Changing habits in anorexia nervosa – a randomized controlled trial (CHAiN)

改变神经性厌食症的习惯 – 一项随机对照试验 (CHAiN)

• 批准号: 441688036
• 负责人: Professor Dr. Timo Brockmeyer
• 金额: --
• 依托单位: Department of Psychiatry
• 依托单位国家: 德国
• 项目类别: Research Grants
• 资助国家: 德国
• 项目状态: 未结题
• 来源: https://gepris.dfg.de/gepris/projekt/441688036?language=en
• 关键词: Changing; habits; anorexia; nervosa; randomized

Anorexia Nervosa (AN) is a serious mental disorder that is mainly characterized by severe restriction of food intake, resulting in underweight. AN affects up to 4% of women during their lifetime, a chronic course with severe somatic sequelae is common, and the mortality rate is the highest of any mental disorder. Irrespective of the treatment approach, recovery rates are low to moderate, whereas attrition and relapse rates are high. One reason for the unsatisfactory effectiveness of available treatments is that still relatively little is known about the etiology and maintenance of the disorder. However, recently, a neurobiologically informed, mechanistic model of AN has been developed which suggests that much of the problematic behaviors in AN (e.g. dietary restraint, counting calories, body checking, excessive exercising) are habitual, meaning that these have shifted from goal-directed to rigid, cue-elicited, automatic behaviors that have been uncoupled from positive or negative consequences. In line with his, neuroimaging research has shown that patients with AN show increased brain activity in the dorsal striatum (a brain region that mediates habitual behavior) during food-related decision-making. Joanna Steinglass, a collaborator on the proposed research project, has recently translated these findings into a novel psychological intervention that specifically targets eating-related habits in AN (REaCH). In a small randomized controlled proof-of-concept study (n=22), this intervention outperformed an active control group (supportive psychotherapy) in terms of reductions in eating-related habit strength (d=1.28) and self-reported eating disorder psychopathology (d=0.81), and increased caloric intake in a laboratory meal (d=1.16). Based on these promising preliminary findings, the central research question of the proposed research project is whether this specific intervention definitely changes the proposed mechanisms and leads to improved clinical results. The planned study is a mono-center randomized controlled superiority trial in n=110 patients with AN, comparing two parallel treatment arms as adjunct to inpatient treatment as usual. The primary outcome will be change in body mass index (BMI), measured at baseline, during each week of the intervention (4 weeks), at the end of treatment and at 6 months follow-up. Secondary outcomes comprise further clinical parameters (self-reported eating disorder psychopathology), surrogate measures (food choices and caloric intake in a laboratory meal), and changes in the mechanism(s) that are targeted by the intervention (eating-related habit strength). The proposed study will provide important results with both direct clinical implications and relevance for an improved understanding of the etiology and maintenance of AN.

神经性厌食症（AN）是一种严重的精神障碍，其主要特征是严重限制食物摄入，导致体重不足。AN影响高达4%的妇女在其一生中，慢性过程与严重的躯体后遗症是常见的，死亡率是最高的任何精神疾病。无论治疗方法如何，恢复率都是低到中等，而损耗和复发率很高。现有治疗效果不令人满意的一个原因是对该疾病的病因和维持知之甚少。然而，最近，已经开发出一种神经生物学信息的AN机制模型，该模型表明AN中的许多问题行为（例如饮食限制，计算卡路里，身体检查，过度锻炼）是习惯性的，这意味着这些行为已经从目标导向转变为刚性的，线索引发的，自动的行为，这些行为已经与积极或消极的后果脱钩。与他的观点一致，神经影像学研究表明，AN患者在与食物相关的决策过程中，背侧纹状体（一个调节习惯行为的大脑区域）的大脑活动增加。Joanna Steinglass是该研究项目的合作者，她最近将这些发现转化为一种新的心理干预措施，专门针对AN（REaCH）中与饮食相关的习惯。在一项小型随机对照概念验证研究（n=22）中，该干预在减少饮食相关习惯强度（d=1.28）和自我报告的饮食障碍精神病理学（d=0.81）方面优于积极对照组（支持性心理治疗），并增加了实验室餐的热量摄入（d=1.16）。基于这些有希望的初步发现，拟议研究项目的中心研究问题是，这种特定的干预是否确实改变了拟议的机制，并导致改善的临床结果。计划的研究是一项单中心随机对照优效性试验，在n=110例AN患者中比较两个平行治疗组作为常规住院治疗的辅助治疗。主要结局将是在基线、干预每周（4周）、治疗结束时和6个月随访时测量的体重指数（BMI）变化。次要结局包括进一步的临床参数（自我报告的进食障碍精神病理学）、替代指标（实验室膳食中的食物选择和热量摄入）以及干预目标机制的变化（进食相关习惯强度）。这项研究将提供重要的结果，直接的临床意义和相关性，为更好地了解AN的病因和维护。