Targeting Relationship Domains in Community- Based Treatment of Binge-Eating Disorder and Bulimia Nervosa

项目摘要/摘要 暴饮暴食障碍(BED)和神经性暴食症(BN)的心理社会治疗 在专科环境中证明了疗效，然而，大多数Bed/BN的治疗都发生在门诊患者 资源更有限的设置。为回应RFA-MH-16-410，我们建议测试 以夫妻为基础的Bed/BN干预措施的初步效果 饮食失调的治疗[联合])相对于已建立的循证个体 社区诊所环境中的治疗(认知-行为疗法增强；CBT-E)。一 增强有效性的策略是激活患者环境中的资源(例如， 将伴侣包括在治疗中)。除非合作伙伴了解BED/BN以及如何 帮助，关系可能是一种压力源。事实上，人际关系的压力源很常见 暴食/清除触发因素和不利的人际环境促成了疾病的维持。 患有BED/BN的人报告了高水平的关系困扰、负面互动和 沟通能力差。让伴侣参与治疗可以将关系从 将应激源转化为积极变化的推动者。我们建议增强BED/BN的有效性 通过将伴侣纳入治疗，直接解决人际因素的治疗。 我们将在一项小型随机对照试验(RCT)中测试联合治疗的初步效果。 社区诊所的28名成年患者和他们的伴侣(24对完整的夫妇)。我们 假设结果将产生支持联合比较结果增强的证据 CBT-E对暴饮暴食禁欲(和BN中的净化禁欲)的主要结果的影响 精神病理学和一般功能的其他测量，以及显著更大的治疗 满足感。此外，我们建议，将通过以下方式实现和维持治疗成果 参与进食障碍相关的关系目标，包括改善(T1) 围绕床/BN进行沟通，(T2)特定于以下方面的问题解决/行为改变技能 Bed/BN和(T3)伴侣辅助情绪调节。评估将包括观察性的 夫妻临床互动中的语音韵律测量和自我报告反映 在诊所外发挥作用。数据监测组将监督招聘工作， 评估和人类主体保护。如果我们表现出初步的有效性和 在社区诊所环境中的目标参与，我们将计划一个更大的RCT，以隔离我们的 关系目标以及在执行科学方面的进展(如果有效)。我们的终极目标是 扩大社区临床治疗床位和BN的医疗机构，增加 为患有这些疾病的个人提供治疗选择。

Project Summary/Abstract Psychosocial treatments for binge-eating disorder (BED) and bulimia nervosa (BN) have demonstrated efficacy in specialty settings, yet, most treatment for BED/BN occurs in outpatient settings with more limited resources. In response to RFA-MH-16-410, we propose to test the preliminary effectiveness of a couple-based intervention for BED/BN (UNiting couples In the Treatment of Eating disorders [UNITE]) relative to an established evidence-based individual treatment (cognitive-behavioral therapy-enhanced; CBT-E) in a community clinic setting. One strategy to bolster effectiveness is to activate resources in the patient’s environment (e.g., include partners in treatment). Unless partners understand BED/BN and how to be of assistance, relationships can be a stressor. Indeed, relationship stressors are common binge/purge triggers and adverse interpersonal environments contribute to illness maintenance. Individuals with BED/BN report high levels of relationship distress, negative interactions, and poor communication skills. Including a partner in treatment can transform the relationship from a stressor into an agent of positive change. We propose to augment effectiveness of BED/BN treatment by addressing interpersonal factors directly by including partners in treatment. We will test the preliminary effectiveness of UNITE in a small randomized controlled trial (RCT) of 28 adult patients and their partners (24 completing couples) in a community clinic. We hypothesize that results will yield evidence supporting enhanced outcomes in UNITE compared with CBT-E on the primary outcome of binge abstinence (and purge abstinence in BN) and other measures of psychopathology and general functioning, and significantly greater treatment satisfaction. Moreover, we propose that treatment gains will be achieved and maintained by engaging eating disorder-related relationship targets, including improved (T1) communication around BED/BN, (T2) problem-solving/behavioral change skills specific to BED/BN, and (T3) partner-assisted emotion regulation. Assessment will include observational and speech prosody measures during couples’ clinic interactions and self-reports reflecting functioning outside of the clinic. The Data Monitoring Group will oversee recruitment, assessments, and human subject protections. If we demonstrate preliminary effectiveness and target engagement in a community clinic setting, we will plan a larger RCT isolating our relationship targets and, if effective, progress towards implementation science. Our ultimate is to expand the community clinician’s armamentarium for treating BED and BN and increase the available treatment options for individuals with these illnesses.