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

项目总结/摘要 暴食症（BED）和神经性贪食症（BN）的心理社会治疗 在专科环境中证明了疗效，但大多数BED/BN治疗发生在门诊 资源更加有限的环境。根据RFA-MH-16-410，我们建议测试 以夫妇为基础的BED/BN干预措施的初步效果（ 饮食失调的治疗[UNITE]）相对于已确立的循证个体 治疗（认知行为治疗增强; CBT-E）在社区诊所设置。一 支持有效性的策略是激活患者环境中的资源（例如， 包括治疗伙伴）。除非合作伙伴了解BED/BN以及如何 援助，关系可以是一个压力源。事实上，关系压力源是常见的， 暴饮暴食/清除触发和不利的人际环境有助于疾病的维持。 患有BED/BN的人报告了高水平的关系困扰，消极的互动， 沟通能力差。在治疗中包括一个伴侣可以将这种关系从一种 压力源转化为积极变化的推动者。我们建议提高BED/BN的有效性 通过直接解决人际因素，包括治疗伙伴的治疗。 我们将在小型随机对照试验（RCT）中测试UNITE的初步有效性 28名成年患者和他们的伴侣（24对夫妇）在社区诊所。我们 假设结果将产生证据，支持UNITE与 CBT-E对狂欢式禁欲（和BN中的净化式禁欲）的主要结局， 精神病理学和一般功能的其他措施，以及显著增加的治疗 满意此外，我们建议通过以下方式实现并维持治疗收益： 参与饮食失调相关的关系目标，包括改善（T1） 围绕BED/BN的沟通，（T2）解决问题/行为改变技能，具体到 BED/BN和（T3）伴侣辅助情绪调节。评估将包括观察 和言语韵律测量在夫妇的诊所互动和自我报告反映 在诊所外工作。数据监测小组将监督招聘工作， 评估和人类受试者保护。如果我们展示出初步的有效性， 目标参与社区诊所设置，我们将计划一个更大的随机对照试验， 关系目标，如果有效的话，在实现科学执行方面取得进展。我们的终极目标是 扩大社区临床医生治疗床和BN的设备， 为患有这些疾病的人提供治疗选择。

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.