Our Pilot Projects

Year 1 Pilot Projects

  • Written Exposure Therapy | Ian Kronish, MD, MPH

    • CVD event survivors receive psychoeducation and write in guided sessions about their memory of the event

    Project Leader(s): Ian Kronish, MD, MPH

    NIH Stage Model: Stage IB (Feasibility and Pilot Testing)

    Study Description: Written Exposure Therapy (WET) represents a potentially scalable exposure-based intervention for CVD event survivors. WET is comprised of brief psychoeducation plus five 30-minute sessions at which patients are instructed to write about their memory of the traumatic CVD event with particular attention to the felt emotions and the meaning of the event. Acute CVD events are inherently different from other trauma exposures that promote CVD-related fear. As opposed to external threats (e.g., combat, physical/emotional abuse), CVD events represent ongoing internal somatic threats. Thus, WET for CVD patients requires adaptation to target current and ongoing cardiac threat perceptions, rather than solely memories of the index CVD event. It is also unclear whether CVD event survivors will accept exposure therapy, as few such patients currently seek treatment for CVD-associated distress and may be uninterested in psychological therapies in this context. Accordingly, we are testing the feasibility of conducting an RCT employing a modestly adapted WET intervention to usual care in CVD event survivors. As part of intervention development, we collaborated with the experts who developed WET at the National Center for PTSD in Boston (Drs. Sloan and Marx) to modify the WET protocol for CVD patients to have increased focus not just on fear from the index event, but also on ongoing fear of recurrence and interoceptive bias.

    Headshot of Ian Kronish
  • Office-Based Heart Rate Variability Training (HRVT) | Jeffrey Birk, PhD

    • ACS patients participate in a single-session Heart Rate Variability Training

    Project Leader(s): Jeffrey Birk, PhD

    NIH Stage Model: Stage IA and IB

    Study Design: This is a single-arm pilot study examining the feasibility of administering a single in-person session of HRVT to 10 acute coronary syndrome patients as determined by ability of patients to comprehend and follow the intervention procedures, as well as assessing patient satisfaction with HRVT.

    Intervention Description: A growing body of research shows that heart rate variability training (HRVT) increases HRV and reduces symptoms of stress and anxiety with a large, standardized effect size. The intervention is believed to restore autonomic balance by increasing activity in the vagus nerve. The current predominant version of HRVT involves asking people to practice breathing at the respiratory rate at which their variability in beat-to-beat heart rate (HR) is maximized. For many people, this rate tends to be 6 breaths/minute. Participants practice breathing at this rate with the goal of improving their post-training resting state HRV. We will provide patients with an external (e.g., visual) form of feedback about their otherwise largely inaccessible autonomic physiology (i.e., vagus nerve activity). HRVT involves showing participants their HRV by presenting them with a depiction of their rising and falling heart rate in real time on a computer monitor that will change as they practice the slow-paced breathing technique.

    Headshot of Jeffrey Birk

Year 2 Pilot Projects

  • Home-Based Heart Rate Variability Training: The Care After Life-threatening Medical Events (CALME) Study | Jeffrey Birk, PhD

    • Cardiac arrest survivors with elevated symptoms of PTSD are trained to modify their breath in a paced breathing task using an app and heart rate monitoring device

    Project Leader(s): Jeffrey Birk, PhD

    NIH Stage Model: IA and IB

    Study Design: This single arm pilot study seeks to build on the experience of the single session office-based HRVT pilot study to examine the feasibility, acceptability, appropriateness, and usability of a more intensive multi-session home-based HRV biofeedback training intervention in 10 patients with elevated cardiac anxiety after cardiac arrest. The data collected from participants as part of this feasibility pilot will influence the decision to continue to a stage II RCT.

    Intervention Description: Participants will receive video-delivered training in how to use a heart rate monitoring device (Polar), warn around the chest, in conjunction with the Elite HRV application on their smartphone to do paced breathing at a rate intended to maximize HRV, and then will be expected to practice the paced breathing task 5-10 minutes for day for at least 5 days per week across 4 weeks. Participants will also have the option of learning how to do paced breathing in manner that is personalized according to their own biorhythm, an approach that is expected to maximize improvements in HRV  and anxiety reduction.

    Headshot of Jeffrey Birk
  • Stellate Ganglion Blockade to Reduce PTSD Symptoms in Cardiac Arrest Survivors: A Pilot Randomized Clinical Trial | Sachin Agarwal, MD, MPH

    • Cardiac arrest survivors with elevated symptoms of PTSD during hospitalization receive a single stellate ganglion block (SGB) injection to the neck, as well as psychoeducation

    Project Leader(s): Sachin Agarwal, MD, MPH

    NIH Stage Model: IB

    Study Design: We will conduct a pilot RCT in 15 cardiac arrest survivors to gain preliminary evidence regarding the acceptability, tolerability, safety, and efficacy of a combined intervention of Stellate Ganglion Blockade (SGB) and psychoeducation on trauma symptoms and health behaviors in patients exhibiting early PTSD symptoms after cardiac arrest (CA). Patients will be randomized in a 2:1 ratio to the SGB + psychoeducation intervention versus a sham-control.

    Intervention Description: The intervention is a single stellate ganglion block (SGB) injection provided in combination with a single session of psychotherapy explaining the connection between cardiac anxiety, PTSD symptoms, and recovery after cardiac arrest. The SGB procedure involves injection of local anesthetic in and around the stellate ganglion (located at the base of the neck) to temporarily block its function. While the precise mechanisms by which temporary interruption of the cervical sympathetic chain influences PTSD are not well understood, a growing number of studies has shown that this procedure reduces PTSD symptoms. Due to the somatic nature of the intervention, this procedure may be less stigmatizing and more acceptable to patients than conventional psychotherapies.

    Headshot of Sachin Agarwal
  • Acceptance and Mindfulness-Based Exposure Therapy (AMBET) in Cardiac Arrest Survivors with Elevated Posttraumatic Stress Disorder (PTSD) Symptoms | Maja Bergman, MS

    • Cardiac Arrest survivors with elevated symptoms of PTSD complete weekly sessions with a psychologist

    Project Leader(s): Maja Bergman, MS and Yuval Neria, PhD

    NIH Stage Model: IA and IB

    Study Design: The goal of this pilot study is to develop a de novo protocol for AMBET for cardiac arrest survivors, modeled after other forms of exposure therapy and to then determine the feasibility of enrolling 10 cardiac arrest survivors with elevated PTSD symptoms into a clinical trialcomparing an acceptance and mindfulness-based exposure intervention with usual

    Intervention Description: The intervention being studied is an 8-session acceptance and mindfulness enhanced exposure therapy intervention (~60-90minutes/session, 1x/week) delivered by Master or PhD-trained psychologists with experience in conducting trauma-focused psychotherapy. The goals of the treatment will be to reduce PTSD symptoms and hypervigilance to internal stimuli (i.e., interoceptive bias) and increase cardiovascular health behaviors (medication adherence, physical activity) following cardiac arrest. Sessions will be delivered to patients individually, preferably in person, but with an option for Zoom-hosted video visits if in-person visits are not feasible.

    Headshot of Maja Bergman
  • The Reducing Exercise Sensitivity with Exposure Training (RESET) Study | Andrea Duran, PhD 

    • ACS patients who have some fear of exercise participate in guided sessions of light exercise and counseling to process the physical sensations they experience during exercise

    Project Leader(s): Andrea Duran, PhD 

    NIH Stage Model: Stage 1A (Adaptation and Refinement of Existing Interventions)

    Patients that survive acute CVD events can develop maladaptive hyperawareness and threatening interpretations of normal physiological signals, known as interoceptive bias. To our knowledge, no intervention has been developed specifically to reduce interoceptive bias in CVD event survivors. Thus, we are developing a de novo protocol for Interoceptive Bias Reduction Training (IBRT). We will model IBRT on Anxiety Sensitivity Amelioration Training (ASAT). ASAT combines psychoeducation about the acute effects of interoceptive anxiety on the body, with behavioral exercises that promote habituation to threatening interoceptive cues. To develop our IBRT intervention, we plan to replace behavioral exercises with actual physical activity on the hospital floor as a means of triggering real-world physiologic signals (e.g., faster HR and respiratory rate). We then plan to conduct preliminary testing of the protocol in groups of 5 ACS patients, with assessments of treatment credibility, acceptability, and compliance. We are also determining the feasibility of obtaining permission and finding the opportunity to conduct our IBRT training before patients are discharged from the hospital. We then plan to continue piloting our protocol in groups of 5 patients until we are satisfied that we have developed a robust protocol for Stage 1B testing, involving a randomized design.

    Headshot of Andrea Duran

Year 3 Pilot Projects

  • Family-Authored ICU Diaries to Reduce Fear in Patients Experiencing a Cardiac Arrest: A Pilot Intervention Study (FAID Fear) | Talea Cornelius, PhD

    • Partners and family members of cardiac arrest patients write in a diary during their loved ones’ hospitalization

    Project Leader(s): Talea Cornelius, PhD

    NIH Stage Model: Stage IA & IB

    Study Design: 15 partners of patients who have experienced a cardiac arrest will be randomized in a 2:1 ratio to either complete an ICU diary or to a control condition, and will complete surveys in the ICU, at patient discharge, and 30 days post-discharge. Patients will complete surveys at discharge and 30 days post-discharge. In addition to feasibility outcomes (rate of enrollment, retention, intervention acceptability), key outcomes measured at baseline and 30 days will include the 8-item fear subscale of the Cardiac Anxiety Questionnaire, post-traumatic stress symptoms as measured by the PCL-5, and aversive cognitions toward exercise.

    Intervention Description: The present study will test the feasibility of a Family-Authored ICU-diary intervention to reduce fear of CA in patients’ partners, with the long-term goal of developing and implementing a large scale RCT to test whether fear reductions in family members improve patients’ mental wellbeing, health behaviors, and, ultimately, health outcomes. Following the methods of a RCT published in 2020, partners will receive a bound diary from a trained research assistant and a brief explanation of how to use the diary, including recommended frequency for writing and how to express themselves and its potential value to them and to patients.

    Headshot of Talea Cornelius
  • The SleepWell Study - Chronotherapeutic Intervention to Improve Sleep Following ACS | Ari Shechter, PhD

    • ACS patients who report poor sleep receive education about sleep hygiene and use two devices (light visor and blue-light blocking glasses) for one month

    Project Leader(s): Ari Shechter, PhD

    NIH Stage Model: Stage IA & IB

    Study Design: The goal of this project is to conduct preliminary testing of a chronotherapeutic intervention targeting disturbed sleep in survivors of acute coronary syndrome (ACS). This is important because sleep disturbances are common in patients who experience ACS, and sleep disturbances after a medical event can contribute to the development of further psychological distress. Phase 1 of the study will be a single-arm open-label study of the home-based combined chronotherapy (CC) intervention in 5 post-ACS patients to primarily assess feasibility of enrollment and administering the intervention. If successful, this will be followed by Phase 2 of the study, which will be a pilot randomized clinical trial (RCT) in which 15 post-ACS patients will be randomized (using a 2:1 allocation) to active CC treatment or sleep hygiene education control group. We will examine the feasibility of administering the intervention for 1 month following an ACS event, and specifically, the acceptability, appropriateness, and usability of the intervention. We will also examine whether the intervention affects sleep, physical activity, cardiac anxiety, and psychological distress.  

    Intervention Description:  The intervention being tested here is a “combined chronotherapy” (CC) that has two components: 1) exposure to morning bright light (bright light therapy, [BLT]) via a wearable light visor (Luminette) for 30 minutes after awakening, and 2) blocking out exposure to short-wavelength light by wearing blue-light blocking (BLB) glasses from 8:00pm to bedtime.

    Headshot of Ari Shechter
  • Initial Assessment of the Feasibility and Efficacy of a Scalable Digital CBT for Generalized Anxiety and Associated Health Behaviors in a Cardiovascular Disease Population | Marie Parsons, PhD

    • Cardiovascular disease patients with clinically elevated symptoms of Generalized Anxiety Disorder use a Digital Cognitive Behavior Therapy intervention app

    Project Leader(s): Marie Parsons, PhD

    NIH Stage Model:  Stage I & II

    Study Design: The purpose of this pilot study is to evaluate feasibility/acceptability and to provide an empirical evaluation of mechanistic target engagement and initial estimates of effect sizes for the clinical impact of a scalable Digital Cognitive Behavior Therapy (dCBT) intervention for generalized anxiety disorder (GAD) and negative health behaviors in a cardiovascular disease (CVD) population. The data collected from participants as part of this feasibility pilot will influence the decision to continue with a larger randomized clinical trial (RCT) powered for a direct focus on longer-term changes in CVD health behaviors that are associated with reductions in GAD-related worry and anxiety. We propose to enroll up to 5 participants in Phase 1, and 90 participants in Phase 2. Eligible participants will be those who have experienced an acute CVD event, have clinical levels of GAD symptoms as operationalized by a score of ≥10 on the GAD‐7, and are age 18 or older. In Phase 1, 5 participants will complete up to four modules of dCBT. In Phase 2, participants will be randomly assigned to either the dCBT program or a waitlist (Control) condition with a 1.5:1 allocation (dCBT: Control) using a blocked (male, female) randomization sequence.

    Intervention Description: Participants in the dCBT condition will be asked to complete up to four models of the dCBT intervention across 6 weeks. All participants will complete self-report assessments of affective symptoms, worry, quality of life, sleep, and health behaviors at Week 0 (baseline), Week 3 (mid-treatment), Week 6 (end of treatment), and Week 10 (follow-up). Participants in the control condition will receive access to the dCBT intervention after completing the Week 10 assessment.

    Headshot of E. Marie Parsons, Ph.D.
  • Remote-delivered Mindfulness-Based Cognitive Therapy to Target Far of Recurrence among SCAD Survivors | Christina Luberto, PhD

    • SCAD survivors attend remote mindfulness-based cognitive therapy sessions in small groups

    Project Leader(s): Christina Luberto, PhD

    NIH Stage Model: Stage IA and Stage IB

    Study Design: The goal of this pilot study is to explore the feasibility, acceptability, and changes in psychological and behavioral health outcomes of UpBeat-MBCT for SCAD survivors. The goal of the proposed project is to explore the feasibility of enrolling and retaining SCAD survivors into the intervention; the feasibility of completing the data collection procedures (surveys, daily diaries, actigraphy); the acceptability and effects of the intervention on psychological and behavioral health outcomes; and make intervention refinements. Our goal will be to enroll 16 SCAD survivors into this single-arm study. We will run two intervention groups sequentially such that the results from the first group will be used to inform refinements for further pilot testing in the second group.

    Intervention Description:  The intervention being studied is an 8-session group Mindfulness-Based Cognitive Therapy intervention, adapted for survivors of acute cardiac events (UpBeat-MBCT). There are 1.5-hour weekly sessions delivered by a trained master’s or PhD-level clinical psychologist or social worker with experience in MBCT, and approx. 20-30 minutes of home practice in between weekly sessions. The intervention is delivered via synchronous group videoconference (HIPPA-secure Zoom platform).  The goals of the treatment will be to reduce fear of recurrence symptoms and mechanistic processes (e.g., interoceptive bias, intolerance of uncertainty) and increase cardiovascular health behaviors (sleep, physical activity) following spontaneous coronary artery dissection (SCAD). Sessions will be delivered in groups of approx. 6-8 participants along with the trained facilitator.

    Christina Luberto, PhD headshot

Year 4 Pilot Projects

  • Messy Memories: A Mobile Application Exposure Therapy Intervention to Reduce Psychological Distress and Improve Health Behaviors Following Critical Illness

    • Patients formerly hospitalized in an ICU for a critical illness with elevated symptoms of distress related to this hospitalization utilize a self-directed mobile app to process their ICU memory.

    Project Leader(s): Nadia Liyanage-Don, MD, MS

    NIH Stage Model: Stage IA and Stage IB

    Study Design: The goal of this pilot study is to assess the feasibility and acceptability of recruiting and engaging at least 30 survivors of critical illness in the intervention. We also aim to explore the efficacy of the intervention in engaging the mechanistic target (PTSD symptoms) to reduce psychological distress.

    Intervention Description: The proposed pilot study will conduct preliminary patient testing of a novel mobile application (Messy Memories) that uses remotely delivered (self-administered) exposure therapy to reduce psychological distress and improve health behaviors in survivors of critical illness formerly hospitalized in the ICU. Participants will download the app to their smartphones and be asked to use the app over a 6-week timeframe, focusing on their memory of their ICU experience. The app allows individuals to record their memory and revisit this recording with prompts to aid processing. The app also contains modules that focus on how social support as well as opportunities to set goals in support of overall health (e.g., through sleep, diet, exercise). Participants will answer questionnaires prior to, during, and after the intervention.  

    Headshot of Dr. Nadia Liyanage-Don
  • Aligning dimensions of interoceptive experience in patients with functional seizures

    • Interoceptive training therapy for patients who experience recurring functional seizures

    Project Leader(s): Mahinda Yogarajah, PhD, MRCP, MBBS

    NIH Stage Model: Stage IA and Stage IB

    Study Design: The goal of this feasibility/pilot study is to develop a de novo protocol for ADIE for functional seizures, modeled after ADIE therapy in the treatment of anxiety, and to then determine the feasibility of enrolling patients with functional seizures into a pilot randomized control trial comparing an interoceptive based therapy with treatment as usual in patients with functional seizures. Our goal will be to enroll 20 patients with functional seizures at a frequency of at least 2 or more seizures per month into this single-arm study.

    Intervention Description: The intervention being studied is a 6-session interoceptive training therapy intervention (~15-30 minutes/session, 1x to 2x/week) delivered by a senior neuropsychologist (Dr Rachel Dean) with experience in the psychological treatment of patients with functional seizures. The training sessions will be book-ended by baseline and end therapy assessments (~2 hours/session) and a follow-up session at 3 months (~2 hours). The goals of the treatment will be to reduce the frequency of functional seizures and how bothersome they are perceived to be, reduce co-morbid trait anxiety and dissociation levels, and improve physical activity levels and psycho-social functioning. Sessions will be delivered to patients individually, in person.

  • Brief Internet-Delivered Exposure-Based Therapy Following An Acute Coronary Syndrome: A Stage 1b Randomized Clinical Trial

    • Patients with ACS receive therapist-guided, internet-delivered CBT to reduce symptoms of PTSD and cardiac anxiety and improve QOL

    Project Leader(s): Josefin Särnholm, PhD

    NIH Stage Model: Stage IB

    Study Design: The aim of the proposed pilot study is to develop and evaluate a brief internet-delivered exposure-based CBT intervention for recent acute coronary syndrome (ACS) patients to reduce symptoms of PTSD and cardiac anxiety and increase physical activity and quality of life. This randomized pilot study will be carried out in an interdisciplinary collaboration between psychologists, CBT researchers, and cardiology researchers specialized in ACS at Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden and Columbia University, USA. The data collected from participants as part of this feasibility pilot will influence the decision to continue with a larger stage II or stage III randomized clinical trial (RCT) using the methods in this pilot.

    Intervention Description: The study is an open, two-arm RCT design in which participants are randomized 1:1 to either therapist guided internet-delivered CBT for four weeks (N=15) or to a waitlist (WL) control group (N=15). Assessments will be conducted pre-treatment, post-treatment, two - and six months after treatment. The WL will be crossed over to treatment after completion of the two-month follow-up (primary endpoint) and the final measurement points will not include the WL. The WL will serve as a control for the influence of time on symptom change and natural recovery.

    Josefin Sarnholm headshot
  • Feasibility and Acceptability of Pain Reprocessing Therapy in Racially/Ethnically Diverse Adults with Chronic Back Pain

    • Chronic back pain sufferers receive remotely delivered pain reprocessing therapy (PRT), cognitive behavioral therapy (CBT), or usual care to test PRT’s feasibility and acceptability.

    Project Leader(s): Yoni Ashar, PhD 

    NIH Stage Model: Stage 2 

    Study Design: Patients suffering from chronic back pain will be randomized in a controlled trial testing a novel psychological treatment, pain reprocessing therapy (PRT), for the treatment of adults with primary chronic back pain. PRT is compared to cognitive behavioral therapy (CBT) and to usual care. The goal of this pilot is to test the feasibility and acceptability of PRT in a diverse population and to pilot an adapted form of PRT designed to address hypothesized barriers to treatment feasibility and acceptability, including medical mistrust. 

    Intervention Description: PRT aims to reduce pain intensity by helping patients reattribute chronic back pain to mind or brain processes and targeting pain-related fear and avoidance. PRT will be delivered remotely to test its effectiveness in a diverse population. Dr. Yoni Ashar, based at the University of Colorado Anschutz Medical Campus, is building on his previous research in PRT, with the goal of advancing the intervention to a Phase 3 trial. 

    Yoni Ashar headshot

Year 5 Pilot Projects

  • Community health worker Assisted Task specific and Cognitive therapy at Home with Exposure after Stroke (CATCHES)

    • Stroke patients who endorse fear of falling participate in a home-based interdisciplinary intervention.

    Project Leader(s): Imama Naqvi, MD

    NIH Stage Model: Stage IA and Stage IB

    Study Design: The CATCHES study aims to test the feasibility of a novel, home-based intervention in 30 minor acute stroke patients. The study also aims to explore the efficacy of the intervention in engaging the mechanistic target (avoidance) to reduce fear of falling. The results of this initial study will be used to make refinements to the research protocol in preparation for a future adequately powered randomized controlled trial testing whether the intervention can significantly reduce fear of falling and, in turn, improve behavioral outcomes (e.g., improved physical activity) among stroke survivors.  

    Intervention Description: The CATCHES Study will conduct a novel intervention, integrating Task Specific Therapy at home guided by Community Health Workers (CHW) under the supervision of a licensed Physical Therapist (PT) in conjunction with telehealth based Cognitive Behavioral Therapy (CBT) to reduce task specific fears through repetitive exposure and adaptive behavioral activation strategies to facilitate engagement in physical activity. Minor stroke patients will receive an in-home assessment with a physical therapist and community health worker to conduct an intake visit for task specific training. Further follow up study visits will be conducted by the community health worker where treatment sessions will be tailored to a patient’s specific goals and individualized to allow for challenging practice while promoting successful performance to increase self-efficacy. Sessions will be followed by an interdisciplinary discussion for a patient-centered training plan.

  • Removing Surrogates Uncertainty to Reduce Fear and Anxiety after Cardiac Events (RESURFACE): a Pilot Randomized Clinical Trial

    • Loved ones of cardiac arrest patients utilize an internet-based educational intervention in the face of uncertainty

    Project Leader(s): Sachin Agarwal, MD, MPH (PI), Talea Cornelius, PhD, MSW (Co-I), Jeff Birk, PhD (Co-I)

    NIH Stage Model: Stage 1

    Study Design: The goal of the RESURFACE study is to identify, recruit, and retain 45 surrogates of cardiac arrest (CA) patients into a pilot and feasibility randomized trial comparing the reported feelings of uncertainty when engaged with a web-based information platform to the reported feelings of uncertainty with the typical standards of care. The study aims to test the feasibility and acceptability of a web-based educational intervention program developed by a multidisciplinary team of researchers, patient-surrogate stakeholders, and technical team.

    Intervention Description: The RESURFACE intervention is a newly developed web-based educational platform (https://ourheartsight.com/) that allows the participant to explore videos, audio, infographics, images, and articles that provide knowledge, logistics, and support in relation to their loved one’s cardiac arrest. Participants are asked to explore the platform at their leisure and when they believe it is appropriate for their own circumstances. The platform also provides suggestions for materials that would best suit their needs based on the timing of the hospitalization and frequency of use. Participants will engage with the RESURFACE platform using their own smartphone device or personal computer. They may proceed through each package of the platform once there has been an appropriate passage of time has occurred (i.e. the “Focusing on You” package will be given at one-month post-discharge) and return to packages as many times as they desire throughout the study period.

  • Optimizing Recruitment Methodology for Medication Adherence Interventions: The ENGaging Patients in Adherence Interventions UsinG Behavioral SciencE (ENGAGE) Randomized Factorial Trial

    • Optimizing message-framing and delivery to improve medication adherence in hypertensive patients via clinician-delivered medication counseling

    Project Leader(s): Rushelle Byfield, MD, MS 

    NIH Stage Model: Stage I & III

    Study Design: The ENGAGE study is a 2x2x2 factorial randomized trial developed in collaboration with the Brigham and Women’s Hospital Roybal Center (BWH), which is concurrently conducting a similar trial in a different patient population. The ENGAGE trial tests message-framing and recruitment strategies in the context of an intention to determine an optimal method to effectively engage nonadherent (avoidant) hypertensive patients in a medication counseling session. These strategies include, (1) sending (or not sending) a “priming” postcard to introduce the medication counselling, (2) sending a behavioral theory-informed and tested recruitment letter (versus usual care), and (3) calling patients over the phone (with low or high frequency). 584 hypertensive patients exhibiting suboptimal adherence to their antihypertensive medication are randomized into one of eight groups based on these strategies. Interested patients participate in one brief medication counseling session based on the STIC2IT intervention (more information below).

    Intervention Description: Patients who agree to participate are scheduled to receive the STIC2IT intervention, a medication adherence intervention developed in a stage IV pragmatic cluster randomized trial (N=4,040) led by Dr. Niteesh Choudhry of the BWH Roybal Center and colleagues. This involves a 30-minute or less telephone or video visit with a nurse or clinical pharmacist who uses a semi-structured guide to confirm the patient’s treatment regimen, engages the patient in sharing potential barriers to adherence or other factors that may be contributing to poor disease control, discusses the patient’s readiness to modify behaviors, and works with the patient to develop a shared plan. Prior to delivering the brief counseling intervention, nurses or pharmacists that deliver the counseling intervention undergo a standardized training.