Adaptation of a CBT Intervention for Eating Disorders

描述(由申请人提供)：进食障碍是一种衰弱的精神疾病，会产生许多医疗并发症。在确定经验性支持的饮食障碍治疗方法方面取得了进展，特别是对神经性贪食症。在许多研究中，最有希望的方法，认知行为疗法(CBT)，被发现比替代疗法更有效。然而，所有这些研究都是使用功效设计进行的。这些发现是否适用于一般的临床应用环境，尤其是强化门诊(IOP)项目，目前尚不清楚。这项拟议的研究的目的是使CBT的一个关键组成部分，即饮食正常化(NOE)，适应IOP计划，并使用有效性设计来评估其影响。在为期4个月的适应阶段，研究团队将与眼压总监和治疗师合作，调整CBT手册中关于厌食症和神经性贪食症的关键组件，以用于LOP，并培训IOP治疗师。该项目的具体目标是：1)调整CBT治疗手册中的NOE程序，供接受IOP计划治疗的AN和BN谱患者使用；2)收集治疗师对NOE适应过程的评估的描述性数据，以及他们对LOP方法在照常治疗(TAU)和TAD NOE阶段治疗进食和体重问题的有效性的看法；以及3)通过在两个IOP点将TAU NOE计划与TAU进行比较，对TAU NOE计划进行试点测试。这项研究将分三个阶段进行：8个月的TAU、4个月的适应阶段和8个月的TAU NOE。TAU和TAU NOE阶段的结果将通过评估患者的基线、治疗后和6个月的体重随访、进食障碍检查、DSM-IV轴I障碍的结构化临床访谈和几种广泛使用的进食障碍自我报告指标来评估。

DESCRIPTION (provided by applicant): Eating disorders are debilitating psychiatric conditions that produce numerous medical complications. Progress has been made in identifying empirically supported treatments for eating disorders, especially for bulimia nervosa. The most promising approach, cognitive-behavior therapy (CBT), has been found to be more effective than alternate treatments in a number of studies. However, all of these studies have been conducted using efficacy designs. The applicability of these findings to applied clinical settings generally, and to intensive outpatient (IOP) programs in particular, is unknown. The purpose of the proposed research is to adapt a key component of CBT, called Normalization of Eating (NOE), to IOP programs and to evaluate its impact using an effectiveness design. During a 4-month Adaptation Phase, the research team will work collaboratively with the IOP directors and therapists to adapt key components of CBT manuals for anorexia and bulimia nervosa for use in the lOPs and to train IOP therapists in their application. The specific aims of the project are to: 1) adapt NOE procedures from CBT treatment manuals for use among AN- and BN-spectrum patients treated at an IOP program; 2) collect descriptive data on the therapists' evaluation of the NOE adaptation process as well as their perceptions of the effectiveness of the lOP's approach to treating eating and weight problems during the treatment-as-usual (TAU) and TAD + NOE phases of the study; and 3) conduct a pilot test of the TAU + NOE program by comparing it with TAU at two IOP sites. The study will be conducted in three phases: Eight months of TAU, four months of the Adaptation Phase, and eight months of TAU + NOE. Outcome during the TAU and TAU + NOE phases will be evaluated by assessing patients at baseline, post-treatment, and a 6-month follow-up on body weight, the Eating Disorders Examination, the Structured Clinical Interview for DSM-IV Axis I Disorders and several widely-used selfreport measures of disordered eating.