Reward Re-Training: A new treatment to address reward imbalance during the COVID-19 pandemic

项目摘要 减少COVID-19传播的公共卫生方法，如社交距离，就地庇护 命令、隔离、远程工作和远程学习对社会产生了突然而广泛的破坏。 网络.观察到的对社交网络的破坏正在导致社会孤立和孤独的增加 从日常生活活动中获得足够回报的机会有限。减少暴露于日- 奖励的日常来源可以导致对常规奖励刺激的低奖励反应，并减少对奖励的反应。 个人从事他们通常认为愉快的活动的动机。当快乐不足时， 从日常生活活动中经历，有些人可能更有可能寻求刺激， 立即有力地激活神经奖励通路。对特定疾病的超奖励反应 刺激可能会发展为个人寻求更大的数量或更频繁地暴露于有限的范围内， 强烈刺激的奖励来源。总的来说，这可能会产生奖励不平衡， 从典型的愉快的日常生活活动中获得很少的回报，而是实现他们的大部分目标。 从行为或物质中获得的奖励，这些行为或物质有很大的潜在不良后果。虽然奖励 不平衡可能是许多心理健康状况的相关维护因素，有一个强壮的身体 的文献表明，饮食失调（艾德）患者的主要特征是暴食 饮食体验奖励不平衡。 在2019冠状病毒病大流行之前，我们的团队开始开发一种新的基于小组的治疗方法， 我们称之为奖励再训练（RRT）。RRT旨在间接改变 通过直接专注于建立一个更有意义的生活来改变饮食习惯。RRT假设， 随着生活变得更有意义，暴饮暴食的减少将会发生，因为个人将不再需要 依赖暴饮暴食作为短暂奖励的主要来源。RRT指出，为了过上满意的生活， 个人需要在两个重叠但可区分的领域中体验足够的奖励： 瞬时奖励（即，此刻快乐的积极体验）和持续的奖励（即，更深 以及从建立个人价值生活中产生的更持久的成就感和意义感）。一个关键 RRT的一个方面是强调建立持久和有意义的社会关系，因为有明确的证据 社会活动和社会联系可以增强瞬时奖励和持续奖励。在 在目前的研究中，我们将修改现有的10节组RRT治疗手册，以专门解决 于COVID-19疫情期间，我们在提升短暂及持续回报方面面临挑战。我们将 进行一项小型试点随机对照试验，将随机选择个人接受10次RRT（n=30）或 支持性治疗（n=30），均通过视频会议软件进行分组治疗，以评估 RRT的可行性、可接受性、目标参与和疗效的初步估计。

PROJECT SUMMARY Public health approaches to reducing the spread of COVID-19 such as social distancing, shelter-in-place orders, quarantine, telework, and remote learning have produced a sudden and widespread disruption to social networks. The observed disruptions to social networks are leading to increases in social isolation and loneliness and limited opportunities to obtain sufficient reward from day-to-day life activities. Reduced exposure to day-to- day sources of reward can lead to a hypo-reward response to conventionally rewarding stimuli and reduce an individual’s motivation to engage in activities that they usually find pleasurable. When insufficient pleasure is experienced from day-to-day life activities, some individuals may be more likely to seek out stimuli that can immediately and powerfully activate neural reward pathways. A hyper-reward response to disorder specific stimuli may develop as individuals seek out larger quantities or more frequent exposure to a limited range of intensely stimulating sources of reward. Collectively, this may produce a reward imbalance such that individuals achieve very little reward from typically enjoyable day-to-day life activities and instead achieve most of their reward from behaviors or substances that have high potential for adverse consequences. While the reward imbalance is likely a relevant maintenance factor for numerous mental health conditions, there is a strong body of literature suggesting that individuals with an eating disorders (ED) characterized predominately by binge eating experience a reward imbalance. Prior to the COVID-19 pandemic, our team began to develop a novel group-based treatment approach for transdiagnostic binge eating that we call Reward Re-Training (RRT). RRT is designed to indirectly change disordered eating behaviors by directly focusing on building a more rewarding life. RRT hypothesizes that reductions in binge eating will occur as life becomes more rewarding because individuals will no longer need to rely on binge eating as a primary source of momentary reward. RRT notes that in order to live a satisfying life, individuals need to experience an adequate amount of reward in two overlapping yet distinguishable domains: momentary reward (i.e., the active experience of pleasure in the moment) and sustained reward (i.e., a deeper and more long-lasting sense of fulfillment and meaning that arises from building a personally valued life). A key aspect of RRT is an emphasize on building lasting and meaningful social relationships given the clear evidence that social activities and social connection can enhance both momentary reward and sustained reward. In the current study, we will revise our existing 10-session group RRT treatment manual to specifically address the challenges in enhancing both momentary and sustained reward during the COVID-19 pandemic. We will conduct a small pilot RCT that will randomize individuals to receive either 10-sessions of RRT (n=30) or supportive therapy (n=30), both delivered as group-treatments via videoconferencing software, to evaluate the feasibility, acceptability, target engagement and preliminary estimates of efficacy for RRT.