Adaptation of a CBT Intervention for Eating Disorders

描述（由申请人提供）：进食障碍是使人衰弱的精神疾病，会产生许多医疗并发症。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。最有前途的方法，认知行为疗法（CBT），已被发现比替代治疗更有效的一些研究。然而，所有这些研究均采用疗效设计进行。这些研究结果的适用性，一般应用的临床环境，特别是强化门诊（IOP）计划，是未知的。拟议研究的目的是使CBT的一个关键组成部分，即饮食正常化（NOE）适应IOP计划，并使用有效性设计评估其影响。在为期4个月的适应阶段，研究团队将与IOP主任和治疗师合作，调整CBT手册中神经性厌食症和贪食症的关键组成部分，以用于IOP，并培训IOP治疗师应用。该项目的具体目标是：1）调整CBT治疗手册中的NOE程序，用于在IOP计划中接受治疗的AN和BN谱患者; 2）收集关于治疗师对NOE适应过程的评估以及他们对在常规治疗（TAU）和常规治疗+期间IOP治疗进食和体重问题的方法的有效性的看法的描述性数据。研究的NOE阶段;和3）通过在两个IOP部位将TAU与TAU进行比较，对TAU + NOE程序进行初步测试。该研究将分三个阶段进行：八个月的TAU，四个月的适应阶段和八个月的TAU + NOE。将通过评估患者基线、治疗后和6个月随访时的体重、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，评价TAU和TAU + NOE阶段的结局。

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.