIOR TO TDCS+CCN PRIMING AND AGAIN AT THE COMPLETION OF 5 SESSIONS OF TDCS+CCN PRIMING (ONE WEEK LATER). TASK-BASED AND RESTING STATE FUNCTIONAL CONNECTIVITY WILL BE USED TO EXAMINE NETWORKS ASSOCIATED WITH CRAVING (CR) AND COGNITIVE CONTROL. IN THE UG3 PHASE (N=60), FMRI WILL PROVIDE VALIDATION OF EXPECTED CHANGES IN THESE NETWORKS FOLLOWING TDCS STIMULATION. GO/NO GO CRITERIA FOR THE UH3 PHASE WILL BE DEMONSTRATION OF GREATER FMRI CHANGE IN ANY NODE OF THE CR OR CCN NETWORKS AND GREATER CHANGE IN SUBJECTIVE CRAVING MEASURED PRIOR TO (OUTSIDE FMRI SCAN) OR DURING AN FMRI CUE REACTIVITY TASK FOLLOWING THE TDCS+CCN PRIMING INTERVENTION COMPARED TO SHAM TDCS+CCN PRIMING. IN THE UH3 PHASE (N=100), WE WILL PERFORM A LARGER RCT (VS. SHAM CONTROL) TO ADDRESS LONG-TERM NEUROBEHAVIORAL OUTCOMES, INCLUDING OPIOID RELAPSE, CRAVING, AND SUSTAINED FMRI CHANGES. BECAUSE TDCS IS SAFE, INEXPENSIVE AND PORTABLE, IF THIS INTERVENTION PROVIDES FMRI VALIDATION OF TARGETED BRAIN EFFECTS AND PRODUCES CLINICAL RESPONSE, IT COULD HAVE GREAT IMPACT AUGMENTING THE CARE OF PERSONS ENTERING BUPRENORPHINE TREATMENT, A POPULATION AT HIGH RISK FOR TREATMENT FAILURE.

EVALUATING THE EFFECTIVENESS OF MINDFULNESS-BASED THERAPY FOR SMI IMPLEMENTED IN A COMMUNITY MENTAL HEALTH SETTING - SERIOUS MENTAL ILLNESS (SMI), ENCOMPASSING SCHIZOPHRENIA-SPECTRUM AND MAJOR MOOD DISORDERS, HAS BEEN ESTIMATED TO AFFECT APPROXIMATELY 5.4% OF THE U.S. ADULT POPULATION EACH YEAR. RESEARCH SHOWS LOW RATES OF EVIDENCE-BASED TREATMENT BEING PROVIDED TO PATIENTS WITH SMI. THIS IS UNFORTUNATE, BECAUSE EVIDENCE-BASED PSYCHOLOGICAL THERAPIES HAVE BEEN SHOWN TO BE EFFECTIVE FOR IMPROVING OUTCOMES IN SMI. ONE SUCH EFFICACIOUS PSYCHOLOGICAL INTERVENTION IS MINDFULNESS-BASED THERAPY (MBT), WHICH INTEGRATES MINDFULNESS PRACTICE WITH COGNITIVE-BEHAVIORAL STRATEGIES TO IMPROVE ILLNESS MANAGEMENT. PREVIOUS TRIALS CONDUCTED IN THE UNITED KINGDOM HAVE SHOWN THAT MBT IMPROVES SYMPTOMS AND FUNCTIONING IN COMMUNITY-BASED OUTPATIENTS WITH SMI, INCLUDING IN ROUTINE PRACTICE SETTINGS. IN THE U.S., MOST PATIENTS WITH SMI RECEIVE TREATMENT AT LOCAL COMMUNITY MENTAL HEALTH CENTERS (CMHCS). HOWEVER, PATIENTS IN CMHCS OFTEN CANNOT ACCESS EVIDENCE-BASED THERAPIES LIKE MBT DUE TO THE LACK OF TRAINED STAFF ABLE TO PROVIDE THESE INTERVENTIONS. FURTHER, PREVIOUS STUDIES OF MBT HAVE BEEN CONDUCTED EXCLUSIVELY OUTSIDE THE U.S. IT IS ESSENTIAL TO CONFIRM THAT MBT IS EFFECTIVE WHEN DELIVERED FOR PATIENTS WITH SMI IN THE U.S., AND HOW IT CAN BE SUSTAINABLY IMPLEMENTED IN CMHCS WHERE THIS CLINICAL POPULATION IS COMMONLY TREATED. THUS, WE PROPOSE TO TEST THE EFFECTIVENESS OF MBT FOR SMI AND STUDY ITS IMPLEMENTATION IN A TYPICAL CMHC SETTING. ADDITIONALLY WE WILL SPECIFY A CERTIFIED TRAINING PROGRAM IN MBT FOR FRONTLINE CLINICIANS, GIVEN THE DIFFERENCES BETWEEN U.K. AND U.S. HEALTHCARE SYSTEMS. TO SPEED TRANSLATION TO CLINICAL PRACTICE, WE ALSO WILL COLLECT INFORMATION FROM DIVERSE COMMUNITY PARTNERS ON IMPLEMENTATION BARRIERS AND FACILITATORS TO PROMOTE FUTURE UPTAKE. WE WILL RANDOMIZE 160 PATIENTS WITH SMI (PSYCHOTIC-SPECTRUM AND MAJOR MOOD DISORDERS) TO RECEIVE TREATMENT AS USUAL (TAU) VS TAU PLUS MBT DELIVERED BY FRONTLINE CLINICIANS IN A LARGE, DIVERSE CMHC. WE WILL CONDUCT BLINDED ASSESSMENTS AT BASELINE AND AT 6- (MID), 12- (POST), AND 24- WEEKS (FOLLOW-UP). CONSISTENT WITH AN EXPERIMENTAL THERAPEUTICS APPROACH, WE WILL EXAMINE POTENTIAL MECHANISMS OF ACTION (E.G., MINDFULNESS SKILLS), AS WELL AS COLLECT IMPLEMENTATION-FOCUSED QUANTITATIVE AND QUALITATIVE DATA FROM OUR COMMUNITY PARTNERS (PATIENTS, ADMINISTRATORS, CLINICIANS). IF FOUND TO BE EFFECTIVE AND AIDED BY A CERTIFIED TRAINING PROGRAM AND THE IMPLEMENTATION DATA COLLECTED, MBT COULD BE ADOPTED AS A FUTURE EVIDENCE-BASED PRACTICE AND INTEGRATED INTO THE ROUTINE COMMUNITY CARE OF PATIENTS WITH SMI, THEREBY REDUCING HEALTH DISPARITIES.

PILOT MULTISITE RANDOMIZED CONTROLLED TRIAL OF YOGA TO REDUCE DEPRESSION INADOLESCENTS - PROJECT SUMMARY EVEN BEFORE THE ONSET OF THE COVID PANDEMIC, ADOLESCENT DEPRESSION HAS BEEN INCREASING, AND HEALTH DISPAR- ITIES AND DISPARITIES IN ACCESS TO TREATMENT HAVE CONTINUED TO WIDEN. THUS, THERE IS A CLEAR NEED FOR INNOVATIVE, ACCESSIBLE TREATMENTS FOR DEPRESSED ADOLESCENTS, INCLUDING TREATMENTS THAT DO NOT RELY ON A LIMITED POOL OF CHILD AND ADOLESCENT HEALTH PROVIDERS. YOGA-BASED INTERVENTIONS (YBIS) HAVE SHOWN PROMISE FOR ADULT DEPRESSION. SEVERAL ATTRACTIVE ASPECTS OF YOGA INCLUDE ITS: 1) AVAILABILITY THROUGHOUT THE U.S.; 2) ACCESSIBILITY VIA ONLINE CLAS- SES; 3) INDEPENDENCE FROM AN OVERBURDENED MENTAL HEALTH CARE SYSTEM; AND 4) GENERALIZABILITY--YOGA STUDENTS STATE THAT THEY USE MINDFULNESS AND BREATHING PRACTICES TO COPE WITH STRESS IN EVERYDAY LIFE. FUNDED BY A NCCIH R34, WE DEVELOPED A YBI FOR DEPRESSED ADOLESCENTS, AND DEMONSTRATED THAT THIS IN-PERSON PROGRAM WAS ACCEPTABLE AND FEASIBLE IN A SMALL SAMPLE (N=11) OF DEPRESSED ADOLESCENTS AS WELL AS IN A PILOT RCT (N=42) OF YBI VS. AN EXISTING EVIDENCE-BASED TREATMENT, GROUP COGNITIVE-BEHAVIORAL THERAPY (GCBT). THE RCT CLASSES WERE INITIALLY IN-PERSON, BUT WE MIGRATED TO SYNCHRONOUS ONLINE CLASSES DUE TO COVID-19. IN THE RCT, PARTICIPANTS WITHIN EACH STUDY ARM SHOWED DECREASED DEPRESSION SYMPTOMS AND INCREASED SELF-COMPASSION OVER TIME. MOST A PRIORI FEASIBILITY AND ACCEPTABILITY TARGETS WERE MET (E.G., RECRUITMENT, RETENTION, EXPECTANCY, SATISFACTION, CREDIBILITY, ATTENDANCE, AND ADHERENCE). HOWEVER, PARTICIPANTS DID NOT ENGAGE IN HOME (OUTSIDE-OF- CLASS) PRACTICE AT THE TARGETED RATE. THUS, IN THE PRESENT PROPOSAL WE HAVE MODIFIED OUR PROTOCOL TO PROVIDE AN OPPORTUNITY FOR TWICE-WEEKLY SUPERVISED YOGA PRACTICE (ONE IN-PERSON CLASS ON THE WEEKEND, AND ONE VIRTUAL CLASS MIDWEEK). OUR PRIOR PILOT TRIAL WAS BASED AT ONLY ONE SITE (PROVIDENCE RI) WITH ONE PRIMARY YBI INSTRUCTOR AND TWO GCBT LEADERS. MULTIPLE SITES AND INSTRUCTORS/LEADERS, AND RECRUITMENT OF A MORE RACIALLY AND ETHNICALLY DIVERSE SAMPLE, WILL BE IMPORTANT TO DEMONSTRATE GENERALIZABILITY AND TO ENHANCE EFFECTIVENESS. WE NOW PRO- POSE TO CONDUCT A TWO-PHASE MULTI-SITE FEASIBILITY TRIAL. PHASE 1 (N=20) WILL FOCUS ON INCREASING ACCESSIBILITY AND FEASIBILITY OF YBI FOR PARTICULAR GROUPS OF ADOLESCENTS. WE WILL CONDUCT INDIVIDUAL INTERVIEWS WITH TEENS WHO WERE LESS REPRESENTED IN OUR PILOT TRIAL (AFRICAN-AMERICAN/BLACK, ASIAN AMERICAN, AND MALE ADOLESCENTS) TO GAIN THEIR FEEDBACK ON YOGA BASED INTERVENTIONS, WITH A FOCUS ON INCREASING ACCESSIBILITY AND FEASIBILITY FOR ADOLESCENTS WITH THESE IDENTITIES. PHASE 2 (N=128) WILL BE A PILOT RCT OF YBI VS. GCBT AT TWO GEOGRAPHICALLY DISTINCT SITES: BOSTON, MA AND COLUMBUS, OH. GIVEN THE RISING PREVALENCE OF ADOLESCENT DEPRESSION AND THE EXISTENCE OF ESTABLISHED, EFFICACIOUS GROUP TREATMENT FOR DEPRESSION (I.E., GROUP CBT), WE DETERMINED THAT A NON-INFERIORITY TRIAL REPRESENTED THE MOST ETHICAL WAY TO PROCEED. WE WILL INCORPORATE LESSONS LEARNED FROM THIS STUDY TO FURTHER REFINE STUDY MATERIALS AND CREATE A TEMPLATE FOR ONBOARDING MULTIPLE FUTURE SITES. THIS PROJECT WILL PREPARE US TO CONDUCT A MULTISITE, ADEQUATELY POWERED, NON-INFERIORITY RCT OF YBI VS. GCBT IN DEPRESSED ADOLESCENTS.

AMBULATORY ASSESSMENT OF GLUCOSE REGULATION IN SUICIDAL THOUGHTS AND BEHAVIORS - PROJECT SUMMARY SUICIDE RATES IN THE UNITED STATES ALARMINGLY INCREASED BY 37% IN THE LAST TWO DECADES. DESPITE EXTENSIVE RESEARCH EFFORTS TO IDENTIFY RISK FACTORS, ACCURATE PREDICTION OF SUICIDAL THOUGHTS AND BEHAVIORS (STBS) REMAINS POOR. THERE IS A CRITICAL NEED TO IMPROVE DETECTION OF WHO IS AT GREATEST RISK FOR SUICIDE AND WHEN SUICIDAL CRISES WILL OCCUR TO ENABLE PERSONALIZED AND TIMELY INTERVENTIONS. PASSIVE AMBULATORY MEASUREMENT METHODS THAT CAN DETECT RISK FOR STBS IN DAILY LIFE, WITHOUT RELYING ON PARTICIPANT SELF-REPORTING DURING PERIODS OF DISTRESS, MAY BE THE KEY TO MAKING PROGRESS ON THIS CRITICAL ISSUE. ONE PROMISING STB RISK FACTOR THAT IS AMENABLE TO PASSIVE MONITORING IS PERIPHERAL GLUCOSE (BLOOD SUGAR) REGULATION. PSYCHIATRIC AND METABOLIC DISORDERS ARE HIGHLY COMORBID, AND ROBUST LITERATURE IDENTIFIES ABNORMAL GLUCOSE REGULATION IN INDIVIDUALS WITH STBS. HOWEVER, PRIOR STUDIES OF GLUCOSE REGULATION IN STBS WERE CROSS-SECTIONAL AND RETROSPECTIVE, PREVENTING THE ASSESSMENT OF WHETHER GLUCOSE PATTERNS SIGNAL RISK FOR STBS IN REAL-TIME AND DURING HIGH-RISK PERIODS. THIS K23 PROPOSES TO CONDUCT THE FIRST STUDY EXAMINING HOW AMBULATORY GLUCOSE REGULATION RELATES TO STBS IN DAILY LIFE. WE PROPOSE TO ENROLL 110 NON-DIABETIC ADULT PSYCHIATRIC INPATIENTS WITH RECENT STBS, A POPULATION AND TIME-PERIOD WITH EXTRAORDINARILY HIGH SUICIDE RISK. PARTICIPANTS WILL COMPLETE A MULTIMODAL AMBULATORY ASSESSMENT PROTOCOL FOR 28 DAYS FOLLOWING HOSPITALIZATION, INCLUDING CONTINUOUS GLUCOSE MONITORING AND ECOLOGICAL MOMENTARY ASSESSMENT (EMA). USING STATE-OF-THE-SCIENCE ANALYTIC METHODS FOR MULTIMODAL INTENSIVE LONGITUDINAL DATA, WE WILL EXAMINE PASSIVELY COLLECTED GLUCOSE METRICS AS PROSPECTIVE PREDICTORS OF (1) PROXIMAL SUICIDAL IDEATION (CAPTURED VIA EMA) AND SUICIDAL BEHAVIOR AT FOLLOW-UP (AIM 1), AND (2) PROXIMAL AFFECTIVE-COGNITIVE RISK FACTORS FOR STBS (CAPTURED VIA EMA) AND OVERALL AFFECTIVE-COGNITIVE RISK FACTORS MEASURED AT FOLLOW-UP (AIM 2). WE WILL ALSO EXPLORE POTENTIAL MECHANISMS LINKING GLUCOSE REGULATION TO STBS BY INVESTIGATING IF THESE PATHWAYS VARY ACROSS MODIFIABLE HEALTH BEHAVIORS THAT IMPACT GLUCOSE REGULATION (EXPLORATORY AIM 3). THIS KNOWLEDGE COULD IMPROVE PERSONALIZED STB RISK DETECTION AND INFORM THE DEVELOPMENT OF PRECISION INTERVENTIONS THAT TARGET MODIFIABLE METABOLIC RISK FACTORS FOR SUICIDE. THE CANDIDATE’S TRAINING PLAN DIRECTLY ALIGNS WITH THE PROPOSED STUDY AND WILL PROVIDE IMMERSIVE TRAINING IN (1) DESIGNING AND DIRECTING MULTIMODAL AMBULATORY ASSESSMENT PROTOCOLS; (2) ETHICAL AND REGULATORY ASPECTS OF SUICIDE RESEARCH IN HIGH-RISK SAMPLES; (3) UNDERSTANDING AND ASSESSING METABOLIC RISK FACTORS FOR SUICIDE; (4) ADVANCED ANALYSES FOR MULTIMODAL DATA; AND (5) GRANT-WRITING, LABORATORY MANAGEMENT, AND INTERDISCIPLINARY COLLABORATION. THE CANDIDATE’S TEAM OF INTERDISCIPLINARY MENTORS, DRS. ABRANTES, SCHATTEN, RICHARDSON, TYRKA, AND BRICK, ARE RENOWNED EXPERTS IN THESE TOPICS, AND BUTLER HOSPITAL AND BROWN UNIVERSITY PROVIDE AN EXCEPTIONAL TRAINING ENVIRONMENT WITH AN EXTENSIVE HISTORY OF SUPPORTING CAREER DEVELOPMENT AWARDS. THIS K23 WILL FACILITATE THE CANDIDATE’S SUCCESSFUL TRANSITION TO AN INDEPENDENT RESEARCH CAREER FOCUSED ON ADVANCING SUICIDE PREDICTION AND PREVENTION USING ECOLOGICALLY VALID AND BIOBEHAVIORAL APPROACHES.

INTEGRATIVE YOGA AND MINDFUL SELF-COMPASSION TO REDUCE DISTRESS IN WOMEN SURVIVORS OF INTERPERSONAL VIOLENCE - PROJECT ABSTRACT THE OVERALL OBJECTIVE OF THIS MENTORED RESEARCH SCIENTIST CAREER DEVELOPMENT AWARD IS TO SUPPORT DR. TOSCA BRAUN’S TRANSITION TO AN INDEPENDENT INVESTIGATOR WITH A FOCUS ON USING COMMUNITY-ENGAGED APPROACHES TO DEVELOP AND DISSEMINATE COMMUNITY-ENGAGED MINDFULNESS-BASED INTERVENTIONS TO ADVANCE HEALTH IN VULNERABLE AND MINORITY POPULATIONS. INTERPERSONAL VIOLENCE IS COMMONLY EXPERIENCED AMONG BLACK/AFRICAN AMERICAN (AA; 44%), HISPANIC/LATINO/A/X (34%), AND NON-HISPANIC/LATINO/A/X WHITE WOMEN (37%) IN THE US, AS WELL AS STIGMATIZATION RELATED TO IV AND OTHER ATTRIBUTES (E.G., RACE/ETHNICITY, WEIGHT). VIOLENCE AND STIGMA BOTH DRIVE “DOWNSTREAM” POOR BEHAVIORAL AND PHYSICAL HEALTH. STIGMA SEQUELAE – DISTRESS IN RESPONSE TO STIGMA, ANTICIPATED (FEAR OF) STIGMA, INTERNALIZED STIGMA – INDEPENDENTLY FOSTER SHAME AND AFFECT DYSREGULATION, THUS MAGNIFYING DISTRESS AND CONSEQUENT HEALTH IMPACTS. THESE INTERPERSONAL VIOLENCE (IV) SEQUELAE CAN BE ALLEVIATED BY REDUCING DISTRESS, YET CULTURALLY SENSITIVE TRANSDIAGNOSTIC APPROACHES TO REDUCE SURVIVOR DISTRESS ACROSS ETHNO- RACIAL POPULATIONS ARE RARE. WE PROPOSE TO USE COMMUNITY-ENGAGED RESEARCH TO DEVELOP A COMPLEMENTARY MEDICINE PROGRAM THAT INTEGRATES ADAPTED MINDFUL SELF-COMPASSION (MSC) TRAINING WITH TRAUMA-INFORMED YOGA (TIY) TO IMPROVE STIGMA SEQUELAE AND REDUCE DISTRESS IN ETHNO-RACIALLY DIVERSE SURVIVORS: INTEGRATED TIY AND MSC (I-YMSC). MSC TARGETS STIGMA-RELATED PROBLEMS (AFFECT DYSREGULATION, SHAME) AND IMPROVES DISTRESS IN THE LONG-TERM, YET CAN TEMPORARILY INCREASE SHORT-TERM DISTRESS. TIY REDUCES SHORT-TERM DISTRESS AND PROMOTES PHYSIOLOGICAL-AUTONOMIC REGULATION. DR. BRAUN’S PROGRAM EVALUATION DATA SUGGESTS ADAPTING MSC TO EXPLICITLY ADDRESS CULTURAL FACTORS AND INTERSECTIONAL STIGMA AND INTEGRATING THIS APPROACH WITH TIY IS STRONGLY WARRANTED AND HAS POTENTIAL TO AMELIORATE HEALTH INEQUITIES EXPERIENCED BY ETHNO-RACIALLY DIVERSE IV SURVIVORS. FURTHER, TRAINING COMMUNITY YOGA INSTRUCTOR SURVIVORS TO TEACH I-YMSC REPRESENTS AN ADDITIONAL LEVEL OF ENGAGEMENT WITH OUR STIGMATIZED TARGET POPULATION THAT IS UNUSUAL IN MINDFULNESS RESEARCH. IN THIS K23 PROPOSAL, BLACK/AA, HISPANIC/LATINO/A/X, AND WHITE SURVIVORS WILL BE EQUALLY REPRESENTED ACROSS ALL PROJECT PHASES (33% EACH), WITH RESULTS CONSIDERED BOTH ACROSS PARTICIPANTS AND WITHIN EACH SUBGROUP. SPECIFIC AIMS INCLUDE: (1) (1.1) DEVELOP I- YMSC USING COMMUNITY-ENGAGED RESEARCH WITH WOMEN IV SURVIVOR STAKEHOLDER PARTNERS, (1.2) PRE-PILOT THE INTERVENTION IN AN OPEN PILOT TRIAL TO FURTHER REFINE THE INTERVENTION, (1.3) DEVELOP A COMMUNITY-ENGAGED TEACHER TRAINING, AND (2) (2.1) CONDUCT A 2-ARMED TEST OF THE BEHAVIORAL INTERVENTION COMPARED TO A HEALTH EDUCATION CONTROL TO ASSESS THE FEASIBILITY AND ACCEPTABILITY OF THE I-YMSC INTERVENTION, AND (2.2) PILOT THE TEACHER TRAINING. THE ESSENTIAL HANDS-ON LEARNING AND MENTORED TRAINING IN THIS GRANT WILL SUPPORT DR. BRAUN IN ESTABLISHING HER PROGRAM OF RESEARCH AS AN INDEPENDENT INVESTIGATOR IN COMMUNITY-ENGAGED MIND-BODY RESEARCH WORKING WITH VULNERABLE AND MINORITY POPULATIONS, INCLUDING WOMEN SURVIVORS OF VIOLENCE. FINDINGS MAY ALSO HAVE APPLICABILITY TO PROMOTING HEALTH RESILIENCY AND RESTORATION IN OTHER MARGINALIZED POPULATIONS WHO EXPERIENCE HEALTH INEQUITIES.

AFFECTIVE EXECUTIVE FUNCTIONING AS A MECHANISM OF MINDFULNESS-BASED COGNITIVE THERAPY: A PILOT RANDOMIZED CONTROLLED TRIAL - PROJECT SUMMARY/ABSTRACT MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) IS AN EFFICACIOUS TREATMENT FOR PATIENTS WITH SYMPTOMS OF DEPRESSION. HOWEVER, THE PROCESSES BY WHICH MBCT ACHIEVES ITS OUTCOMES ARE NOT WELL UNDERSTOOD. DRAWING ON LITERATURE ON BASIC COGNITIVE FUNCTIONING AND COGNITIVE BIASES IN DEPRESSION, THIS K23 WILL USE A RANDOMIZED CONTROLLED TRIAL TO TEST THE EFFECT OF MBCT VS. HEALTH EDUCATION (HE) ON AFFECTIVE INHIBITION (AN IMPORTANT COMPONENT OF EXECUTIVE FUNCTIONING (EF)), AND A POSSIBLE MECHANISM OF ACTION BY WHICH MBCT HAS AN IMPACT ON DEPRESSION SYMPTOMS. AS A SECONDARY AIM, THIS PROJECT WILL ALSO TEST THE EFFECT OF MBCT VS. HE ON AFFECTIVE UPDATING AND AFFECTIVE SHIFTING (TWO REMAINING COMPONENTS OF EF). IN EXPLORATORY ANALYSES, WE WILL EXAMINE WHETHER DEPRESSION SYMPTOM SEVERITY COVARIES WITH CHANGE IN AFFECTIVE EF (I.E., AFFECTIVE INHIBITION, SHIFTING, AND UPDATING) OVERTIME, AND WHETHER ADHERENCE TO THE TREATMENT PROTOCOL PREDICTS ENDPOINT EF. TO ACCOMPLISH THESE GOALS, 76 ADULT PARTICIPANTS WITH ELEVATED DEPRESSION SYMPTOMS WILL BE RECRUITED FROM THE COMMUNITY AND WILL BE RANDOMIZED TO EITHER AN 8-WEEK MBCT COURSE AT THE MINDFULNESS CENTER AT BROWN UNIVERSITY OR AN 8-WEEK PSYCHOEDUCATIONAL HEALTH EDUCATION CLASS (I.E., A CONTROL ARM). PARTICIPANTS WILL COMPLETE VALIDATED COMPUTER-BASED TASKS OF AFFECTIVE EF AT 5-ASSESSMENTS, 2 BEFORE, 2 DURING, AND 1 AFTER, THE 8-WEEK MBCT OR HE PROGRAMS. THIS PROJECT DIRECTLY ADDRESSES NCCIH’S OBJECTIVE TO ADVANCE THE UNDERSTANDING OF MECHANISMS THROUGH WHICH MIND AND BODY APPROACHES AFFECT HEALTH, RESILIENCE AND WELL-BEING. THIS PROJECT WILL DIRECTLY ADDRESS THE CANDIDATE’S TRAINING GOALS OF GAINING CLINICAL TRIALS METHODS EXPERIENCE WITH MOOD DISORDERS, EXPANDING KNOWLEDGE OF MINDFULNESS-BASED INTERVENTIONS (SPECIFICALLY MBCT), GAIN KNOWLEDGE IN NEUROCOGNITIVE ASSESSMENT OF INDIVIDUALS WITH DEPRESSION SYMPTOMS, RECEIVE TRAINING IN REPEATED LONGITUDINAL ASSESSMENT, AND FURTHER DEVELOP PROFESSIONAL DEVELOPMENT, RESEARCH ETHICS, AND GRANTS MANAGEMENT SKILLS. THE CANDIDATE WILL COMPLETE A NUMBER OF FORMAL AND INFORMAL ACTIVITIES (E.G., COURSES, WORKSHOPS, CONFERENCES, DIRECTED READINGS, AND REGULARLY SCHEDULED MEETINGS WITH MENTORS) TO MEET THE TRAINING GOALS. THESE TRAINING GOALS WILL ASSIST THE CANDIDATE TO BECOME A SUCCESSFUL INDEPENDENT INVESTIGATOR EXAMINING COGNITIVE MECHANISMS OF MIND-BODY INTERVENTIONS FOR DEPRESSION AND RELATED DISORDERS. THE MINDFULNESS CENTER AT BROWN UNIVERSITY AND BUTLER HOSPITAL ARE THE IDEAL ENVIRONMENTS FOR THIS PROJECT, AS THEY ARE LEADING INSTITUTIONS IN CLINICAL TRIALS RESEARCH AND MINDFULNESS-BASED INTERVENTIONS, WITH NUMEROUS OPPORTUNITIES FOR TRAINING AND SUPPORT SERVICES EMBEDDED WITHIN THE SYSTEMS.

DEVELOPMENT OF A LIFESTYLE PHYSICAL ACTIVITY INTERVENTION TO REDUCE RISK FOR PERINATAL CANNABIS USE - ABSTRACT RATES OF PRENATAL CANNABIS USE (CU) HAVE RISEN SHARPLY IN RECENT YEARS, A SERIOIUS CONCERN GIVEN ASSOCIATED ADVERSE MATERNAL AND INFANT OUTCOMES. MOTIVATION TO CHANGE POTENTIALLY UNHEALTHY BEHAVIORS LIKE CU IS HIGH AMONG MANY PREGNANT WOMEN. HOWEVER, UNFORTUNATELY, INTERVENTION APPROACHES FOR THIS POPULATION ARE CURRENTLY LACKING. IN ADDITION, MANY WOMEN EXPERIENCE MENTAL HEALTH SYMPTOMS (ANXIETY, DEPRESSION) AND UNCOMFORTABLE PREGNANCY SYMPTOMS (NAUSEA, PHYSICAL DISCOMFORT) THAT POSE CHALLENGES TO ABSTAINING FROM CU. THUS, INTERVENTIONS THAT HELP PREGNANT WOMEN DEVELOP ALTERNATE COPING STRATEGIES TO COPE WITH THESE SYMPTOMS MAY HAVE AN IMPORTANT ROLE IN DECREASING OR PREVENTING CU DURING PREGNANCY AND LONGER TERM. GIVEN PRIOR RESEARCH DEMONSTRATING BENEFITS OF PHYSICAL ACTIVITY TO POTENTIATE LONG-TERM EFFECTS ON DEPRESSION/ANXIETY AND PREGNANCY SYMPTOMS, AS WELL AS ACUTE EFFECTS ON NEGATIVE AFFECT AND CANNABIS CRAVINGS, A LIFESTYLE PHYSICAL ACTIVITY (LPA) INTERVENTION COULD BE HIGHLY IMPACTFUL. OUR TEAM’S R34 AWARD (R34DA055317-01A1; BATTLE) IS THE FIRST STUDY TO EXAMINE WHETHER AN LPA INTERVENTION COULD REPRESENT A FEASIBLE AND ACCEPTABLE STRATEGY TO HELP REDUCE CANNABIS USE AND CRAVINGS DURING PREGNANCY. THE PROPOSED ADMINISTRATIVE SUPPLEMENT WOULD ALLOW OUR TEAM TO EXTEND THE IMPACT OF THIS R34 STUDY BY EXAMINING THE POTENTIAL MECHANISMS OF ACTION OF THE LPA INTERVENTION. OUR TEAM PROPOSES TO USE SUPPLEMENTAL FUNDING IN RESPONSE TO NOT-OD-22-140 TO ADD AN ECOLOGICAL MOMENTARY ASSESSMENT (EMA) PROTOCOL TO THE PLANNED CLINICAL TRIAL, WHICH WOULD BE COMPRISED OF THREE 7-DAY BURSTS OF DAILY EMA ASSESSMENT TO MEASURE DAILY-LEVEL PHYSICAL ACTIVITY, MATERNAL AFFECT, PHYSICAL DISCOMFORT, AS WELL AS CANNABIS CRAVINGS AND USE. WITH THIS ADDITIONAL DATA COLLECTION, WHICH WILL INCLUDE 30 PARTICIPANTS IN THE PILOT RANDOMIZED TRIAL, WE WILL BE ABLE TO MORE FULLY EVALUATE THE CONCEPTUAL MODEL ON WHICH THE STUDY INTERVENTION IS BASED. FINDINGS FROM THE ANALYSIS OF THE ADDITIONAL EMA DATA COLLECTED AS PART OF THIS SUPPLEMENT WILL PROVIDE VALUABLE INFORMATION REGARDING THE RELATIONSHIP BETWEEN WOMEN’S MENTAL HEALTH AND CANNABIS CRAVINGS -- AND WHETHER PHYSICAL ACTIVITY CAN HELP REDUCE NEGATIVE AFFECT, PHYSICAL DISCOMFORTS AND CANNABIS CRAVINGS. IN ADDITION, THIS SUPPLEMENTAL DATA WILL PROVIDE CRITICAL FEASIBILITY DATA REGARDING IMPLEMENTING AN EMA WITH THIS POPULATION TO INFORM FUTURE STUDIES.

OPTIMIZATION AND MULTI-SITE FEASIBILITY OF YOGA FOR CHRONIC PAIN IN PEOPLE IN TREATMENT FOR OPIOID USE DISORDER

DEVELOPMENT AND PRELIMINARY TESTING OF A PEER NARRATIVE VIDEO INTERVENTION FOR OLDER ADULTS WITH CHRONIC PAIN - CHRONIC MUSCULOSKELETAL (MSK) PAIN, WHICH INCLUDES SPINAL PAIN, OSTEOARTHRITIS, AND FIBROMYALGIA, IS A COMMON AND COSTLY PROBLEM FOR OLDER ADULTS AND IS ASSOCIATED WITH DECREASED QUALITY OF LIFE. THERE IS A CLEAR NEED FOR INTERVENTIONS THAT INCREASE ONE’S ABILITY TO COPE WITH CHRONIC PAIN AND ENGAGE IN MEANINGFUL LIFE ACTIVITIES EVEN WITH THE PRESENCE OF CHRONIC PAIN. ACCEPTANCE AND COMMITMENT THERAPY (ACT) IS A PSYCHOTHERAPY THAT USES MINDFULNESS AND PSYCHOLOGICAL ACCEPTANCE TO SUPPORT INDIVIDUALS IN WORKING TOWARD BEHAVIORAL GOALS GUIDED BY THEIR PERSONAL VALUES, EVEN IN THE PRESENCE OF UNDESIRABLE EXPERIENCES SUCH AS CHRONIC PAIN. CLINICAL PRACTICE GUIDELINES RECOMMEND THE USE OF ACT FOR TREATING CHRONIC PAIN BASED ON EVIDENCE OF EFFECTIVENESS FROM MULTIPLE RCTS. HOWEVER, UPTAKE AND REACH ARE LIMITED BECAUSE THERE ARE INSUFFICIENT NUMBERS OF MENTAL HEALTH PROFESSIONALS WHO CURRENTLY OFFER ACT OR OTHER RECOMMENDED THERAPIES (E.G., COGNITIVE-BEHAVIORAL THERAPY) FOR CHRONIC PAIN. IN ADDITION, MANY OLDER ADULTS ARE NOT WILLING OR ABLE TO ENGAGE IN TRADITIONAL PSYCHOTHERAPY FOR CHRONIC PAIN EVEN WHEN IT IS AVAILABLE. ALTHOUGH SOME BIBLIOTHERAPY AND DIGITAL HEALTH INTERVENTIONS (E.G., APPS) HAVE BEEN DEVELOPED FOR TREATING PAIN, MANY OLDER ADULTS FAIL TO USE THEM DUE TO LOW LEVELS OF COMFORT WITH TECHNOLOGY OR LACK OF MOTIVATION FOR INTENSIVE SELF-GUIDED APPROACHES. NARRATIVE COMMUNICATION IS AN ALTERNATIVE WAY TO DELIVER BEHAVIOR CHANGE PRINCIPLES THAT INVOLVES “STORYTELLING” INVOLVING REAL PATIENTS TALKING ABOUT THEIR STRUGGLES AND RECOVERY PROGRESS. THERAPEUTIC NARRATIVES DELIVERED VIA VIDEOS MAY BE MORE ENGAGING AND IMMERSIVE THAN TRADITIONAL SELF-HELP FORMATS FOR OLDER ADULTS. IN PREVIOUS GRANT-FUNDED RESEARCH, OUR TEAM HAS DEVELOPED METHODS FOR CREATING NARRATIVE, VIDEO-BASED INTERVENTIONS DESIGNED TO REDUCE DEPRESSION IN PRIMARY CARE PATIENTS AND PREVENT SUICIDE IN PATIENTS FOLLOWING A PSYCHIATRIC HOSPITAL. THUS, IN THIS PROJECT, WE PROPOSE TO CREATE RECLAIM YOUR DAY (RYD), WHICH WILL CONSIST OF 6, 30-MIN WEEKLY VIDEO EPISODES HIGHLIGHTING PATIENTS’ INSPIRING AND ILLUSTRATIVE EXPERIENCES LIVING WITH CHRONIC PAIN IN ORDER TO TEACH CURRENT PATIENTS WITH CHRONIC MSK PAIN HOW TO APPLY ACT’S EVIDENCE-BASED STRATEGIES. IN PHASE 1 OF THIS PROJECT, WE WILL INTERVIEW OLDER ADULTS WITH CHRONIC MSK PAIN ABOUT THEIR COPING HISTORY, AND CODE INTERVIEWS FOR CONSISTENCY WITH ACT PRINCIPLES. WE WILL INVITE A SUBSET OF THESE INDIVIDUALS TO WORK WITH A PROFESSIONAL STORYTELLING COACH TO DEVELOP AND VIDEORECORD THEIR ACT-CONSISTENT STORIES. THESE DOCUMENTARY-STYLE VIDEOS THAT WILL FORM THE BASIS OF RYD. IN PHASE 2, WE WILL CONDUCT A PILOT RCT (N=100) OF OLDER ADULTS WITH CHRONIC MSK PAIN. ALL PARTICIPANTS WILL RECEIVE A 30-MIN INTRODUCTORY PAIN EDUCATION VIDEO. PARTICIPANTS WILL BE RANDOMIZED TO RECEIVE EITHER RYD OR A COMPARISON INTERVENTION (HEALTH EDUCATION VIDEOS). WE WILL EXAMINE RYD FEASIBILITY AND ACCEPTABILITY AS WELL AS CHANGES OVER TIME IN OUTCOMES (PAIN INTERFERENCE, DEPRESSION, QUALITY OF LIFE) AND PUTATIVE MEDIATORS.

DEVELOPMENT AND PRELIMINARY TESTING OF A PEER NARRATIVE VIDEO INTERVENTION FOR OLDER ADULTS WITH CHRONIC PAIN - CHRONIC MUSCULOSKELETAL (MSK) PAIN, WHICH INCLUDES SPINAL PAIN, OSTEOARTHRITIS, AND FIBROMYALGIA, IS A COMMON AND COSTLY PROBLEM FOR OLDER ADULTS AND IS ASSOCIATED WITH DECREASED QUALITY OF LIFE. THERE IS A CLEAR NEED FOR INTERVENTIONS THAT INCREASE ONE’S ABILITY TO COPE WITH CHRONIC PAIN AND ENGAGE IN MEANINGFUL LIFE ACTIVITIES EVEN WITH THE PRESENCE OF CHRONIC PAIN. ACCEPTANCE AND COMMITMENT THERAPY (ACT) IS A PSYCHOTHERAPY THAT USES MINDFULNESS AND PSYCHOLOGICAL ACCEPTANCE TO SUPPORT INDIVIDUALS IN WORKING TOWARD BEHAVIORAL GOALS GUIDED BY THEIR PERSONAL VALUES, EVEN IN THE PRESENCE OF UNDESIRABLE EXPERIENCES SUCH AS CHRONIC PAIN. CLINICAL PRACTICE GUIDELINES RECOMMEND THE USE OF ACT FOR TREATING CHRONIC PAIN BASED ON EVIDENCE OF EFFECTIVENESS FROM MULTIPLE RCTS. HOWEVER, UPTAKE AND REACH ARE LIMITED BECAUSE THERE ARE INSUFFICIENT NUMBERS OF MENTAL HEALTH PROFESSIONALS WHO CURRENTLY OFFER ACT OR OTHER RECOMMENDED THERAPIES (E.G., COGNITIVE-BEHAVIORAL THERAPY) FOR CHRONIC PAIN. IN ADDITION, MANY OLDER ADULTS ARE NOT WILLING OR ABLE TO ENGAGE IN TRADITIONAL PSYCHOTHERAPY FOR CHRONIC PAIN EVEN WHEN IT IS AVAILABLE. ALTHOUGH SOME BIBLIOTHERAPY AND DIGITAL HEALTH INTERVENTIONS (E.G., APPS) HAVE BEEN DEVELOPED FOR TREATING PAIN, MANY OLDER ADULTS FAIL TO USE THEM DUE TO LOW LEVELS OF COMFORT WITH TECHNOLOGY OR LACK OF MOTIVATION FOR INTENSIVE SELF-GUIDED APPROACHES. NARRATIVE COMMUNICATION IS AN ALTERNATIVE WAY TO DELIVER BEHAVIOR CHANGE PRINCIPLES THAT INVOLVES “STORYTELLING” INVOLVING REAL PATIENTS TALKING ABOUT THEIR STRUGGLES AND RECOVERY PROGRESS. THERAPEUTIC NARRATIVES DELIVERED VIA VIDEOS MAY BE MORE ENGAGING AND IMMERSIVE THAN TRADITIONAL SELF-HELP FORMATS FOR OLDER ADULTS. IN PREVIOUS GRANT-FUNDED RESEARCH, OUR TEAM HAS DEVELOPED METHODS FOR CREATING NARRATIVE, VIDEO-BASED INTERVENTIONS DESIGNED TO REDUCE DEPRESSION IN PRIMARY CARE PATIENTS AND PREVENT SUICIDE IN PATIENTS FOLLOWING A PSYCHIATRIC HOSPITAL. THUS, IN THIS PROJECT, WE PROPOSE TO CREATE RECLAIM YOUR DAY (RYD), WHICH WILL CONSIST OF 6, 30-MIN WEEKLY VIDEO EPISODES HIGHLIGHTING PATIENTS’ INSPIRING AND ILLUSTRATIVE EXPERIENCES LIVING WITH CHRONIC PAIN IN ORDER TO TEACH CURRENT PATIENTS WITH CHRONIC MSK PAIN HOW TO APPLY ACT’S EVIDENCE-BASED STRATEGIES. IN PHASE 1 OF THIS PROJECT, WE WILL INTERVIEW OLDER ADULTS WITH CHRONIC MSK PAIN ABOUT THEIR COPING HISTORY, AND CODE INTERVIEWS FOR CONSISTENCY WITH ACT PRINCIPLES. WE WILL INVITE A SUBSET OF THESE INDIVIDUALS TO WORK WITH A PROFESSIONAL STORYTELLING COACH TO DEVELOP AND VIDEORECORD THEIR ACT-CONSISTENT STORIES. THESE DOCUMENTARY-STYLE VIDEOS THAT WILL FORM THE BASIS OF RYD. IN PHASE 2, WE WILL CONDUCT A PILOT RCT (N=100) OF OLDER ADULTS WITH CHRONIC MSK PAIN. ALL PARTICIPANTS WILL RECEIVE A 30-MIN INTRODUCTORY PAIN EDUCATION VIDEO. PARTICIPANTS WILL BE RANDOMIZED TO RECEIVE EITHER RYD OR A COMPARISON INTERVENTION (HEALTH EDUCATION VIDEOS). WE WILL EXAMINE RYD FEASIBILITY AND ACCEPTABILITY AS WELL AS CHANGES OVER TIME IN OUTCOMES (PAIN INTERFERENCE, DEPRESSION, QUALITY OF LIFE) AND PUTATIVE MEDIATORS.

MECHANISMS OF ACCELERATED AGING: STRESS, HEALTH BEHAVIORS, AND THE ROLE OF MITOCHONDRIA - EARLY LIFE ADVERSITY, INCLUDING CHILDHOOD MALTREATMENT AND OTHER TRAUMAS, IS A MAJOR RISK FACTOR FOR A HOST OF AGING-RELATED CONDITIONS, INCLUDING CARDIOVASCULAR DISEASE, STROKE, PAIN SYNDROMES, AND DIABETES. HEALTH BEHAVIORS, SUCH AS POOR DIET AND SEDENTARY LIFESTYLE, AND ADULT STRESSORS, ARE LINKED TO CHILDHOOD ADVERSITY AND FURTHER CONTRIBUTE TO RISK FOR THESE DISEASES. THESE EFFECTS COMPOUND OVER TIME AND POOR HEALTH OUTCOMES ARE MOST EVIDENT IN ADULTS WHEN BIOLOGICAL EFFECTS OF STRESS AND HEALTH BEHAVIORS COMBINE WITH AGE-RELATED DECLINE TO PRODUCE FRANK DISEASE. THERE IS NOW SUBSTANTIAL EVIDENCE OF GLUCOCORTICOID AND INFLAMMATORY MECHANISMS THAT ACCELERATE AGING AND CONFER RISK FOR DISEASE FOLLOWING EARLY ADVERSITY. CONVERGING EVIDENCE FROM ANIMAL MODELS AND RECENT HUMAN STUDIES INDICATE THAT MITOCHONDRIA PLAY A KEY ROLE IN COORDINATING THE STRESS RESPONSE AND IN THE AGING PROCESS, AND MAY BE A MECHANISM OF RISK FOR THESE STRESS- AND AGE-RELATED DISORDERS. RECENT WORK IN HUMANS HAS IMPLICATED MITOCHONDRIA IN THE EFFECT OF EARLY TRAUMA ON RISK FOR PSYCHIATRIC DISORDERS. OUR LABORATORY SHOWED THAT MITOCHONDRIAL DNA COPY NUMBER (MTDNACN) IS INCREASED IN LEUKOCYTES OF HEALTHY ADULTS WITH A HISTORY OF CHILDHOOD TRAUMA, AS WELL AS THOSE WITH DEPRESSIVE AND ANXIETY DISORDERS. RESULTS OF OTHER RECENT STUDIES SUGGEST THAT STRESS IS LINKED WITH ALTERATIONS OF MITOCHONDRIAL ENZYMES AND IMPAIRED MITOCHONDRIAL RESPIRATION. HEALTH BEHAVIORS, SUCH AS DIET, EXERCISE, AND SLEEP, MAY BE ALTERED WITH EARLY ADVERSITY AND PLAY AN IMPORTANT ROLE IN THE EFFECTS OF EARLY ADVERSITY ON MOLECULAR AND HEALTH OUTCOMES INDICATIVE OF ACCELERATED AGING. THE PROPOSED STUDY LEVERAGES DATA AND SPECIMENS AVAILABLE IN A STUDY OF CHILDHOOD MALTREATMENT THAT INCLUDES RICH DATA ON EXPOSURES, HEALTH BEHAVIORS, BIOLOGICAL SPECIMENS, AND HEALTH OUTCOMES. RESULTS OF THIS STUDY ARE EXPECTED TO PROVIDE INSIGHT INTO THE BIOLOGICAL MECHANISMS OF ADVERSITY-RELATED RISK FOR ACCELERATED AGING AND RISK FOR DISEASE, AND PROVIDE TARGETS FOR NEW TREATMENT AND PREVENTION APPROACHES.

PROVIDE PSYCHIATRIC DOCTOR TO DIRECT THE PSYCHIATRIC RESIDENCT TRAINING PROGRAM AT VAMC PROVIDENCE

STRUCTURING APPROPRIATE AND FEASIBLE EVALUATIONS OF RISK (SAFER) - ABSTRACT SUICIDE REMAINS A LEADING PUBLIC HEALTH CRISIS, CLAIMING OVER 49,000 LIVES IN 2022. AMONG COLLEGE-AGED INDIVIDUALS, SUICIDE IS THE SECOND LEADING CAUSE OF DEATH, WITH STUDIES INDICATING THAT 6.4% OF STUDENTS DEVELOP NEW-ONSET SUICIDAL IDEATION, EXCEEDING RATES SEEN IN THE GENERAL POPULATION. TO ADDRESS THIS, RESEARCHERS INCREASINGLY UTILIZE TECHNOLOGICAL TOOLS FOR REAL-TIME SUICIDE RISK ASSESSMENT. WHILE THESE TOOLS ENHANCE RISK DETECTION, THEY ALSO INTRODUCE ETHICAL CHALLENGES, PARTICULARLY IN BALANCING PARTICIPANT SAFETY WITH SCIENTIFIC VALIDITY. EXISTING PROTOCOLS FOR MANAGING SUICIDE RISK IN RESEARCH LACK EMPIRICAL VALIDATION, CREATING INCONSISTENCIES THAT DELAY STUDIES AND HINDER PROGRESS. THE PROPOSED STUDY, STRUCTURING APPROPRIATE AND FEASIBLE EVALUATIONS OF RISK (SAFER), AIMS TO ADDRESS THIS GAP BY DEVELOPING EVIDENCE-BASED SUICIDE RISK MANAGEMENT PROTOCOLS. SAFER WILL INCORPORATE PERSPECTIVES FROM STUDENTS WITH LIVED EXPERIENCE AND SUICIDOLOGISTS TO CREATE AND EVALUATE RISK ASSESSMENT AND INTERVENTION PROTOCOLS. THE PROJECT HAS THREE PRIMARY AIMS: (1) EXAMINING STAKEHOLDER VIEWS ON THE ACCEPTABILITY OF SUICIDE RISK MANAGEMENT PROTOCOLS, (2) EVALUATING THE EFFECTS OF DIFFERENT PROTOCOLS ON PARTICIPANT SAFETY, AND (3) ASSESSING THEIR IMPACT ON DATA VALIDITY. AIM 1 WILL DEVELOP A STAKEHOLDER PANEL CONSISTING OF ~16 STUDENTS WITH LIVED EXPERIENCE AND ~16 SUICIDOLOGISTS. SEMI-STRUCTURED INTERVIEWS WILL BE CONDUCTED UNTIL SATURATION IS REACHED. AIM 2 WILL ASSESS THE PERCEIVED ACCEPTABILITY AND EFFECTIVENESS OF VARIOUS SUICIDE RISK MANAGEMENT PROTOCOLS AMONG HIGH-RISK COLLEGE STUDENTS (N=30) AND SUICIDOLOGISTS (N=10). PARTICIPANTS WILL EVALUATE DIFFERENT RISK RESPONSE STRATEGIES, INCLUDING VARIATIONS IN OUTREACH, SAFETY MEASURES, AND RESOURCE PROVISION. AIM 3 WILL TEST THE IMPACT OF DIFFERENT LEVELS OF RESEARCH PERSONNEL OUTREACH ON REPORTS OF SUICIDAL IDEATION AND BEHAVIORS. A COHORT OF 50 STUDENTS AT RISK FOR SUICIDE WILL COMPLETE DAILY ASSESSMENTS. RESPONSES WILL TRIGGER STRATIFIED INTERVENTIONS, RANGING FROM AUTOMATED RESOURCE REMINDERS TO DIRECT OUTREACH BY RESEARCH STAFF. PARTICIPANTS WILL EVALUATE THE ACCEPTABILITY OF THESE INTERVENTIONS AT THE STUDY’S CONCLUSION. THIS PROJECT WILL GENERATE EMPIRICAL DATA TO REFINE ETHICAL GUIDELINES FOR SUICIDE RISK MANAGEMENT, ENSURING THEY ARE BOTH PROTECTIVE AND CONDUCIVE TO RESEARCH INTEGRITY. BY BALANCING PARTICIPANT SAFETY WITH SCIENTIFIC FEASIBILITY, SAFER WILL PROVIDE SCALABLE, EVIDENCE-BASED RISK MANAGEMENT STRATEGIES APPLICABLE TO DIVERSE RESEARCH SETTINGS. THESE FINDINGS WILL CONTRIBUTE TO NATIONAL EFFORTS IN BIOETHICS, ALIGNING WITH THE BELMONT REPORT PRINCIPLES WHILE ADDRESSING CRITICAL GAPS IN SUICIDE RESEARCH METHODOLOGIES.

ACCREDITATION OF PSYCHOLOGY INTERNSHIP PROGRAM AND POSTDOCTORAL RESIDENCY PROGRAM AT VAMC PROVIDENCE RI

IFG::OT::IFG CLINICAL PSYCHOLOGY TRAINING SERVICES

REDUNDANT MPLS WAN

VA SHARE OF APA ACCREDIATION FEE FOR PSYCHOLOGY IN

KATHY NEILL CHRIS MORSE WOULD LIKE TO ATTEND A CO

CHRIS MOORSE WILL BE ATTENDING A CONFERENCE ON FRI