Optimizing Mindfulness and Acceptance-Based Treatments for Bulimia Nervosa and Binge Eating Disorder using a Factorial Design

使用析因设计优化针对神经性贪食症和暴食症的正念和基于接受的治疗

• 批准号: 10356884
• 负责人: ADRIENNE SARAH JUARASCIO
• 金额: $ 70.44万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10356884
• 关键词: Aftercare; Attention; Awareness; Behavior; Behavior Therapy; Behavioral; Binge Eating; Binge eating disorder; Bulimia; Clinical; Clinical Trials; Cognitive; Cognitive Therapy; Complement; Decision Making; Disease; Disease remission; Eating; Eating Disorders; Elements; Emotional; Emotions; Fright; Future; Goals; Gold; Hunger; Individual; Informal Social Control; Intervention; Lead; Literature; Manuals; Manuscripts; Meta-Analysis; Motivation; Outcome; Participant; Patients; Pattern; Population; Recurrence; Reporting; Research; Research Personnel; Research Support; Science; Series; Symptoms; Techniques; Testing; Treatment Efficacy; Treatment outcome; Weight Gain; Work; active method; arm; base; behavior change; clinical practice; clinically significant; common treatment; design; dietary restriction; distress tolerance; eating pathology; efficacy testing; experience; improved; improved outcome; interest; mindfulness; psychologic; randomized trial; systematic review; therapy outcome; treatment optimization

PROJECT SUMMARY Cognitive Behavioral Therapy (CBT) is typically considered the current gold standard and first line treatment for disorders characterized by recurrent binge eating such as bulimia nervosa (BN) and binge eating disorder (BED). Outcomes, while clinically significant, leave substantial room for improvement with recent systematic reviews and meta-analyses finding that 40-50% of patients with BED and nearly 70% of patients with BN remain at least partially symptomatic after a full course of CBT. In an effort to improve outcomes, a growing number of researchers have begun to evaluate the use of mindfulness and acceptance-based behavioral treatments (MABTs) for BN and BED and preliminary evidence suggests such treatments can be effective for this population. Although the research on MABTs for binge eating remains nascent, MABTs are frequently used in clinical practice for BN and BED, with one recent study showing that patients are more likely to report that their therapist has used mindfulness-based techniques than CBT-specific techniques. Given the widespread clinical interest in MABTs and the growing body of research supporting the preliminary efficacy of these treatments, a fully powered tests of the efficacy, mechanisms of action, and moderators of outcome for MABT appears warranted. In particular, rather than testing any specific MABT treatment package (e.g. acceptance and commitment therapy, dialectical behavioral therapy, mindfulness-based eating interventions) in a large clinical trial, we believe that a study that can isolate and evaluate the independent and synergistic efficacy of the most commonly used MABT components has the highest potential for impact. A review of MABTs for BN and BED suggests that there are four commonly used MABT components: (1) Mindful Awareness, (2) Distress Tolerance, (3) Emotion Modulation, and (4) Values-Based Decision Making. MABT treatment packages have vary widely in which of these components they incorporated and which they emphasized. By identifying which components of MABTs are most effective (and for whom they are effective), we can emphasize the powerful elements of MABTs and deemphasize or eliminate inert components. A traditional RCT would not provide the power necessary to evaluate the independent and synergistic efficacies of four distinct treatment components compared to an active treatment approach such as CBT. Instead, the proposed study will use a Multiphasic Optimization Strategy (MOST) approach (including a full factorial design) in which 256 individuals with transdiagnostic binge eating pathology are assigned to one of sixteen behavioral treatments, i.e., representing each permutation of the MABT component described above being included or excluded from the base treatment (a version of CBT that emphasizes the key behavioral ingredients of this treatment approach). Results of the component analysis set up future work to evaluate an optimized treatment containing only effective components (which can be expected to have superior efficacy, efficiency and disseminability) against current gold-standard CBT.

项目摘要 认知行为疗法（CBT）通常被认为是目前的黄金标准和一线治疗， 以反复暴饮暴食为特征的疾病，如神经性贪食症（BN）和暴饮暴食症 （床）。结果虽然具有临床意义，但仍有很大的改进空间， 综述和荟萃分析发现，40-50%的BED患者和近70%的BN患者仍然存在 至少部分出现症状为了改善结果，越来越多的 研究人员已经开始评估正念和基于接受的行为治疗的使用， （MABT）用于BN和BED，初步证据表明此类治疗对此有效。 人口虽然关于MABTs用于暴食的研究仍处于起步阶段，但MABTs经常用于 BN和BED的临床实践，最近的一项研究表明，患者更有可能报告他们的 治疗师使用基于正念的技术，而不是CBT特定的技术。 鉴于对MABT的广泛临床兴趣以及越来越多的支持初步研究的研究 这些治疗的有效性，有效性的充分动力测试，作用机制，以及调节剂， MABT的结果似乎是合理的。特别是，与其测试任何特定的MABT治疗方案， (e.g.接受和承诺疗法，辩证行为疗法，正念饮食 在一项大型临床试验中，我们认为，一项能够分离和评估独立和 最常用的MABT组分的协同功效具有最高的影响潜力。一 对BN和BED的MABT的回顾表明，有四个常用的MABT组件：（1）正念 意识，（2）痛苦容忍，（3）情绪调节，（4）基于价值观的决策。MABT 治疗包在它们所结合的这些组件中的哪些以及它们所 重点介绍通过确定MABT的哪些组成部分最有效（以及对谁有效）， 我们可以强调MABT的强大元素，而不强调或消除惰性成分。 传统的随机对照试验无法提供评价独立和协同疗效所需的把握度 四个不同的治疗组成部分相比，积极的治疗方法，如CBT。而是 拟定研究将使用多相优化策略（MOST）方法（包括全因子设计） 其中，256名具有跨诊断暴食病理学的个体被分配到16种行为之一， 治疗，即，表示包括上述MABT组分的每个排列，或者 排除在基本治疗之外（CBT的一个版本，强调这种治疗的关键行为成分， 治疗方法）。成分分析的结果建立了未来的工作，以评估优化的治疗 仅含有有效成分（可预期具有上级功效、效率和 目前的黄金标准CBT。