Adaptive Coping Skills Training to Improve Psychological Distress Among Cardiorespiratory Failure Survivors

Inclusion criteria

• Inclusion criteria present in the hospital
• Adult (age ≥18)
• Managed in an ICU or stepdown unit for ≥24 hours during the time inclusion criterion #3 is met
• Serious acute cardiorespiratory condition, defined as ≥1 of the following:
• mechanical ventilation via endotracheal tube for ≥4 hours
• non-invasive ventilation (CPAP, BiPAP) for ≥4 hours in a 24-hour period provided for acute respiratory failure
• new use of supplemental oxygen ≥6 liters per minute (or increase in baseline continuous oxygen)
• use of vasopressors for shock of any etiology
• use of inotropes for shock of any etiology
• use of pulmonary vasodilators
• use of aortic balloon pump or cardiac assist device for cardiogenic shock
• use of diuretic intravenous drip
• evidence of acute coronary ischemia (i.e., elevated troponin level, supporting EKG changes, unstable angina symptoms documented)
• urgent cardiac catheterization
• Cognitive status intact
• No history of pre-existing significant cognitive impairment (e.g., dementia) as per medical chart
• Absence of severe mental illness
• Treatment for severe mental illness (e.g., psychosis, bipolar affective disorder, schizoaffective disorder, schizoid personality disorder, schizophrenia \[as per medical record\], hospitalization for any psychiatric disorder) within the 6 months preceding the current hospital admission
• Evidence of poorly managed severe mental illness
• No endorsement of suicidality at time of admission or informed consent
• Functional fluency in English or Spanish (i.e., sufficient knowledge of English or Spanish to complete study tasks like watch videos, complete surveys)
• Inclusion criteria present after hospital discharge (i.e., at the time of arrival home after discharge from the hospital)
• \. Elevated baseline psychological distress symptoms, defined as a Hospital Anxiety and Distress Scale (HADS) total score ≥8

Exclusion criteria

• Exclusion criteria present in the hospital
• Active alcohol or drug abuse (e.g., admission for alcohol withdrawal, drug-related complication, positive toxicology screening at admission, endorsement of active addiction)
• Anticipated complex medical needs after discharge that would be disruptive to intervention and follow up; for example:
• Anticipated surgical procedures
• Anticipated complex medical regiment (e.g., new chemotherapy, new dialysis, need for repeat surgery, pregnant and near term)
• Plan for comfort care
• Other complex needs anticipated that could interfere with the ability to complete study procedures. Examples include:
• Anticipated disruptive travel
• Inability to use mobile app
• Anticipated unstable living situation
• Anticipated or actual discharge to a location other than independent in a home setting (e.g., nursing home, long-term acute care facility, inpatient rehabilitation facility, home hospice)
• Persistently impaired cognition as a result of illness (Impairment defined as ≥3 errors on the Callahan cognitive status screen and/or the lack of decisional capacity (i.e., patient could be consented by medical team for a procedure if necessary)
• Currently imprisoned or incarcerated or in home detention
• Lack a reliable smartphone with cellular data plan or access to the internet
• Currently enrolled in another study involving an intervention whose objectives conflict with the objectives of this study
• Previously enrolled in the trial
• Exclusion criteria present after hospital discharge (i.e., at T1 Data Collection conducted at the time of arrival home from the hospital)
• Failure to randomize within 14 days from planned start date (planned start date is within 3 days post-discharge from the hospital to home to accommodate weekends)
• Readmission to hospital before randomization completed