UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa

描述（由申请人提供）：本R01是为了响应RFA-MH-07-090治疗青春期晚期和成年期神经性厌食症的创新试验而提交的。我们特别关注成人神经性厌食症（AN），我们建议将AN治疗团队的专业知识与世界领先的夫妻干预措施的发展结合起来，为一方患有AN的夫妇开发一种创新的干预措施。干预“UCAN：联合夫妻（治疗）神经性厌食症”承认AN发生在人际环境中，既受到个人社会环境的影响，也影响重要的人际关系。此外，家庭治疗对年轻AN患者的成功证明了在AN治疗中利用家庭支持的重要性。UCAN量身定制了基于夫妻的认知行为干预措施，这些干预措施已成功用于治疗抑郁症、焦虑症、戒烟和癌症，以解决AN的核心精神病理学问题，同时也解决了AN对亲密关系造成的独特和具有挑战性的压力。我们对干预的初步概念首先侧重于在关系的背景下解决AN，重点是改变围绕饮食和体重的相互作用，使活动和健康行为正常化，身体形象，身体情感和性行为，其次是解决更广泛的关系，以保持治疗效果，防止复发，并促进关系满意度。具体目标是：1)为一方患有AN的夫妇开发和规范一种手动干预；2)在公开试验中确定UCAN的beta版本作为常规治疗（TAU）的补充的可行性和可接受性，并根据初步试验的反馈完善UCAN；3)在24对夫妻中一方患有AN的随机对照试验中检验UCAN+TAU与TAU；4)调整观察性夫妻评估措施，最终目标是纳入隶属关系和压力的生物学测量。我们的主要患者结果将是BMI和整体改善，我们的次要患者结果将是抑郁、焦虑、关系调整和沟通。合作伙伴成果还将包括照料措施。该试验将明确设计为收集初步结果数据，为后续更大的随机对照试验的样本量和功效计算提供信息。这项调查的结果有可能导致创造一种有效的、可接受的、适合发展的干预措施，这将改善核心an病理和夫妻功能。干预的未来扩展将包括以夫妻为基础的饮食失调干预，如神经性贪食症和暴饮暴食症。我们建议为患有神经性厌食症的成年人开发一种以夫妻为基础的干预措施，名为“UCAN：联合夫妻（治疗）神经性厌食症”。我们将创造一种有效的、可接受的、适合发展的干预措施，利用伴侣的支持来改善核心神经性厌食症病理和夫妻功能。

DESCRIPTION (provided by applicant): This R01 is submitted in response to RFA-MH-07-090 Innovative Trials for the Treatment of Anorexia Nervosa in Late Adolescence and Adulthood. With a specific focus on adult anorexia nervosa (AN), we propose to unite the expertise of a team skilled in the treatment of AN with world leaders in the development of couple-based interventions to develop an innovative intervention for couples in which one member is suffering from AN. The intervention "UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa" acknowledges that AN occurs in an interpersonal context, both being affected by the person's social environment and impacting important interpersonal relationships. Moreover, the demonstrated success of family therapy for younger individuals with AN underscores the importance of leveraging family support in the treatment of AN. UCAN tailors cognitive-behavioral couple-based interventions that have been employed successfully for the treatment of depression, anxiety disorders, smoking cessation, and cancer to address the core psychopathology of AN, while also addressing the unique and challenging stresses that AN places on intimate relationships. Our initial conceptualization of the intervention focuses first on addressing AN within the context of the relationship with foci such as altering interactions around eating and weight, normalizing activity and health behaviors, body image, physical affection, and sexuality and second on addressing the broader relationship to maintain treatment gains, prevent relapse, and foster relationship satisfaction. The specific aims are: 1) to develop and standardize a manualized intervention for couples in which one member suffers from AN; 2) to determine feasibility and acceptability of a beta- version of UCAN in an open trial as an augmentation to treatment as usual (TAU) and to refine UCAN based on feedback from the preliminary trial; 3) to test UCAN+TAU versus TAU in a randomized controlled trial of 24 couples in which one member has AN; and 4) to adapt an observational couples assessment measure with the eventual goal of incorporating biological measures of affiliation and stress. Our primary patient outcomes will be BMI and global improvement, and our secondary patient outcomes will be depression, anxiety, and relationship adjustment and communication. Partner outcomes will also include caregiving measures. This trial will be designed explicitly to gather preliminary outcome data to inform sample size and power calculations for a subsequent larger randomized controlled trial. Findings from this investigation have the potential to result in the creation of an effective, acceptable, developmentally tailored intervention that will improve both core AN pathology as well as couple functioning. Future extensions of the intervention will include couple-based interventions for eating disorders such as bulimia nervosa and binge eating disorder. We propose to develop a couple-based intervention for adults with anorexia nervosa entitled "UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa." We will create an effective, acceptable, developmentally tailored intervention that leverages the support of partners to improve both core anorexia nervosa pathology as well as couple functioning.