PROJECT SUMMARY This K23 award will support the Candidate’s training and development toward an independent clinical research career focused on clinical trials of Mindfulness-Based Cognitive Therapy (MBCT) for emotional and physical health improvement in patients with comorbid emotional and medical problems. BACKGROUND. Among acute coronary syndrome (ACS) patients, depressive symptoms are common and deadly, and accessible mind-body treatments are needed. MBCT, an evidence-based depression treatment, can be delivered via electronic health (e-health) technologies to promote accessibility, but no research has applied MBCT via e-health technology to ACS patients with depressive symptoms. Specific Aims. The proposed study aims to: (1) identify ACS patients’ specific needs and preferences for an e-health MBCT intervention to inform treatment adaptation and delivery, (2) explore the initial feasibility and acceptability of the adapted MBCT intervention and research procedures in an open pilot trial and make refinements as necessary, and (3) establish the feasibility and acceptability of the MBCT and health enhancement control interventions and research procedures in a pilot RCT, and (3a) explore within-group changes in depression symptoms, potential mechanisms (inflammation, emotion regulation, pro-sociality), and cardiac outcomes (health behaviors, physical function). TRAINING. Training in three areas will promote expertise in adapting and testing the efficacy and mechanisms of MBCT for group videoconferencing delivery in chronic illness populations: (1) novel e-health technology formats for MBCT delivery; (2) qualitative research for MBCT adaptation; and (3) stress physiology and inflammatory biomarker research. These training goals will be supported by (1) a team of expert mentors, collaborators, and consultants – Elyse R. Park, PhD, MPH (primary mentor), Gloria Yeh, MD, MPH (co-mentor), Jeff Huffman, MD (co-mentor), Bettina Hoeppner, PhD (collaborator), David Victorson, PhD (consultant); (2) a resource-rich institutional environment; (3) targeted advanced coursework, research seminars, and scientific meetings; and (4) the proposed research studies. IMPACT. The skills gained will promote an independent research career focused on targeting MBCT for e-health delivery in patients with comorbid emotional and medical problems, and conducting rigorous studies of MBCT efficacy and physiological mechanisms. The results will provide feasibility data for an R01 application of an efficacy trial of MBCT via group videoconferencing for ACS patients with depressive symptoms at risk for poor outcomes. In line with the institute’s funding priorities, this work will advance mind-body medicine research by identifying feasible and acceptable interventions for difficult to treat problems, and innovative data collection methods to inform theoretical models of MBCT mechanisms.

PROJECT NARRATIVE Depression is common and deadly among acute coronary syndrome patients: up to 45% experience elevated depression symptoms, and depression doubles the risk of mortality through behavioral and biological pathways. Mind-body interventions that are accessible and address the underlying pathophysiology of comorbid depression and cardiovascular disease are needed, and MBCT delivered via e-health technologies could address this need. The proposed study will establish the feasibility and acceptability of MBCT via group videoconferencing to reduce depression symptoms in ACS patients with elevated depression symptoms at risk for poor cardiac outcomes.