Implementation, Outcome and Mechanisms of Family-Based Treatment for Adolescent Anorexia Nervosa Adapted for the Home Setting: A Pilot Effectiveness Trial

适合家庭环境的青少年神经性厌食症家庭治疗的实施、结果和机制：试点有效性试验

• 批准号: 10192963
• 负责人: Andrea Beth Goldschmidt
• 金额: $ 24.57万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-24 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10192963
• 关键词: Address; Adherence; Adolescent; Affect; Ambulatory Care; Anorexia Nervosa; Behavior Therapy; Body mass index; Caregivers; Caring; Clinical; Communities; Competence; Country; DSM-V; Data; Development; Disease; Distress; Dose; Eating; Eating Disorders; Effectiveness; Enrollment; Environment; Evidence based treatment; Exposure to; Extinction (Psychology); Failure; Family; Family Practice; Family psychotherapy; Food; Fright; Goals; Health Personnel; Home; Hour; Hybrids; Individual; Intervention; Investigation; Knowledge; Language; Longterm Follow-up; Low income; Measures; Mental Health; Mental Health Services; Mental disorders; Modeling; Monitor; Morbidity - disease rate; Outcome; Outpatients; Patients; Population; Preparation; Process; Provider; Psychopathology; Public Health; Randomized; Research; Resources; Risk; Sampling; Schools; Scientific Advances and Accomplishments; Self Efficacy; Service setting; Services; Standardization; Starvation; Stimulus; Structure; Suicide; Supervision; Testing; Third-Party Payer; Training; Transportation; Treatment Cost; Treatment Step; Treatment outcome; Underserved Population; Weight; Weight Gain; Work; barrier to care; base; behavioral health; caregiving; community setting; comorbidity; effectiveness evaluation; effectiveness research; effectiveness trial; effectiveness-implementation RCT; efficacious intervention; empowered; ethnic diversity; ethnic minority population; feeding; follow-up; food environment; high risk; implementation outcomes; improved; innovation; lower income families; medical appointment; medical complication; medical specialties; mortality; outcome prediction; racial and ethnic; racial diversity; response; skills; sociodemographic group; sound; treatment as usual; uptake; weight restoration

PROJECT SUMMARY/ABSTRACT Anorexia nervosa (AN) is a serious psychiatric illness that affects ~1% of adolescents and is associated with high rates of morbidity and mortality. Family-based treatment (FBT), which involves empowering caregivers to take control of refeeding to restore the adolescent to a normative weight and eating trajectory, is postulated to operate via increasing caregiver self-efficacy related to refeeding, and decreasing adolescent distress through repeated exposure to eating- and weight-related stimuli. Although FBT is currently considered the “first line” treatment for adolescent AN, it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, limited availability of trained providers in many regions of the country), particularly those from underrepresented sociodemographic groups. Furthermore, a substantial subset of families do not optimally respond to FBT, which may be due to failure of newly acquired intervention skills to generalize outside of the (typically office-based) treatment context. Home-based treatment is an alternative to traditional office-based outpatient treatment that can reduce many pragmatic barriers to treatment uptake and engagement, and may enhance generalizability of treatment skills as it is delivered in multiple naturalistic settings where refeeding often occurs (e.g., home, school, community). Although home-based models have been successfully applied to other psychiatric conditions, home-based treatments for AN have never been tested. Moreover, FBT has undergone limited investigation in “real world” settings outside of specialty academic and clinical environments dedicated to eating disorders. As a result, much of what is known about FBT is based on relatively homogeneous samples with limited representation from individuals from lower income and racial/ethnic minority backgrounds. Furthermore, it is unclear if putative FBT mechanisms apply in the effectiveness context. The proposed R34 pilot effectiveness trial will assess outcomes, implementation, and mechanisms of FBT for adolescent AN adapted for the home setting (FBT-HB), delivered in the context of two community-based behavioral health agencies that serve a primarily lower-income, racially and ethnically diverse clientele. Adolescents with AN-spectrum disorders (n=50) and their caregivers will be randomly assigned to either FBT-HB or home-based usual care (integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self- efficacy, adolescent distress, and generalizability of treatment skills. Implementation constructs will be measured among providers and participating families. Overall aims are to assess preliminary effects of FBT- HB on adolescent eating and weight outcomes; FBT-HB acceptability, appropriateness, feasibility, and fidelity; and caregiver- and adolescent-level mechanisms of change. The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting may improve its accessibility and effects on treatment outcome.

项目总结/摘要 神经性厌食症（AN）是一种严重的精神疾病，影响约1%的青少年，并与 发病率和死亡率高。以家庭为基础的治疗（FBT），其中包括赋予照顾者权力， 控制再喂养，使青少年恢复正常体重和饮食轨迹， 通过增加与再喂养相关的照顾者自我效能感，并通过以下方式减少青少年的痛苦， 反复暴露于饮食和体重相关的刺激。尽管FBT目前被认为是“一线” 治疗青少年AN，它在社区环境中利用不足，许多家庭无法获得， 许多实际原因（例如，治疗费用，许多地区训练有素的提供者有限 特别是来自代表性不足的社会人口群体的妇女。此外，大量 一部分家庭对FBT的反应不是最佳的，这可能是由于新获得的干预措施的失败 在（通常以办公室为基础的）治疗环境之外进行概括的技能。家庭治疗是一种 替代传统的基于办公室的门诊治疗，可以减少治疗的许多实际障碍 吸收和参与，并可能提高治疗技能的普遍性，因为它是在多个 经常发生再喂养的自然环境（例如，家庭、学校、社区）。虽然家庭基础 模型已成功应用于其他精神疾病，AN的家庭治疗已 从未被测试过。此外，FBT在“真实的世界”背景下进行了有限的调查， 致力于饮食失调的专业学术和临床环境。因此，我们所知的大部分 关于FBT是基于相对同质的样本，来自较低水平的个人的代表性有限。 收入和种族/少数民族背景。此外，目前还不清楚假定的FBT机制是否适用于 有效性的背景。拟议的R34试点有效性试验将评估结果，实施， 和适应家庭环境的青少年AN的FBT机制（FBT-HB），在以下背景下提供 两个以社区为基础的行为健康机构，主要服务于低收入，种族和民族 多元化的客户。AN谱系障碍青少年（n=50）及其照顾者将被随机 分配到FBT-HB或家庭常规护理（综合家庭治疗方法）。照顾者和 青少年将提供有关体重、饮食和假定治疗机制的数据，包括照顾者自我- 疗效，青少年的困扰，和治疗技巧的普遍性。实现结构将是 在提供者和参与家庭之间进行衡量。总体目标是评估FBT的初步影响- HB对青少年饮食和体重结果的影响; FBT-HB的可接受性、适当性、可行性和保真度; 以及照顾者和病人层面的变化机制。拟议的研究显然有可能 推进对FBT治疗AN的真实有效性的科学和临床理解，包括是否 使其适应家庭环境可能会改善其可获得性和对治疗结果的影响。