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

奖励再培训：解决 COVID-19 大流行期间奖励失衡的新疗法

• 批准号: 10218350
• 负责人: ADRIENNE SARAH JUARASCIO
• 金额: $ 23.27万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-18 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10218350
• 关键词: Address; Aftercare; Alcohol or Other Drugs use; Behavior; Binge Eating; Binge eating disorder; Bulimia; COVID-19; COVID-19 pandemic; Computer software; Disease; Disease remission; Eating Behavior; Eating Disorders; Exposure to; Food; Home environment; Individual; Lead; Learning; Life; Literature; Loneliness; Maintenance; Manuals; Mental Depression; Mental Health; Motivation; Palate; Pathway interactions; Public Health; Quality of life; Quarantine; Randomized; Rewards; Shelter facility; Social Distance; Social Functioning; Social Network; Social isolation; Social support; Source; Stimulus; Supportive care; Symptoms; Testing; Time; Training; Value of Life; Videoconferencing; Waiting Lists; adverse outcome; base; design; experience; follow-up; novel; peer; pilot trial; pleasure; randomized trial; reduced food intake; relating to nervous system; response; secondary outcome; social; social anxiety; social relationships; stressor; telework; treatment group

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.

项目概要 减少 COVID-19 传播的公共卫生方法，例如保持社交距离、就地避难 订单、隔离、远程办公和远程学习对社会造成了突然而广泛的破坏 网络。观察到的社交网络中断正在导致社会孤立和孤独感增加 从日常生活活动中获得足够奖励的机会有限。减少日常接触 白天的奖励来源可能会导致对传统奖励刺激的低奖励反应，并减少 个人从事他们通常感到愉快的活动的动机。当快乐不足时 由于在日常生活活动中经历过，一些人可能更有可能寻找能够 立即有效地激活神经奖励通路。对特定疾病的超奖励反应 当个体寻求更大数量或更频繁地接触有限范围的物质时，刺激可能会发展。 强烈刺激的奖励来源。总的来说，这可能会产生奖励失衡，使得个人 从通常令人愉快的日常生活活动中获得的回报很少，而是获得了大部分的回报 来自极有可能产生不良后果的行为或物质的奖励。奖励的同时 不平衡可能是许多心理健康状况的相关维持因素，有一个强壮的身体 大量文献表明患有饮食失调（ED）的人主要以暴食为特征 饮食经历奖励不平衡。 在 COVID-19 大流行之前，我们的团队开始开发一种新型的基于群体的治疗方法 跨诊断暴食，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更有意义的生活来纠正饮食失调行为。 RRT 假设 随着生活变得更加有意义，暴食现象将会减少，因为人们不再需要暴饮暴食 依靠暴饮暴食作为暂时奖励的主要来源。 RRT 指出，为了过上令人满意的生活， 个人需要在两个重叠但又可区分的领域中体验足够的奖励： 瞬时奖励（即当下快乐的积极体验）和持续奖励（即更深层次的奖励） 以及因建立个人有价值的生活而产生的更持久的成就感和意义）。一把钥匙 RRT 的一个方面是在有明确证据的情况下强调建立持久且有意义的社会关系 社交活动和社交联系可以增强瞬时奖励和持续奖励。在 目前的研究中，我们将修订现有的 10 次小组 RRT 治疗手册，以专门解决 在 COVID-19 大流行期间，增强短期和持续奖励面临的挑战。我们将 进行小型试点随机对照试验，随机分配个体接受 10 次 RRT (n=30) 或 支持治疗 (n=30)，均通过视频会议软件作为团体治疗进行，以评估 RRT 的可行性、可接受性、目标参与度和功效的初步估计。