Developing a Brief Cognitive-Behaviour Therapy for Underweight Eating Disorders

制定针对体重不足饮食失调的简短认知行为疗法

• 批准号: 2752165
• 金额: --
• 依托单位: University of Sheffield
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2752165
• 关键词: Developing; Brief; Cognitive; Behaviour; Therapy

This project will explore the feasibility, acceptability, and preliminary effectiveness of an adapted Cognitive Behavioural Therapy (CBT) intervention for treating underweight eating disorders. It will contribute to knowledge by extending an existing psychological treatment to a novel population, improving patient outcomes and treatment access. This aligns with the Wellbeing, Health, and Communities (WHC) Pathway mental health agenda.IntroductionPsychological treatment options for underweight eating disorders (particularly anorexia nervosa) have limited effectiveness, with low recovery rates and reduced life quality (Solmi et al., 2021). Anorexia nervosa affects 8% of the UK's 1.25m people with eating disorders (BEAT, n.d.). It involves a range of physiological and psychological characteristics, such as low weight (typically BMI<18.5) and disordered thoughts, feelings, and behaviours around food and body image. These make it particularly difficult to treat, with poor outcomes relative to non-underweight eating disorders (around 25% versus 50% recovery rate) (Waller, 2016). Demand for treatment, long treatments (over a year), and poor recovery rates result in long waiting lists, which have worsened since the COVID-19 pandemic (Robinson et al., 2020).Waller et al. (2019) recently developed a brief CBT-based intervention (CBT-T) for non-underweight eating disorders (e.g., bulimia nervosa), taking ten sessions rather than NICE's (NICE, 2020) recommended twenty. Research to date reports medium-to-large effect sizes (Rose et al., 2021; Tatham et al., 2020), showing briefer therapies can be both effective and efficient. This therapy stresses evidence-based elements (e.g., early changes in eating; use of exposure therapy; body image work). These features have the potential to be carried over to briefer work with underweight eating disorders. However, it remains to be established whether a briefer approach to anorexia nervosa can be effective.The principles of CBT-T are compatible with the needs of anorexia nervosa patients. Early weight restoration and exposure to anxiety about weight gain are necessary elements (Steinglass et al., 2011), key to CBT-T. However, they are not part of existing CBT recommendations for anorexia nervosa (Murphy et al., 2010), potentially explaining existing therapies' limited outcomes. Furthermore, these methods tend to be neglected by most practitioners (Waller et al., 2012), typically because typically because exposure can be uncomfortable and anxiety-provoking for both patients and practitioners. Delivering these anxiety-inducting elements of therapy require practitioners to balance empathic delivery with adhering to treatment guidelines (Elliott et al., 2011). CBT-T address this issue directly in individuals with non-underweight eating disorders and is therefore likely to be applicable to treating anorexia nervosa. However, it has not yet been tested with this clinical group.This project will therefore seek to develop and pilot an adapted version of CBT-T for underweight eating disorders (CBT-T-AN), exploring its feasibility, acceptability, and effectiveness. Being half the length of existing CBT for anorexia nervosa, it has the potential to enhance efficiency and reduce waiting lists substantially, thus enhancing quality of life and patients' therapeutic experience. It will meet PhD requirements by adapting an existing psychological intervention to a novel population. Aligned with the WHC Pathway's mental health agenda, this project's overall aim is to contribute to improved patient outcomes whilst addressing economic and socio-political problems of treatment demand outstripping supply.

该项目将探讨适应性认知行为疗法（CBT）干预治疗体重不足饮食失调的可行性，可接受性和初步有效性。它将通过将现有的心理治疗扩展到新的人群，改善患者的治疗效果和治疗途径来促进知识。这与福利，健康和社区（WHC）途径心理健康议程相一致。介绍体重不足饮食失调（特别是神经性厌食症）的心理治疗选择效果有限，恢复率低，生活质量降低（Solmi et al.，2021年）。神经性厌食症影响了英国125万饮食失调患者中的8%。它涉及一系列生理和心理特征，例如体重低（通常BMI<18.5）以及围绕食物和身体形象的混乱思想，感觉和行为。这使得它特别难以治疗，相对于非体重不足的饮食失调症（约25%与50%的恢复率），结果较差（Waller，2016）。对治疗的需求、长时间的治疗（超过一年）和低恢复率导致了漫长的等待名单，自COVID-19大流行以来，这种情况已经恶化（罗宾逊等人，2020). Waller等人（2019）最近开发了一种针对非体重不足饮食失调（例如，神经性贪食症），服用十次而不是NICE（NICE，2020）推荐的二十次。迄今为止的研究报告了中等至大的效应量（Rose等人，2021; Tatham等人，2020年），显示更简短的治疗方法既有效又有效。这种疗法强调循证元素（例如，饮食的早期改变;暴露疗法的使用;身体形象工作）。这些特征有可能被用于治疗体重不足的饮食失调症。然而，它仍然有待建立一个简短的方法，神经性厌食症是否可以有效。CBT-T的原则是兼容的神经性厌食症患者的需要。早期体重恢复和对体重增加的焦虑是必要的因素（Steinglass等人，2011年），CBT-T的关键。然而，它们不是现有的CBT对神经性厌食症的建议的一部分（Murphy等人，2010），这可能解释了现有疗法的有限结果。此外，这些方法往往被大多数从业者忽视（Waller等人，2012），通常是因为暴露对于患者和从业者而言可能是不舒服的和引起焦虑的。提供这些焦虑诱导元素的治疗需要从业者平衡移情传递与坚持治疗指南（Elliott等人，2011年）。CBT-T直接解决了患有非体重不足饮食失调的个体的这个问题，因此可能适用于治疗神经性厌食症。然而，它还没有在这个临床群体中进行测试，因此，本项目将寻求开发和试验一种适应性的CBT-T治疗体重不足饮食障碍（CBT-T-AN），探索其可行性，可接受性和有效性。作为现有神经性厌食症CBT长度的一半，它有可能提高效率并大幅减少等待名单，从而提高生活质量和患者的治疗体验。它将通过将现有的心理干预适应新的人群来满足博士学位的要求。该项目与世界卫生中心途径的精神卫生议程相一致，其总体目标是促进改善患者的治疗效果，同时解决治疗需求超过供应的经济和社会政治问题。