Behavioral and Momentary Assessment of Fear-based Mechanisms underlying Remission in Weight-restored Anorexia Nervosa

体重恢复神经性厌食症缓解过程中基于恐惧的机制的行为和瞬时评估

• 批准号: 10386020
• 负责人: Caroline Christian
• 金额: $ 3.72万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10386020
• 关键词: Address; Adult; Affective; Anorexia Nervosa; Anxiety; Anxiety Disorders; Award; Behavior; Behavior assessment; Behavioral; Behavioral Paradigm; Caring; Cellular Phone; Cessation of life; Clinical; Cognitive; Cognitive Therapy; Computers; Consultations; Dangerousness; Data; Data Collection; Development; Disease; Disease remission; Eating Disorders; Empirical Research; Environment; Exposure to; Extinction (Psychology); Food; Fright; Future; Goals; Gold; Impairment; Individual; Intake; Intervention; Investigation; Lead; Learning; Literature; Maintenance; Mental disorders; Modeling; Nutritional; Partial Remission; Participant; Pathology; Persons; Play; Population; Population Intervention; Prevalence; Procedures; Process; Recovery; Relapse; Research; Research Design; Resources; Role; Sampling; Self-Examination; Series; Stimulus; Symptoms; Testing; Time; Training; Treatment outcome; United States; Weight; Weight Gain; approach avoidance behavior; approach behavior; avoidance behavior; base; behavior test; career; cognitive enhancement; comorbidity; conditioned fear; cost; critical period; disorder later incidence prevention; experience; food restriction; healthy weight; improved outcome; interest; meetings; mortality; personalized approach; personalized intervention; prevent; preventive intervention; prospective; reduce symptoms; relapse risk; response; standard care; statistics; theories; treatment optimization; trend; vector; weight restoration

Project Summary/Abstract Anorexia nervosa (AN) is a psychiatric illness characterized by low weight, extreme food restriction, intense fear of weight gain, and disturbance in body self-evaluation. AN is markedly persistent, and there are no empirically supported treatments for adults with this deadly illness. Indeed, over half of individuals with AN do not reach full remission during treatment, and approximately one third of individuals experience at least one relapse after discharge. There is great need for identifying remission-promoting targets to adapt and create optimized interventions for this population. The period of partial remission in AN (i.e., weight- restored individuals who continue to endorse significant cognitive-affective AN pathology) represents a critical time for identifying mechanisms underlying remission. Specifically, unaddressed cognitive-affective AN symptoms (e.g., extreme fear of weight gain) at this stage represent the greatest barrier to achieving lasting full remission, and thus, mechanisms underlying the persistence vs. reduction of these symptoms are critical to study at this stage. AN is highly comorbid with anxiety disorders and shares several maintenance factors, including high levels of fear, anxiety, and harm avoidance. Despite considerable overlap with anxiety disorders, fear and avoidance have not been tested as mechanisms inhibiting remission in weight- restored AN. The proposed study will test how fear-based learning (e.g., fear extinction, fear renewal, fear approach, fear avoidance) relates to AN pathology in the naturalistic environment in a sample of 45 individuals meeting criteria for AN in partial remission. This study will use both behavioral assessment (i.e., Approach- Avoidance Task, Behavioral Approach Task, associative fear-learning paradigm) and momentary assessment (i.e., smartphone-based intensive longitudinal data collection) of fear, avoidance, and approach behaviors to conceptualize how these mechanisms of interest operate in the ‘real world’. First, we will test whether behavioral approach, avoidance, fear extinction, and fear renewal are correlated with real-time approach, avoidance, fear, and AN symptoms (Aim 1). Second, vector autoregressive models using the intensive time- series data will elucidate prospective associations across fear-based processes and AN symptoms between subjects (Aim 2) and within individuals (Aim 3) to identify group-level and intraindividual targets for care during this critical stage in recovery. In the between-subjects models, we will test behavioral fear extinction and renewal as moderators (Aim 2). The opportunities, resources, and expert consultation afforded by this award would support my training goals to collect and analyze behavioral data, learn new analytic approaches with intensive longitudinal data, and gain experience working with clinical AN participants. Overall, this proposed study will implement advanced statistics and multimethod research design, conducted fully remotely, at an important stage of AN. These results will inform precision relapse prevention interventions and step-down care, improving outcomes for this impairing, persistent, and costly disorder.

项目摘要/摘要 厌食症（AN）是一种精神病，以低体重，极端食物限制为特征， 对体重增加的恐惧和身体自我评估的灾难。一个明显持久，有 对这种致命疾病的成年人没有经验支持的治疗。确实，超过一半的人 一个在治疗期间没有完全缓解，大约三分之一的人经历 出院后至少有一次缓解。非常需要识别促进缓解目标以适应 并为该人群创建优化的干预措施。在An（即重量 - 恢复的个人继续认可重大认知影响的病理学）代表着一个关键 确定缓解基础机制的时间。具体而言，未解决的认知影响 症状（例如，对体重增加的极端恐惧）在此阶段代表了实现持久的最大障碍 缓解，因此，持久性与减少这些符号的基础机制对于 在此阶段学习。 A和焦虑症高度合并，并具有多种维护因素， 包括高水平的恐惧，动画和避免伤害。尽管与动画重叠相当大 疾病，恐惧和回避尚未被测试，因为抑制体重缓解的机制 恢复了。拟议的研究将测试基于恐惧的学习（例如，恐惧延长，恐惧，更新，恐惧 方法，避免避免）与45个人样本中自然主义环境中的病理关系 满足部分缓解的标准。这项研究将使用两种行为评估（即方法 - 避免任务，行为方法任务，联想性恐惧学习范​​式和暂时评估 （即基于智能手机的密集纵向数据收集）恐惧，回避和方法行为 概念化这些感兴趣的机制如何在“现实世界”中运作。首先，我们将测试是否 行为方法，避免，恐惧扩展和更新的恐惧与实时方法相关， 避免，恐惧和符号（目标1）。其次，使用密集的时间 - 系列数据将阐明跨基于恐惧的过程和符号之间的潜在关联 受试者（目标2）和个人内部（目标3），以识别在 恢复的关键阶段。在受试者间模型中，我们将测试行为恐惧扩展和 续订为主持人（AIM 2）。该奖项提供的机会，资源和专家咨询 将支持我的培训目标，以收集和分析行为数据，学习新的分析方法 密集的纵向数据，并获得与临床A参与者合作的经验。总体而言，这提出了 研究将实施高级统计和多途径研究设计，并完全远程进行 在一个重要阶段。这些结果将为精确继电器预防干预措施和 逐步护理，改善这种损害，持久和昂贵的混乱的结果。