The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation's medical research agency - making important discoveries that improve health and save lives.
The overarching goal of this Science of Behavior Change (SOBC) project is to utilize an experimental medicine approach to develop an efficient, ecologically valid, within-person approach to measuring and intervening on the deleterious effects of everyday stress on meeting recommended levels of two health behaviors: physical activity and sleep patterns. In Phase 1, we will develop, validate and deliver a stress assay that assesses malleable components of the stress process that drive health behavior decisions and enactment as they unfold, in real-time and in individuals' natural environments. In Phase 2, we will use this assay to evaluate "just-in-time" intervention approaches that target specific stress response components at times and in contexts when they are most malleable and can positively impact health behaviors. In contrast to previous daily stress studies, we will conduct coordinated analyses in 10 intensive longitudinal datasets separating effects of stressor reactivity, recovery and pile-up on health behaviors. By replicating the results across 10 studies we will ensure identification of the most reliable and potent targets for intervention.
The goal of this project is to identify, measure, and influence fear of cardiac event recurrence, a candidate mechanism of change in medication adherence in acute coronary syndrome (ACS) patients. Ironically, rather than promoting preventive health behaviors, fear of recurrence may be associated with worse medication adherence, as patients who develop PTSD symptoms report avoiding medications because they do not want to be reminded of their cardiovascular disease risk. The project tests an easily administered, electronic tablet-based intervention that has been used to reduce fear of recurrence by changing emotion-related patterns of attention allocation and interpretation of neutral stimuli. Secondarily, we will test whether reduction in fear of cardiac event recurrence improves medication adherence.
Worry thinking is a major contributor to anxiety and sleep disturbances in the U.S. Mindfulness training may help people manage anxiety, but the effects of delivering mindfulness training through a digital platform (app-based digital therapeutics) on sleep behaviors has yet to be studied. The proposed study will test a mobile mindfulness training program for worry to help individuals decrease worry and improve sleep. The project aims to 1) Determine the degree to which mindfulness training affects maladaptive reinforcement learning, and 2) Test the degree to which mindfulness training reduces worry-driven sleep disturbance.
Permanent increases in physical activity are necessary for weight management and reducing chronic disease risk, but current behavior change approaches have limited ability to produce the sustained changes necessary to achieve health benefits. The proposed competitive revision is relevant to public health because developing a clearer understanding of the key mechanisms that optimize adherence and long-term efficacy of behavior change interventions is critically important for reducing disease risk and preventing weight gain and regain. The inability to produce sustainable health behavior changes is a major barrier to reducing the burden of chronic disease.
The Resource and Coordinating Center (RCC) aims to provide strategic leadership, efficient coordination, inspired support, and pioneering dissemination of the innovative experimental medicine approaches that SOBC consortium scientists adopt to identify and validate measures, and engage novel behavior change targets.
This proposed Science of Behavior Change (SOBC) study will translate research on delay discounting to the prevention of Type 2 diabetes (T2D) in persons with prediabetes. A cross-sectional design will be used to test if delay discounting (DD) is a target related to behavioral and medical adherence in persons with prediabetes. Specifically, researchers will examine whether measures of DD, region of interest (ROI) neural activation during DD, and other executive functions are predictive of behavioral and medical adherence among prediabetics.
Weight loss maintenance is a formidable challenge in obesity management. Understanding the mechanisms of action that drive behavioral adherence is essential to developing more effective long-term interventions. Using an experimental medicine approach, this study will test whether delayed discounting (i.e., the tendency to devalue larger future rewards in favor of immediate rewards) is engaged by a novel future thinking visualization procedure and whether engagement predicts physical activity outcomes during a maintenance intervention.
Parents are highly motivated to receive information about how to keep their teens healthy but it is not easy for parents to access scientifically derived advice on the nuts and bolts of parenting their teens. By scientifically deriving the conversational elements used by parents that reduce conflict and facilitate upward spirals of healthful behavior change, this project aims to derive a novel intervention to give parents the conversational skills to foster change, inspire learning and internalize motivation to change behavior among their teenage children. A novel interpersonal target; namely, parent-teen conversations about teen health behavior change will be examined in this study.
A recent Cochrane Review of RCTs aimed to increase regimen adherence paints a bleak picture of the current state of the field (Nieuwlaat et al., 2014). The authors summarize the results of 182 RCTs, which aimed to improve regimen adherence through various interventions, noting that most interventions produced little improvements in regimen adherence with small magnitudes of effect; additionally, those that worked were expensive interventions that combined many constituent elements, thereby making it difficult to understand the mechanisms through which they took their effect. The goal of the current study, therefore, is to take an experimental medicine-based approach which first identifies candidate targets related to stress and stress resilience - in particular, temporal discounting, self-efficacy, and executive control - which are likely to affect adherence and other health behaviors; develops interventions to affect these targets and assays to verify target engagement; and tests whether the engagement of these targets affects regimen adherence and other health behaviors.
Corrosive couple conflict—intense conflicts between partners that may involve physical or emotional aggression—and coercive parent-child conflict—escalating conflicts between parents and children that may involve physical or emotional aggression—are a pervasive, powerful, and destructive (but modifiable) poison to a wide range of adult and child health problems. Despite strong research findings and extensive clinical literature, measures that can sensitively, easily assess these patterns of conflict, and interventions that can quickly, precisely reduce these patterns, are both underdeveloped. This project will identify, refine, and develop these tools and seek to establish the resulting impact on health behaviors and adherence to medical regimens.
Based on data from animal studies, racial disparities in breast cancer outcomes are now being attributed to physiological responses to social stressors that activate biological processes that are involved in the initiation and progression of disease. Until these physiological mechanisms have been examined in human samples, our understanding of the biological and behavioral basis of breast cancer disparities will be limited. This research will be the first to use a biobehavioral model to examine biological, psychological, and behavioral pathways that contribute to disease outcomes among African American breast cancer survivors.
Self-regulation, or the ability to intentionally manage cognitive and emotional resources to accomplish goals, is crucial to addressing a wide range of health problems influenced by common behaviors, such as excessive eating, lack of physical activity, addiction, and poor adherence to medical regimens. Mindfulness interventions have initial evidence to influence self-regulation, however it is still poorly understand what specific elements of mindfulness interventions are most effective at influencing self-regulation, and if those changes in self-regulation translate into clinically meaningful health behavior changes, such as improved medial regimen adherence. This study proposes to analyze several existing datasets to answer these questions, as well as test the ability of customized mindfulness interventions to alter self-regulation and medical regimen adherence in four ongoing studies.
In this project we propose to understand self-regulation processes and mechanisms underlying evidence-based behavioral interventions for the treatment of obesity and depression, 2 of the top contributors to the burden of disease and disability in the US and globally. The project synergistically integrates human neuroscience and behavioral science to identify which self-regulation targets are engaged by the intervention among which subgroups of the population and how we can harness these target mechanisms to promote greater health behavior change, better weight management and improved mood. In a series of 3 interrelated studies we will identify, validate and refine a set of assays to measure self-regulation targets; and to engage these targets to optimize behavioral treatment of coexisting obesity and depression among adults. Given the widespread relevance of these disorders and the targeted health behaviors (adherence to self-tracking and medications, physical activity, diet), this research will be a prototype for understanding and optimizing behavioral interventions for multiple chronic conditions, with profound potential impacts on population health.
Mindfulness-Based Cognitive Therapy – Perinatal Depression (MBCT-PD) is a group-based therapy that focuses on developing mindfulness and cognitive behavioral skills and has been shown to be efficacious in reducing depressive symptoms and emergence of major depressive disorder postpartum. This pilot translational fMRI study proposes to examine whether cognitive control and emotion regulation are potential neural mechanisms of action of MBCT-PD. Additionally, the study proposes to explore whether these proposed mechanisms of action may effect intergenerational transmission of risk, namely reported negative infant emotionality.
Opioid use disorder has reached an epidemic level in the United States, and reactivity to stress is a robust predictor of relapse in this population. This project aims to test the impact of behavioral interventions to reduce stress reactivity in adults with opioid use disorder. The results of this study have the potential to inform the development of novel treatment strategies for improving outcomes for those with opioid use disorder. Critically, because of the relevance of stress reactivity across an array of psychiatric disorders (alcohol use disorder, posttraumatic stress disorder), these findings may also have implications for behavior change for other mental health conditions.
Childhood obesity is a critical and ongoing public health problem, with almost 25% of children overweight by age 4 years and 35% by adolescence. Once established, childhood obesity is difficult to treat and tracks into adulthood. The more years of a lifespan one is obese, the greater risk for obesity-associated comorbidities such as coronary heart disease, type 2 diabetes, hypercholesterolemia, asthma, hypertension, arthritis, and cancer. There is thus an urgent need to prevent and treat childhood obesity, but current prevention and treatment programs focused on diet and physical activity have limited efficacy. We posit that one reason for this is a lack of focus on the basic mechanisms of health behavior change, specifically self-regulation processes that may shape whether changes are adopted. The goal of the ABC Brain Games Study is to develop and test measures of childhood self-regulation targets and to evaluate associations with proximal processes known to be associated with later obesity and other health risks (e.g., obesogenic eating behavior, attention problems). Specifically, we are testing whether four brief interventions focused on improving self-regulation can change children's executive function (EF), food bias, emotion regulation, and future orientation as specific self-regulation targets that may be relevant for multiple health behaviors.
This project is to show the relevance of specific vulnerability factors for smoking cessation failure, and to show that modification of these risk factors with intervention results in an improved ability to tolerate periods of nicotine withdrawal/craving without smoking. The vulnerability factors are specifically relevant to low socioeconomic status smokers, and include negative affectivity, low working memory capacity, and low distress tolerance. This research represents a first step toward trying to improve smoking cessation for these individuals by validating new treatment approaches.
Cognitive behavioral stress management (CBSM) is effective in reducing symptom burden and improving health-related quality of life (HRQoL) in prostate cancer (PC) survivors but limited work has targeted racial/ethnic minority patients, comprehensively assessed intra- and inter-personal mechanisms (e.g., self- and emotional-regulation) in patients and spouses/partners, or collected “real time” data that maps onto psychological and physiological adjustment. This revised study will address these shortcomings by assessing how CBSM's impact on primary study outcomes of symptom burden and HRQoL operate through Science of Behavioral Change (SOBC) measures in the self-regulation, interpersonal/ social processes and stress domains, and by using “real time” ecological momentary assessments of social connectivity, positive/negative mood, stress management skills and physiological arousal (SNS & HPAC activation) through mHealth technologies. Further, this revision considers the experience of both patients and their spouses/partners, by conducting spousal/partner. This is a competitive revision application to a RCT evaluating the effects of a group-based linguistically translated and culturally adapted cognitive-behavioral stress and self-management (C-CBSM) intervention on symptom burden and health related quality of life (HRQoL) in Hispanic men treated for localized prostate cancer (PC).
Health risk behavior, including poor diet, physical inactivity, tobacco and other substance use, causes as much as 40% of the illness, suffering, and early death related to chronic diseases. Non-adherence to medical regimens is an important exemplar of the challenges in changing health behavior and its associated impact on health outcomes. Although an array of interventions has been shown to be effective in promoting initiation and maintenance of health behavior change, the mechanisms by which they actually work are infrequently systematically examined. One promising domain of mechanisms to be examined across many populations and types of health behavior is self-regulation. Self-regulation involves identifying one’s goals, and maintaining goal-directed behavior. A large scientific literature has identified the role of self-regulation as a potential causal mechanism in promoting health behavior.
Advances in digital technologies have created unprecedented opportunities to assess and modify self-regulation and health behavior. The proposed project is designed to identify valid and replicable assays of mechanisms of self-regulation across populations to inform an ontology of self-regulation that can ultimately inform development of health behavior interventions of maximal efficacy and potency.
The assessment and treatment of chronic pain (CP) and Posttraumatic Stress Disorder (PTSD) are national priorities for the National Institute of Health (NIH) and the Veterans Health Administration (VHA) as we continue to see steep increases in the prevalence of these conditions among returning Veterans as well as relatively high rates of these conditions among civilians. Health behavior change is important in treating these conditions and proactively preventing long-term negative health sequelae, in order to benefit these individuals directly and reduce the challenges to our healthcare system. We will use an innovative translational research approach to study whether a progressive -based exercise program will help individuals suffering from CP/PTSD achieve exercise maintenance, and shared symptom reduction, through neuropeptide Y mediated improvements in putative factors known to improve exercise related self-efficacy and motivation. This study will compare the effects of a 3-month, individually prescribed progressive exercise training program on: 1) chronic pain (CP), depression and PTSD symptoms, and 2) neurobiological and related neuropsychological mechanisms by which our exercise-training paradigm may foster exercise maintenance.
Diet, exercise, and glucose-lowering medication are first-line treatments for type 2 diabetes, but morbidity and mortality remain high because many patients do not adequately adhere to these treatments. Treatment adherence provides its greatest health benefits (e.g., avoidance of diabetes-related complications such as renal disease) only after months or years of sustained lifestyle change; however, accumulating evidence demonstrates that individuals suffering from type 2 diabetes and related disorders (e.g., obesity) rapidly devalue the future and show a bias for immediate gratification. The overall goal of this project is to improve treatment adherence in type 2 diabetes using an episodic future thinking intervention (i.e., mental prospection) designed to increase valuation of the future.
The goal of this project is to develop knowledge regarding mechanisms linking positive affect and adherence to HIV antiretroviral therapy (ART) through a feasibility pilot test of a positive affect induction intervention conducted in this priority population. Positive affect has been linked to improved health and survival across a number of disease outcomes, and there is growing evidence that it is associated with central components of the HIV care continuum, including improved adherence and retention in care. Positive affect has also been demonstrated to be modifiable and may be a particularly important psychological asset for promoting self-care behavior, in that it is posited to engage several mechanisms of action that have also been linked causally to improved ART adherence, including lower perceived stress, reduced burden of psychological distress, increased resilience, and greater social support. Our team has translated state of the art basic science on methods and processes by which positive affect is most likely to improve adherence in the form of the 3- session APPEAL Program (Affect, Promoting Positive Engagement, and Adherence for Life). We seek to refine the APPEAL protocol to ensure cultural fit with a priority population of Black men and women living with HIV who have challenges with ART adherence, to assess the feasibility and acceptability of the program in the context of a randomized feasibility trial, and to identify whether APPEAL exposure results in changes in mechanisms of action and ART adherence by leveraging measures from the Science of Behavior Change Research Network.