Optimizing Relapse Prevention and Changing Habits (REACH+) in Anorexia Nervosa

优化神经性厌食症复发预防和改变习惯 (REACH)

• 批准号: 10288420
• 负责人: EVELYN ATTIA
• 金额: $ 28.73万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-08 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10288420
• 关键词: Acute; Address; Adherence; Adult; Anorexia Nervosa; Behavior; Behavior Therapy; Behavioral; Caring; Characteristics; Clinical Trials Design; Cognitive; Communities; Data; Development; Eating; Eating Behavior; Eating Disorders; Elements; Ensure; Equilibrium; Feeling; Focus Groups; Future; Goals; Habits; Hospitals; Individual; Interruption; Intervention; Lead; Link; Manuals; Mediator of activation protein; Mental disorders; Monitor; Morbidity - disease rate; Motivation; Neurocognitive; Outcome; Participant; Patients; Phase; Preparation; Randomized; Randomized Controlled Trials; Relapse; Research; Specialist; Testing; Thinking; Time; Training; Treatment Efficacy; Treatment outcome; Weight; acceptability and feasibility; adaptive intervention; base; design; dietary restriction; disorder later incidence prevention; dissemination trial; effective intervention; experimental study; food restriction; food surveillance; improved; improved outcome; mortality; multiphase optimization strategy; neuroimaging; primary outcome; programs; psychoeducation; rate of change; restrictive eating; severe mental illness; skills; success; telehealth; theories; therapy development; treatment adherence; treatment effect; treatment optimization; weight maintenance; weight restoration

Anorexia nervosa (AN) is a serious mental illness with significant morbidity and mortality rates, and relapse rates ranging from 40-80% after acute treatment. A central behavioral disturbance in AN is the restriction of food intake, which is promoted by entrenched thoughts, feelings, and routines. While many approaches to reducing relapse after hospital care have been tried, there is little information about which treatment elements confer benefit. Relapse Prevention and Changing Habits (REACH+) targets the habitual control of maladaptive behavior to support patients with AN in the 6 months after acute treatment, a time of high vulnerability to relapse. REACH+ builds on preliminary data that indicate that behavioral interventions that target habits in AN can lead to changes in entrenched behaviors in the acute treatment setting. This approach has not yet been developed for the relapse prevention setting. We will test whether treatment components can interrupt the habitual control of maladaptive behavior and, by targeting this illness mechanism, decrease relapse and improve outcomes. We will use a Multiphase Optimization STrategy (MOST) framework an ideal means for improving treatment efficacy by simultaneously and efficiently evaluating multiple possible intervention components, to determine which contribute to positive treatment outcomes and should therefore be included in a robust treatment package for relapse prevention. Each component of REACH+ addresses a question that is critical to answer in order to identify and optimize a relapse prevention treatment package that balances efficacy and burden. We will test competing versions of 5 components that together target habits: 1) Behavioral, 2) Cognitive, 3) Motivation, 4) Food Monitoring, and 5) Skill Consolidation. First, we will conduct the final stages of the Preparation Phase (including Focus Groups) to maximize feasibility and acceptability of the intervention components. Second, an Optimization Phase experiment with a finalized treatment manual (including an online platform) will test each component's contribution to weight maintenance after acute treatment. We will provide 6 months of REACH+ for 60 individuals with AN, weight-restored via our Eating Disorders Program. Sessions, conducted via telehealth, will be augmented with psychoeducation, homework assignments, and monitoring through an online platform. Participants will be randomly assigned to different versions of each treatment component. Optimization criteria focus on the contribution of the component to weight maintenance (main effect), and will additionally consider effect sizes, treatment adherence, and end-of- treatment status. This will ensure that the finalized treatment package includes the most effective and feasible components for definitive testing in a future randomized controlled trial. This systematic approach to treatment development is critical for achieving the best outcomes most quickly and efficiently.

神经性厌食症（Anorexia nervosa，AN）是一种严重的精神疾病，发病率高，死亡率高，且易复发 急性治疗后的死亡率为40-80%。AN中的一个中心行为障碍是对 食物摄入，这是由根深蒂固的思想，感情和惯例促进的。虽然许多方法， 减少复发后，医院护理已经尝试，有关于哪些治疗元素的信息很少 给予好处。复发预防和改变习惯（REACH+）的目标是习惯性控制适应不良 行为，以支持患者与AN在6个月后，急性治疗，时间的高度脆弱性， 复发REACH+的基础是初步数据，这些数据表明针对AN习惯的行为干预措施 可以导致急性治疗环境中根深蒂固的行为发生变化。这种方法尚未被 为预防复发而开发。我们将测试治疗成分是否可以中断 习惯性控制适应不良行为，并通过针对这种疾病机制，减少复发， 改善成果。我们将使用多阶段优化策略（MOST）框架，这是一种理想的方法， 通过同时有效地评估多种可能的干预措施提高治疗效果 组成部分，以确定哪些有助于积极的治疗结果，因此应包括在 一个强大的治疗包，用于预防复发。REACH+的每个组成部分都解决了一个问题， 关键是要回答，以确定和优化复发预防治疗包， 功效和负担。我们将测试5个组件的竞争版本，这些组件共同针对习惯： 行为，2）认知，3）动机，4）食物监测，5）技能巩固。首先，我们将进行 准备阶段的最后阶段（包括焦点小组），以最大限度地提高 干预的组成部分。第二，最优化阶段实验，治疗手册定稿 （包括一个在线平台）将测试每种成分对急性后体重维持的贡献。 治疗我们将为60名AN患者提供6个月的REACH+，通过我们的饮食恢复体重 疾病计划。通过远程保健进行的会议将增加心理教育，家庭作业 任务，并通过在线平台进行监测。参与者将被随机分配到不同的 每个治疗组件的版本。优化标准侧重于组件对 体重维持（主效应），并将额外考虑效应量、治疗依从性和治疗结束时 治疗状态这将确保最后确定的一揽子治疗方案包括最有效和最可行的 在未来的随机对照试验中进行确定性测试。这种系统的治疗方法 发展对于最迅速和最有效地取得最佳成果至关重要。