PROJECT SUMMARY/ABSTRACT Up to two thirds of those who survive acute respiratory failure (ARF) requiring mechanical ventilation suffer from symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD) after leaving the intensive care unit (ICU). Memories of frightening and delusional experiences in the ICU appear to be the strongest potentially modifiable risk factor. Research on the formation of fear and associated memories shows that if mitigating information about a traumatic event is introduced during the time between memory formation and its recall, the emotional experience of the memory can be modified in a positive manner. This means that in order to prevent mental health problems in ARF patients, psychological support needs to take place in parallel with medical treatment in the ICU. Previously, application of Psychological Support Based on Positive Suggestions (PSBPS) resulted in shorter duration of mechanical ventilation and decreased need for sedatives. We hypothesize that PSBPS can also mitigate mental health morbidity in ARF survivors. However, providing reliable PSBPS intervention is a challenge for busy ICU clinicians. Doulas, trained lay health care providers who provide emotional support to women in labor have been identified as a reliable yet affordable alternative. Given common elements of their services and our intervention, doulas are in an ideal position to administer PSBPS. The objective of this project is to refine and test a behavioral intervention to be administered in parallel with medical treatment in the ICU. This will be accomplished through two specific aims, which are: 1) to complete the pilot PSBPS with trained doulas and to refine the intervention based on stakeholder feedback and 2) to conduct a randomized controlled trial to evaluate the potential efficacy of PSBPS vs usual care in ARF patients on mental health morbidity and cognitive outcomes. In AIM 1, PSBPS will be performed on 30 ARF patients with subsequent semi-structured interviews of all involved stakeholders; patients will also complete anxiety, depression, acute stress/PTSD, and cognitive function evaluation as measured by validated instruments. For AIM 2, we will conduct a randomized, controlled trial to test the effectiveness of PSBPS. We hypothesize that ARF patients who receive standardized EPSCI will have fewer symptoms of anxiety, depression and acute stress/PTSD at ICU discharge and at 6-month follow-up, and better cognitive function. The proposed Career Development Award supports the NHLBI mission by striving to improve outcomes in ARF patients while training a junior investigator in essential skills to become an independent researcher.