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

项目摘要/摘要 神经性厌食症(AN)是一种以体重低、极端限制饮食、 对体重增加的强烈恐惧，以及对身体自我评估的干扰。AN具有明显的持久性，并且有 没有经验支持对患有这种致命疾病的成年人进行治疗。事实上，超过一半的人患有 AN在治疗期间没有达到完全缓解，大约三分之一的人经历了 出院后至少复发一次。迫切需要确定促进缓解的目标以适应 并为这一人群创建优化的干预措施。部分缓解期(即，重量- 继续认可显著认知-情感病理的恢复者)代表关键 是时候确定缓解的机制了。具体地说，未处理的认知-情感和 这一阶段的症状(例如，对体重增加的极度恐惧)是实现持久饱满的最大障碍 缓解，因此，这些症状的持续和减轻的潜在机制对 在这个阶段学习。AN与焦虑症高度并存，并有几个共同的维持因素， 包括高度的恐惧、焦虑和避免伤害。尽管焦虑与焦虑有相当大的重叠 障碍、恐惧和回避还没有被测试为抑制体重减轻的机制- 恢复了一个。这项拟议的研究将测试基于恐惧的学习(例如，恐惧消退、恐惧新生、恐惧 方法，恐惧回避)与自然环境中的病理有关，在45个个体的样本中 符合部分缓解的标准。这项研究将使用行为评估(即，方法- 回避任务、行为方法任务、联想恐惧-学习范式)和瞬时评估 (即，基于智能手机的密集纵向数据收集)恐惧、回避和接近行为 把这些利益机制如何在“真实世界”中运作概念化。首先，我们要测试一下 行为方法、回避、恐惧消退和恐惧更新与实时方法相关， 回避、恐惧和AN症状(目标1)。其次，使用密集时间序列的向量自回归模型。 系列数据将阐明基于恐惧的过程和症状之间的未来联系 受试者(目标2)和个人内部(目标3)确定小组一级和个人内部的护理目标 这是经济复苏的关键阶段。在受试者之间的模型中，我们将测试行为恐惧消退和 续聘主持人(目标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AN参与者一起工作的经验。总体而言，这项建议 研究将实施先进的统计和多方法研究设计，完全远程进行， 在一个重要的阶段。这些结果将为精确的复发预防干预措施和 阶梯式护理，改善这种损害、持续和代价高昂的疾病的结果。

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.