DESCRIPTION (provided by applicant): Dr. Celano is a clinically trained psychiatrist and research fellow at the Massachusetts General Hospital (MGH). His research, performed primarily with the Cardiac Psychiatry Research Program at MGH, has centered on the promotion of psychological health in patients with cardiovascular disease and psychiatric illness. He has experience as a co-investigator on multiple studies in cardiac patients and currently is the principal investigator of a pilot study to enhance positive psychological states in patients with bipolar depression. He has published 18 articles (7 as first-author) that focus largely on the identification and management of psychiatric illness in cardiac patients. He serves as an ad hoc reviewer for several cardiology journals and has received local and national awards for his research. As a result of his research and clinical experience with cardiac patients, Dr. Celano has developed an increasing interest in the promotion of health behaviors (e.g., physical activity, medication adherence) in patients with heart failure (HF). HF is a chronic, debilitating, and progressive illness that affects nearly 6 million Americans and leads to significant impairments in functioning, quality of life, and survival. Health behaviors are associated with improved outcomes, including survival, in HF, but HF patients often have difficulty adhering to these behaviors. A potential way to improve adherence in this population is to use interventions that can boost positive psychological states, such as optimism, gratitude, or happiness. These states are associated with improved adherence to health behaviors in healthy and medically ill populations, suggesting that an intervention to boost them in HF patients may be an effective way to promote these behaviors and improve physical and mental health. Positive psychology, which uses systematic exercises (e.g., writing a letter of gratitude, using a personal strength in new way) to target positive feelings, may be a highly promising approach to improve health behaviors. In this K23 award proposal, Dr. Celano will obtain the experience needed to become an independent researcher who can develop and implement psychological interventions to increase healthy behavior in patients with HF. This will be accomplished through a research project and formal training plan to enhance his ability to: (1) create, administer, and analyze qualitative interviews, (2) create positive psychology interventions that promote health behaviors in HF patients, (3) develop and complete single-arm and controlled intervention trials, (4) measure and analyze diet and physical activity data, and (5) extend his knowledge of biostatistics. In his research project, Dr. Celano will develop a telephone-based positive psychology intervention to increase health behaviors in patients with New York Heart Association class II or III HF, then test the intervention's feasibility and preliminary efficacy. First, he will perform qualitative interviews to identify links between deficits in positive psychological states (e.g., optimism) and impaired health behavior completion. He will then create a positive psychology intervention based on these results. Next, he will perform a small, proof- of-concept trial to ensure initial feasibility of the intervention and to refine it as needed. Finally, he will perfor a randomized, controlled pilot trial to gather information about the intervention's feasibility, immediate impact on optimism, and preliminary efficacy at promoting health behaviors in this cohort. The results from this project will form the basis of a future R01 application to formally test the efficacy of the intervention in a larger group of subjects. Dr. Celano's research trial will be supplemented by a formal training plan to increase his understanding of biostatistics, HF and its treatment, nutrition and physical activity measurement, the responsible conduct of research, and psychological interventions for cardiac patients. His training will consist of biostatistics classes at the Harvard School of Public Health, clinical and research meetings related to HF, weekly seminars at MGH's Behavioral Medicine Program, formal training in qualitative research and the responsible conduct of research, structured reading programs in diet and physical activity, and regular meetings with mentors and consultants who have expertise in qualitative research, positive psychology, HF, health behavior outcomes, and behavioral interventions. Dr. Celano's proposal will provide him with invaluable experience in performing qualitative research, proof- of-concept trials, and controlled trials and will enhance his knowledge of HF, behavioral interventions, health behavior measurement, and biostatistics. Furthermore, this experience will enable Dr. Celano to become an independent investigator in a critically important area-namely, the promotion of health behaviors in HF. As patients with HF have trouble adhering to life-sustaining health behaviors, effective psychological interventions to enhance positive psychological states and promote these behaviors have the potential to improve mental and physical well-being in patients with this devastating illness.

PUBLIC HEALTH RELEVANCE: Health Behaviors, such as adhering to a wholesome diet, engaging in consistent exercise, and taking medications as directed, can improve survival and functioning in individuals with heart failure, but patients with heart failure often struggle with adherence to these behaviors. This proposal aims to create and test the feasibility of an 8-week, telephone-based positive psychology intervention consisting of easy-to-perform exercises such as writing a letter of gratitude to promote health behaviors in patients with mild to moderate heart failure. If the intervention is successful it has the potential to improve medical outcomes i this high-risk population.