Optimizing Technology in the Treatment of Bulimia Nervosa

描述(申请人提供)：神经性暴食症(BN)是一种严重的精神疾病，以严重的医学和精神障碍为特征。虽然认知-行为疗法(CBT)是BN的首选治疗方法，但这种循证方法的传播一直是次优的，大多数需要护理的人从未接受过治疗。此外，多达三分之一的人在CBT后复发，这表明有必要进行维持干预。因此，评估传播CBT的新战略和开发新的干预措施以最大限度地维持治疗效益，对于提高我们治疗BN的能力至关重要。优化技术是推动该领域向前发展并扩大公共卫生覆盖范围的合乎逻辑的下一步。因此，在本申请中，响应PA-07-295：卫生服务和干预交付中的信息技术和互联网(R01)，我们试图确定通过互联网提供的具有适度聊天组支持的CBT是否与面对面小组CBT一样有效。我们建议在一项为期20周的两点急性治疗试验中，将180名患者随机分为标准面对面组(金标准)或通过互联网进行的CBT(CBT.net)。治疗方法将在消耗、依从性、可接受性、暴饮暴食和清洗频率、禁欲和成本效益等指标上进行比较。具体地说，我们假设CBT.net在主要结果衡量标准上不会逊于CBT组，而且它将更具成本效益。所有参与者将在完成急性治疗后的3个月、6个月和12个月进行随访。这项试验将利用Bulik博士为BN开发的基于互联网的程序(R21MH070781“基于网络的认知疗法治疗神经性暴食症”)。该项目的成功完成将提供有关通过互联网向无法获得循证护理的患者提供治疗的关键信息。如果通过互联网提供的CBT与通过标准面对面小组形式提供的CBT同样有效，拟议的结果将有可能产生一种成本效益高的战略，以传播针对BN的循证治疗。这项研究的目的是比较互联网传递的认知行为治疗(CBT)方案与标准团体CBT治疗神经性暴食症。如果有效，通过互联网进行CBT可能是传播BN循证治疗的一种具有成本效益的策略。

DESCRIPTION (provided by applicant): Bulimia nervosa (BN) is a serious mental illness marked by substantial medical and psychiatric morbidity. Although cognitive-behavioral therapy (CBT) is the treatment of choice for BN, dissemination of this evidence-based approach has been suboptimal, with the majority of individuals requiring care never receiving treatment. Moreover, up to one-third of individuals relapse after CBT, indicating the need for maintenance interventions. Thus the evaluation of new strategies for dissemination of CBT and the development of novel interventions to maximize maintenance of treatment benefits are critical to improve our ability to treat BN. Optimizing technology is a logical next step to move the field forward and enhance public health reach. Thus in this application, in response to PA-07-295: Information Technologies and the Internet in Health Services and Intervention Delivery (R01), we seek to determine whether CBT delivered via the internet with moderated chat-group support is as effective as is face-to-face group CBT. We propose to randomize 180 patients to either standard face to face group CBT (the gold standard) or CBT via the internet (CBT.net) in a two-site, 20 week acute treatment trial. Treatments will be compared on measures of attrition, adherence, acceptability, binge and purge frequency, abstinence, and cost effectiveness. Specifically, we hypothesize that CBT.net will not be inferior to group CBT on primary outcome measures and that it will be more cost-effective. All participants will be followed up at three, six, and twelve months following completion of the acute treatment. This trial will utilize an internet based program for BN developed by Dr. Bulik (R21MH070781 "Web-based Cognitive Therapy for Bulimia Nervosa"). Successful completion of this project will provide critical information about the provision of treatment via the internet for patients who do not have access to evidence-based care. If CBT delivered via the internet is similarly efficacious to that delivered in the standard face to face group format, results of the proposed would have the potential to yield a cost- effective strategy to disseminate evidence-based treatments for BN. The purpose of this study is to compare an internet-delivered cognitive-behavioral treatment (CBT) program for bulimia nervosa with standard group CBT. If effective, CBT via the internet could be a cost-effective strategy to disseminate evidence-based treatments for BN.