The goal of the Columbia Roybal Center for Fearless Behavior Change is to advance behavioral interventions that reduce psychological distress and improve health behaviors in midlife and older adults that experience serious health events. Each year, millions of adults experience events such as heart attacks, strokes, or life-threatening cancer diagnoses. For some, these events serve as a wake-up calls, or “teachable moments,” and those patients acquire health behaviors that prevent recurrent events and slow disease progression. Yet, many of these patients are highly distressed after these events, leading to substantial impact on quality of life, health behaviors, and prognosis. For example, 1 in 3 patients develop PTSD symptoms after cardiac arrest and critical illness, and 1 in 5 patients develop persistent depressive symptoms after heart attacks. Those patients who are highly distressed are less likely to follow recommended health behaviors such as taking medications, exercising, and having good sleep. We have shown that many 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. Accordingly, our Roybal Center is interested in advancing interventions that target these distress-based mechanisms for which interventions are underdeveloped. There are already evidence-based interventions for reducing other common forms of psychological distress after serious health events such as anxiety and depression. Our Center also aims to conduct implementation research that accelerates the adoption of these effective interventions into practice. Our Center will conduct Stage 0-V research through a Behavioral Intervention Development Core that provides implementation science, regulatory, and statistical support to trialists. In the first year, this Core will launch a Stage II randomized clinical trial (N=90) testing an Acceptance and Mindfulness-Based Exposure Therapy for PTSD in cardiac arrest survivors that was that was previously feasibility tested by our Center versus Present-Centered Therapy, a standard of care control,. This trial demonstrates our capacity to advance interventions through the NIH Stage Model within our Center. In the first year, our Center will also initiate a pragmatic cluster randomized trial (N= 50 clinicians; 200 patients) testing the effect of an implementation strategy (a digital patient activation tool) versus usual care on the uptake of evidence-based treaments for depression in patients with recent CVD events. This trial illustrates our Center’s capacity to conduct Stage V research. Our Center will also include an Administrative Core responsible for soliciting proposals for new trials responsive to our Center’s theme via an annual national competition. This Core will collaborate with the Stress Measurement Network and Science of Behavior Change program to ensure robust measurement of behavioral mechanisms in all trials. It will also oversee trials; disseminate findings; promote DEIA values in trial conduct; develop collaborations; and nurture the next generation of behavioral trialists.