The Inaugural IBTN Summer School is an academic program held over 6 days exploring how to breakthrough current obstacles in behavioural trial methodologies and expand the reach, capacity, and impact of trials in the field of behavioural medicine.
When: May 21-26, 2018 (with online activities to be held before and after)
Where: Concordia University and Université du Québec à Montréal (UQAM), Canada
Who: Open to doctoral students and early career researchers who want to develop and extend their knowledge about behavioural trials
View preliminary list of lecturers and program structure… Learn more
The Montréal Behavioural Medicine Centre (MBMC) is looking for a new research assistant. This part-time position (3 days/week) will be directly attached to 2 specific projects: 1) An international project looking to develop targets for increasing physical activity and reducing sedentary behaviour in elderly populations (i.e., aged 65+); and 2) A national guideline development and implementation project around cardiac rehabilitation. The main role of the candidate will be to help undertake a series of systematic reviews around these topic areas, including running search, finding articles, and defining if articles meet the predefined inclusion and exclusion criteria. There will also be opportunities to work with other pertinent projects within the Montreal Behavioural Medicine Centre (www.mbmc-cmcm.ca).
The position is part time for one year and is renewable. Deadline for applications is December 22, 2017.
We are thrilled to announce the following confirmed speakers for the upcoming International Behavioral Trials Network Conference next May 24-26 in Montreal!
Full program details (including new speakers, plenary sessions, workshops, poster sessions, and networking activities) to follow! For further information, contact the IBTN team: firstname.lastname@example.org
Susan Michie, PhD (University College London)
Professor of Health Psychology at University College London (UCL) and Director of its Centre for Behaviour Change and of the Health Psychology Research Group. She leads the Human Behaviour-Change Project, holds an NIHR Senior Investigator’s award, is Associate Editor of Annals of Behavioral Medicine and Fellow of SBM, AcBehMedRes, AcMedSci, AcadSocSci, EHPS and BPS.
Robert Kaplan, PhD (Stanford University) Regenstrief Distinguished Fellow at Purdue University, Adjunct Professor of Medicine at Stanford University, and Director of Research at the Stanford School of Medicine Clinical Excellence Research Center (CERC). He also served as Chief Science Officer at the US Agency for Health Care Research and Quality (AHRQ) and Associate Director of the National Institutes of Health. He is also a Distinguished Emeritus Professor of Health Services and Medicine at UCLA, where he led the UCLA/RAND AHRQ health services training program and the UCLA/RAND CDC Prevention Research Center. He has served as co-chair of the Social Behavioral and Economics Sciences subcommittee (of Committee of Science) of the US National Science and Technology Council, within the United States Executive Office of the President.
Jeremy Grimshaw, MD, PhD (University of Ottawa)
Senior Scientist in the Clinical Epidemiology Program at the Ottawa Hospital Research Institute and Full Professor at the University of Ottawa’s Department of Medicine. He is also Tier 1 Canada Research Chair in Health Knowledge Transfer and Uptake, Co-Chair of the Steering Group for the Campbell Collaboration, a Fellow of the Canadian Academy of Health Sciences, a Corresponding Fellow of the Royal Society of Edinburgh and a Member of the Centre for Implementation Research.
Linda Collins, PhD (Pennsylvania State University)
Director of Pennsylvania State University’s The Methodology Center, Distinguished Professor in the Department of Human Development and Family Studies and Professor in the Department of Statistics.
Robert West, PhD (University College London)
Professor of Health Psychology at University College London, and Director of Tobacco Studies for the Cancer Research UK Health Behaviour Unit in the Department of Epidemiology and Public Health at University College London.
Lynda Powell, PhD (Rush University) Charles J. and Margaret Roberts Professor of Preventive Medicine, Medicine (Cardiology), Behavioral Sciences, and Pharmacology, and chairperson of the Department of Preventive Medicine at Rush University Medical Center in Chicago. She has been a past principal investigator of five major randomized behavioral trials and has served as a standing member of the NHLBI Clinical Trials Study Section. She is currently the principal investigator of the Chicago site of the NHLBI-sponsored Obesity-Related Behavioral Intervention Trials (ORBIT) network. She is a founding faculty member in the NIH/OBSSR-sponsored Summer Institute for Randomized Clinical Trials Involving Behavioral Interventions. She is currently in the process of writing the first book on the strategy of behavioral randomized clinical trial methodology.
Jean Bourbeau, MD (McGill University)
Respirologist and Professor in the Department of Medicine and Epidemiology & Biostatistics at McGill University, and director of the McConnell Centre of Innovative Medicine (CIM) of the Research Institute of the MUHC (RIMUHC) and the Pulmonary Rehabilitation Unit at the Montreal Chest Institute of the McGill University Health Centre (MUHC). He also chairs the COPD axis of the Health Respiratory Network of the FRQS (Fonds de recherche du Québec – Santé), past president and current member of the Canadian Thoracic Society, and sits on the scientific committee of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and leading/co-leading Guidelines/Position statements in COPD (CTS, Chest, ATS/ERS, and GOLD).
Bonnie Spring, PhD (Northwestern University) Professor of Preventive Medicine, Psychology, and Psychiatry at Northwestern University and Director of the Center for Behavior and Health of its Institute for Public Health and Medicine. She serves on the American Psychological Association’s Advisory Steering Committee to Develop Clinical Treatment Guidelines, chairs the American Heart Association’s Health Behavior Change Committee, and author of NIH-funded on-line learning modules on evidence-based practice (ebbp.org). She is also founding editor and editor-in-chief of Translational Behavioral Medicine: Practice, Policy, Research.
Ken Freedland, PhD (Washington University)
Professor of Psychiatry and Psychology at Washington University School of Medicine and co-investigator and clinical supervisor for the multicenter Enhancing Recovery in Coronary Heart Disease (ENRICHD), a co-investigator and assessment core leader for the multicenter CODIACS Vanguard trial, and a co-investigator and clinical supervisor for the multicenter INSPIRE trial of stress management for lung transplant candidates. He is also a founding fellow of the Academy of Cognitive Therapy (ACT) and an ACT-certified cognitive therapy trainer, an instructor in clinical trial methodology on the faculty of the National Institutes of Health Annual Summer Institute on Randomized Behavioural Clinical Trials.
Paul Montgomery, PhD (University of Birmingham, UK)
Professor of Social Intervention at the School of Social Policy at the University of Birmingham, and lead on the development of the CONSORT-SPI, a reporting guideline for randomised trials of complex psychological and social interventions. He maintains a clinical social work practice and specialises in Brief Intervention and Cognitive Behavioural techniques.
Linda Carlson, PhD (University of Calgary)
Enbridge Research Chair in Psychosocial Oncology, Alberta Innovates-Health Solutions Health Scholar, Full Professor in Psychosocial Oncology in the Department of Oncology, Cumming School of Medicine at the University of Calgary, and Adjunct Professor in the Department of Psychology. She is also the Director of Research and works as a Clinical Psychologist at the Department of Psychosocial Resources at the Tom Baker Cancer Centre, and is a fellow of the Society of Behavioral Medicine and the Mind and Life Institute.
David Buckeridge, PhD (McGill University)
Associate Professor of Epidemiology and Biostatistics at McGill University where he holds a Canadian Institutes of Health Research Chair in Applied Public Health. He is also a Medical Consultant to the Montreal Public Health Department and the Quebec Public Health Institute.
Molly Byrne, PhD (National University of Ireland, Galway)
Professor of Health Psychology at the National University of Ireland, Galway and recipient of the Health Research Board (HRB, Ireland) Research Leadership Award (2014-2019) to establish and direct the Health Behaviour Change Research Group (HBCRG).
Kim Lavoie, PhD (Université du Québec à Montréal)
Co-Director of the Montréal Behavioural Medicine Centre, co-lead of the International Behavioural Trials Network (IBTN) and former Director of the Chronic Disease Research Division at Hôpital du Sacré-Coeur de Montréal. She is a Full Professor in the Department of Psychology and Chair of Behavioral Medicine at the Université du Québec à Montréal. She is also Chair of Health Psychology and Behavioural Medicine at the Canadian Psychological Association and an active member of the CHEP recommendation panel (Adherence Subcommittee). She currently holds a Quebec Health Research (FRQS) Senior Investigator Award.
Grégory Ninot, PhD (University of Montpellier)
Professor at the University of Montpellier, France, Director of the CEPS Platform, dedicated to improving the methodology of behavioral trials, and co-lead of the International Behavioural Trials Network.
Susan Czajkowski, PhD (National Cancer Institute)
Chief of the Health Behaviors Research Branch (HBRB) of the National Cancer Institute (NCI) and previously project officer for the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Patients Study and lead project officer for the NIH-funded Obesity-Related Behavioral Intervention Trials (ORBIT) network. She is also a fellow in the Society of Behavioral Medicine, and recently served as President of the Academy of Behavioral Medicine Research.
Karina Davidson, PhD (Columbia College of Physicians and Surgeons)
Professor of Behavioral Medicine and Director of the Center for Behavioral & Cardiovascular Health. She is an expert on behavioral and psychosocial interventions for patients with cardiovascular disease and she has conducted randomized controlled trials of anger management and depression treatment for both hypertensive and post-myocardial infarction patients. She is also the Convening Chair of the Cochrane Behavioral Medicine Field, formed and chaired the Evidence-based Behavioral-Medicine Committee, and led the NIH-funded Summer Institute on Conducting Randomized Controlled Trials with Behavioral Interventions.
Simon Bacon, PhD (Concordia University)
Professor in the Department fo Exercise Science at Concordia University, Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) Chair in Innovative, Patient-Oriented, Behavioural Clinical Trials, Co-Director of the Montréal Behavioural Medicine Centre, fellow of the Obesity Society and the Canadian Cardiovascular Society, and researcher at the Centre intégré universitaire de santé et service sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM) and co-lead of the International Behavioural Trials Network.
Initially interested in both longitudinal epidemiologic studies and clinical trials, Dr. Lynda Powell ultimately turned her attention primarily to behavioural clinical trials. Her projects aim to contribute to our understanding of how to conduct behavioural trials, from design and implementation to analysis, interpretation, and progression.
Overcoming the Challenges Collaboratively
After spending a few years aimlessly teaching public school and serving as a university counselor, Powell was offered the opportunity to work on one of the first behavioural clinical trials ever conducted: The Recurrent Coronary Prevention Project. When results showed a 44% reduction in the cardiovascular recurrence rate in coronary patients with Type A behaviour, Powell was hooked. Her passion for incorporating behavioural treatments into regular medical care has guided her career ever since. “Getting a taste of behavioural clinical trials was like sipping a white Burgundy wine for the first time,” she explains, “there was no going back.”
Today her time is divided between departmental administrative duties —which includes mentoring department faculty and acting as liaison with senior leadership— and her research which involves leading a variety of research teams. Suffice it to say that on most days, Powell is “in a meeting” as virtually all of her work pivots around collaborating with others.
In fact, according to Powell, working with others plays a particularly critical role in her research. The importance of the team is paramount. Powell speaks highly of the expertise of her colleagues in Rush University’s Department of Preventive Medicine, including experts in behavioural clinical trials from the fields of medicine, psychology, biostatistics, and clinical trials, and independent core personnel in their Data Management Centre who develop, implement and analyze trial data, and an independent administrative core that supports capacity in submitting, reporting, and ensuring trial quality control.
Yet, while she acknowledges that behavioural researchers spend a lot of time sharing with one another, she believes that not enough time is spent trying to understand advances in basic science that could strengthen behavioural interventions. Similarly, she believes more effort is needed in interfacing with medical practitioners to better understand the challenges they face in their practice, and explore how behavioural interventions could help meet these challenges. She believes the best advances will come from “networking more across disciplines, and less inside our own.”
Building on Past Successes
The theoretical frameworks that guide all this collaborative research are based in theories about how to generate sustained change. As a graduate student at Stanford, Powell was mentored by Al Bandura, and her work today is guided by social-cognitive theory as well as self-determination theory. More recently, she has found new guidance in the principles of habit modification from the field of neuroscience (where studies have shown that inappropriate eating behaviours are not a question of self-control but instead about the persistence of habits). She has also recently begun embracing mindfulness practices as ways to reduce the appeal of temptations and desires in patients struggling with lifestyle challenges such as unhealthy eating, chronic stress, and sedentary living.
Powell is perhaps most well-known for leading the ORBIT consortium alongside department and institution colleagues and different consortia sites which led to the development of the ORBIT model for behavioural treatment development. (View summary of ORBIT model)
After recently completing two large-scale projects (a dual-level NHLBI-funded P50 Disparities Centre intervention aimed at reducing repeated hospitalization in African American patients with heart failure — an innovative design that is not yet well understood — and an NHLBI-funded U01 mechanism aimed at developing an intervention to prevent the progression of visceral fat in women traversing into menopause), Powell is now preparing a new and ambitious multi-site behavioural clinical trial aimed at determining the effectiveness of a lifestyle intervention to achieve sustained remission of the metabolic syndrome. More meetings lie ahead for Powell as the project will bring together six national American sites and its role will be to offer leadership for both the trial and its data management. The trial is set to begin in 2018.
On the Larger Horizon
Powell believes that the field of behavioural medicine should push toward rigorous evaluation of behavioural treatments in behavioural efficacy and effectiveness trials. Currently, she believes, the field tends to stop at conducting behavioural trials on behavioural or surrogate outcomes. Her current projects aim to use models that steer toward efficacy trials. She feels this is a particularly important direction to explore, particularly for junior-level investigators.
Powell is perhaps most excited about the advent of precision lifestyle medicine — that is, gearing behavioural interventions to those most likely to benefit from them. “We need to spend more time developing behavioural treatments, and tinkering with them to potentiate their strength,” explains Powell. This also means having to rethink our commitment to the generalizability of interventions to a wide range of people with diseases of interest. She believes that a patient-centred approach means offering interventions to patient subgroups who are ready to fully engage with them. “If only 50% of an at-risk population adheres to a pharmacological treatment,” she asks, “why should we expect 100% adherence to our behavioural treatments?”
She explains further by referring to a meta-analysis (Naci & Ionnidis 2015 in British Journal of Sports Medicine) comparing drug and exercise intervention approaches toward reducing cardiovascular recurrences. Whereas both approaches had the same level of efficacy, of the 305 trials reviewed, 81% investigated drug interventions but only 19% investigated exercise interventions, and of the 339,274 patients included in this review, 96% were involved in drug trials but only 4% were involved in exercise trials. No one is surprised, then, that patients are immediately administered drugs after a heart attack rather than being offered lifestyle treatments. “We are simply not doing enough behavioural trials,” concludes Powell, and her upcoming book emphasizes that quantity is nothing without the corresponding quality.
Promoting the Science of Behavioural Clinical Trials for Chronic Diseases
To wit, Powell has been collaborating with IBTN Founding Member Dr. Kenneth Freedland and Dr. Peter Kaufmann on a new book due entitled “The Science of Behavioral Clinical Trials for Chronic Diseases” (Springer, 2018). The book will cover the anatomy and development of a behavioural trial, including the choice of comparator, and will discuss the importance of hypothesized pathways by which behavioural treatments can translate into primary clinical endpoints. Chapters will also be devoted to issues of feasibility, pilot studies, protection of randomization, measurement of outcomes, and the all-important hurdle of clinical significance, not to mention the tricky task of investigator equipoise.
With the true voice of mentors, Powell and her colleagues offer guidance to the future of the field in the book’s introduction:
“An understanding of the mistakes made in the past can foster a richer understanding of how to make decisions in the present and plans for the future. We do not want new investigators to follow in our footsteps. We want them to seek what we sought but in ways that are better informed, more sophisticated, and more successful. We want to pass to them a lighter gavel than the one we received. We are cheerleaders for their success.”
Powell’s ability to translate the impact of this work to junior researchers, and non-researchers alike, underscores the skills she has acquired over the course of her career to communicate the goals of the work that continues to impassion her and her colleagues. At the end of the day, it’s about understanding how to determine if a treatment approach actually works in order to promote it in practice. Though there are salient differences between pharmacological trials and behavioural trials, rigorous evaluation of efficacy and effectiveness is what they must ultimately share. According to Powell, we need to push the development of behavioural interventions “with the methodological purity we see on the medical side. They are the gatekeepers.”
Dr. Powell will be attending the 2018 IBTN Conference in Montréal in May, as well as meetings of the Society for Behavioural Medicine, the International Congress of Behavioural Medicine, and the Academy of Behavioural Medicine Research.
ORBIT Behavioural Intervention Development Model
The NIH’s ORBIT’s model is a comprehensive and structured framework used to develop and then test new behavioural interventions. It parallels frameworks used by the pharmaceutical industry, including basic social science, behavioural research, and phases I-IV. The framework is fluid in that it can move forwards and backwards depending on progress and results. Formally published in 2015, the main paper has become a cornerstone for the field of behavioural medicine.
Begin with the “end” in mind
Process is guided by “significant clinical questions” from end users (patients, providers)
Progression from basic to more clinical/applied stages
Pushes toward the efficacy trial
Each phase includes “clinically meaningful” milestones
Specify a priori criteria for moving to next phase of the intervention development process
Emphasis is on achieving “clinically significant” (not just statistically significant) change in behavioural targets
Flexibility in terms of:
Number & types of studies within phases
Duration of each phase
Movement from one phase to the next (can “skip” a phase if necessary)
Flow is bidirectional
Allows for “failure” and return to earlier phases as needed
Dr. Lynda H. Powell is the Charles J. and Margaret Roberts Professor of Preventive Medicine, Medicine (Cardiology), Behavioral Sciences, and Pharmacology and Chairman, Department of Preventive Medicine and Rush University Medical Center. Her research specializes in the behavioural treatment development and behavioural randomized clinical trials to promote cardiometabolic health. Dr. Powell has been the Principal Investigator of six major randomized behavioural clinical trials and a founding faculty member and former Co-Director of the NIH-OBSSR Summer Institute on Behavioral Clinical trials, now in its seventeenth year. Dr. Powell was a Principal Investigator of the NIH-funded ORBIT network which included 7 sites all of whom were in the process of developing behavioural interventions for obesity and created the ORBIT model for behavioural treatment development from the experiences of the ORBIT.
The Montréal Behavioural Medicine Centre (MBMC) is welcoming applications for a postdoctoral position in motivational communication. This fellowship will be directly attached to a national CIHR-funded study designed to develop and test motivational communication training programs targeting physicians, nurses and allied healthcare providers in the area of chronic disease management. There will also be opportunities to work with other pertinent projects within the MBMC. The position is full time for one year and is renewable. Deadline for applications is February 2, 2018.
As part of their next “1 & 1” workshop series, Methodology Center Director and IBTN Executive Member Linda Collins will present an introduction to the multiphase optimization strategy (MOST) for optimizing interventions on Tuesday, November 14, from 3:00 to 5:00 p.m. EST. The workshop will consist of a one-hour live video presentation on a method followed by a one-hour live question-and-answer session via instant messaging. Workshop is limited to 50 participants admitted first-come first-served as they log in. A video will be published online later for those unable to attend.
MOST is an engineering-inspired framework for optimizing and evaluating behavioural, biobehavioural, and biomedical interventions. It emphasizes efficiency and careful management of resources to move intervention science forward systematically. MOST can be used to guide the evaluation of research evidence, develop optimized interventions, and enhance Type I and Type II translation of research.
IBTN members are invited to participate in a Research Prioritisation project, which seeks the views of IBTN members about the most important topics for methodological research within behavioural intervention research.
Ten of the IBTN’s founding and executive members have generated a comprehensive list of possible topics important for behavioural trials methodology research.
What happens next?
As an IBTN newsletter subscriber, you will soon receive an email request to take part in two short online surveys, one month apart. You will be asked to rate how important you think each topic is and asked to rank your “Top 5” research topics.
What will happen with the results?
Prof. Byrne will present the results of the project at the 2018 IBTN Conference. Results will then be used to inform planning of the IBTN research agenda.
Published in Journal of Medical Internet Research, this viewpoint article co-authored by IBTN Founding Member Dr. S. Michie shares recommendations coming out of a two-day international workshop on how to create, evaluate, and implement effective digital interventions in relation to health behaviours. It makes distinctions between sustained, effective and sufficient patient engagement, and recognizes the potential of digital interventions for testing and advancing theories of behaviour change by generating ecologically valid, real-time objective data.
The Theoretical Domains Framework (TDF) aims to provide a comprehensive, theory-informed approach to identify determinants of behaviour. First published in 2005, a subsequent version following a validation exercise was published in 2012 and offers practical guidance for those who wish to apply the TDF to assess implementation problems and support intervention design. IBTN Founding Member Dr. S. Michie is co-author of this article published in Implementation Science.