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.


Jeffrey Birk, PhD

R21 Principal Investigator; U24 Co-Investigator

Columbia University Medical Center

Center for Behavioral Cardiovascular Health

New York, NY

Dr. Birk is an Instructor in Medical Sciences at Columbia University Irving Medical Center in the Center for Behavioral Cardiovascular Health. Prior to this position he completed his doctoral training in experimental psychology at Tufts University and postdoctoral training at Teachers College, Columbia University. His research focuses on the influence of emotions and their regulation on cardiovascular health. One goal of this research, exemplified by this R21 SOBC project, is to investigate how negative emotions that arise due to serious medical conditions may reduce patients’ engagement in health behaviors. A second research goal concerns the health effects of different strategies for regulating emotion. For example, perseverative thinking involves ruminating about the past or worrying about the future and is generally regarded as a maladaptive regulatory strategy. Dr. Birk and colleagues investigate how the occurrence and duration of perseverative thoughts may contribute to heightened blood pressure by cognitively prolonging the stress response. A third research goal is to understand the behavioral and physiological pathways by which depression and post-traumatic stress disorder have adverse effects on long-term health outcomes.

Catherine Stoney, PhD


Program Official