Feasibility of Combining Family and Cognitive Therapy to Prevent Chronic Anorexia

描述（由申请人提供）：神经性厌食症（AN）通常开始于青春期，是一种严重的精神疾病，具有高发病率、高死亡率和高经济成本。虽然以家庭为基础的治疗（FBT）可使约50%的短期AN青少年完全和稳定康复，但对于那些没有反应的青少年，没有基于证据的干预措施，因此，他们有大约33%的风险成为慢性病。因此，在有合理的成功机会的情况下，必须进行干预，以改变有可能成为慢性病的年轻患者的轨迹。本申请是对PA-12-279 （R34）的回应，提出了研究认知修复疗法（CRT）与FBT结合的可行性，以便将来在充分动力的随机对照试验中使用，以降低青少年发生持续性an的风险。两项研究表明，越严重的强迫特征导致FBT的结果越差。我们建议CRT通过促进更灵活和更少的持久性思维来解决强迫性思维的认知基础。这些改变反过来又能提高接受改变行为和思想的能力，以维持an。两个小病例系列报告了AN成人的显著改善。此外，AN青少年的病例系列数据发现CRT是可以接受的，并且可以改善认知过程。我们提出以下具体目标：目的1：探讨将CRT纳入FBT的可行性。我们将研究FBT + CRT的可接受性、招募性、评估程序和工具的可行性以及比较治疗（FBT +艺术治疗）的可接受性。目的2：探讨与FBT +艺术治疗相比，接受FBT + CRT的患者在认知方式、体重、饮食相关认知和心理社会功能方面的变化。为了完成目标1，我们将招募30名青少年（12-18岁），他们患有AN，并且在YBC-ED上有OC特征的证据（得分为bb0 - 14）。这些参与者将被随机分为FBT（15次）加艺术练习（15次）6个月或FBT加CRT（15次）6个月。我们的主要结果是：招聘的可行性、留任率和评估程序的可行性。次要结局（目标2）是神经心理功能、体重、饮食相关精神病理和社会心理功能的变化。评估将在四个时间点进行：基线、4周、8周和治疗结束（EOT）。

DESCRIPTION (provided by applicant): Anorexia Nervosa (AN) usually begins during adolescence and is a serious psychiatric disorder associated with high morbidity, mortality, and economic cost. Although Family-Based Treatment (FBT) leads to full and stable recovery in about 50% of adolescents with short duration AN, there are no evidence based interventions for those who do not respond and who, as a result, are at approximately 33% risk for becoming chronically ill. Therefore, it is imperative to intervene to change the trajectory of young patient at risk for becoming chronically ill while there is a reasonable opportunity for success. This application in response to PA-12-279 (R34) proposes to study the feasibility of combining Cognitive Remediation Therapy (CRT) with FBT for future use in an adequately powered RCT to reduce the risk of adolescents developing persistent AN. Two studies suggest that higher levels of obsessional features lead to poorer outcome in FBT. It is proposed that CRT addresses the cognitive underpinnings of obsessional thought by promoting more flexible and less perseverative thinking. These changes could in turn lead to an improved ability to accept the need for change in the behaviors and thoughts that maintain AN. Two small case series report significant improvement in adults with AN. In addition, case series data in adolescents with AN find CRT is acceptable and improves cognitive processes. We propose the following Specific Aims: Aim 1: To examine the feasibility of incorporating CRT in FBT. We will examine acceptability, recruitment, feasibility of assessment procedures and instruments of FBT plus CRT and the acceptability of the comparison treatment (FBT plus art therapy). Aim 2: To explore changes in cognitive style, weight, eating related cognitions, and psychosocial functioning in those who received FBT plus CRT compared to FBT plus art therapy. To accomplish Aim 1, we will recruit 30 adolescents (ages 12-18) with AN and evidence of OC features on the YBC-ED (score >14). These participants will be randomized to either FBT (15 sessions) plus art exercises (15 sessions) for 6 months or FBT plus CRT (15 sessions) for 6 months. Our primary outcomes are: feasibility of recruitment, retention rates, and viability of assessment procedures. Secondary outcomes (Aim 2) are changes in neuropsychological functioning, weight, eating related psychopathology and psychosocial functioning. Assessments will occur at four time points: baseline, 4 weeks, 8 weeks, and end of treatment (EOT).