Adaptation of a CBT Intervention for Eating Disorders

描述（由申请人提供）：饮食失调是一种使人衰弱的精神疾病，会产生许多医学并发症。在确定饮食失调，特别是神经性贪食症的经验支持治疗方面取得了进展。最有希望的方法是认知行为疗法（CBT），在许多研究中发现它比其他治疗方法更有效。然而，所有这些研究都是使用功效设计进行的。这些研究结果是否适用于一般的临床环境，特别是强化门诊（IOP）项目，目前尚不清楚。拟议研究的目的是将CBT的一个关键组成部分，称为饮食正常化（NOE），适应于IOP计划，并使用有效性设计评估其影响。在为期4个月的适应阶段，研究小组将与IOP主任和治疗师合作，调整治疗厌食症和神经性贪食症的CBT手册的关键部分，以供lOPs使用，并培训IOP治疗师如何应用这些手册。该项目的具体目标是：1)改编CBT治疗手册中的NOE程序，用于在IOP项目中接受治疗的AN-和bn -谱患者；2)收集描述性数据，分析治疗师在正常治疗（TAU）和TAD + NOE阶段对NOE适应过程的评估，以及他们对lOP治疗饮食和体重问题的有效性的看法；3)在两个IOP站点进行TAU + NOE计划的试点测试，将其与TAU进行比较。该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、饮食失调检查、DSM-IV轴I障碍的结构化临床访谈和几种广泛使用的饮食失调自我报告来评估。

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.