PRINCIPAL RESEARCH CORE a) Intervention Development Program- This Program will focus on developing innovative patientcentered interventions for mood disorders. To facilitate dissemination and implementation, we will emphasize the core values of efficiency, portability across a range of clinical settings and flexibility across diverse clinical and sociodemographic groups. During years 1-3, much of the intervention development program's work will focus on Developmental Project #1 described below. Work for this project, however, will emphasize generalizable methods, structures and procedures (e.g. common theoretical models for motivational enhancement and self-management support, common database structures for web-based programs, common logical structure for treatment algorithms, common procedures for training and supervision, common self-management content, common methods for selfmonitoring). Center scientists will contribute to the Intervention Development program as follows: ? Behavioral Science, Evette Ludman- This component of the Intervention Development Program will build on our expertise in theory-based behavioral intervention design and implementation, treatment material development, treatment fidelity, and quality assurance. During years 1-3, Dr. Ludman will adapt educational and self-management materials for the web-based intervention in Developmental Project 1. Long-term work will focus on generalizable intervention models for use across a range of mood disorders and treatment settings. Continuing previous work 55, she will also collaborate with the Methods Core to develop tools assessing the underlying mechanisms by which self-management interventions change behavior and clinical outcomes. Our self-management interventions are influenced by social cognitive and self-determination theories, and incorporate strategies of cognitive behavioral psychotherapy and motivational enhancement approaches to health behavior change. Key emphases are patient activation and patient-provider collaboration as core components of effective disease management. Goals include increasing motivation and confidence regarding self-management and developing specific self-management skills relevant to mood disorders (e.g., cognitive symptom management, goal setting and problem-solving). The guiding theories emphasize both intervention content and the counseling strategy or communication style. Self-determination theory posits that an """"""""autonomy supportive"""""""" (vs. """"""""controlling"""""""") style creates healthhcare partnerships that foster autonomous motivation for self-management. Autonomy support is demonstrated by the extent to which providers listen fully, take the patients'perspective, provide meaningful information, and offer choices for treatment and self-care. These specific strategies for supporting autonomy are built into each intervention. Each intervention includes an individually tailored balance on motivational enhancement, education/skills training, self-efficacy enhancement and goal setting/action planning. All work will be coordinated with the Information Technology and Applying Evidence to Practice components.
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