# Optimizing a self-directed mobile copying skills training intervention for improving cardiorespiratory failture survivors' psychological distress: a pilot randomized clinical trial

> **NIH NIH R34** · DUKE UNIVERSITY · 2020 · $362,250

## Abstract

As survival has improved for the 2 million people with cardiorespiratory failure managed annually in
US intensive care units (ICUs), research has clarified how these survivors suffer from severe and
persistent symptoms of psychological distress—depression, anxiety, and post-traumatic stress disorder
(PTSD)—after discharge. However, few interventions exist that are relevant to patients' experiences
and that also accommodate their many physical, social, and financial barriers to personalized care. To
fill this gap, we developed a telephone- and web-based coping skills training (CST) program.
 CST is an empirically-supported psychosocial intervention that targets the use of the adaptive coping
skills to decrease psychological distress and improve quality of life. We conducted a multicenter
randomized clinical trial (RCT) called CSTEP that compared CST to an education program (EP) among
a general sample of ICU survivors who received mechanical ventilation for cardiorespiratory failure. CST
reduced depression symptoms and improved quality of life at 6 months in a pre-specified subgroup with
elevated baseline distress. This RCT also identified key questions regarding best practices for identi-
fying patients who are highly distressed yet whose physical illness is manageable, as well as delivering
the intervention in a more convenient, and scalable manner. In a recent RCT testing a mindfulness
intervention (LIFT), we found that a self-directed mobile app approach increased dose, adherence, and
retention. However, many patients reported low enthusiasm for a meditation-based intervention.
 What is needed before a second multicenter RCT is to apply the promising CST content to a LIFT-
inspired mobile app-based delivery system, and then to test it within a targeted patient population with a
high likelihood of response (i.e., high baseline psychological distress). Therefore, we propose a 2-year
R34 mixed-methods project involving 110 cardiorespiratory failure survivors. Our specific aims will: (1)
Optimize the usability of a self-directed mobile app (mCST) and an automated post-discharge distress
screening system; (2) Test two promising iterations of mCST vs. usual care in a pilot 3-arm RCT with 3-
month follow up, and (3) Explore facilitators and barriers to mCST implementation, using these data to
inform any necessary final revisions to the mCST app.
 Our team has the proven expertise to conduct this R34, which is both necessary and sufficient to
inform a next-step efficacy-focused multicenter RCT that could advance the field with a personalizable
yet scalable therapy. Innovations include mCST’s paradigm-shifting approach to automated screening,
therapy, and outcomes assessment. Overall, mCST could significantly improve access to psychosocial
therapies and augment any hospital- or clinic-based intervention. Last, this R34 addresses current
research priorities outlined by the NIH, the National Academy of Medicine, and professional societies.

## Key facts

- **NIH application ID:** 9906936
- **Project number:** 5R34HL145387-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Christopher Ethan Cox
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $362,250
- **Award type:** 5
- **Project period:** 2019-04-15 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9906936

## Citation

> US National Institutes of Health, RePORTER application 9906936, Optimizing a self-directed mobile copying skills training intervention for improving cardiorespiratory failture survivors' psychological distress: a pilot randomized clinical trial (5R34HL145387-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9906936. Licensed CC0.

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