Facing Eating Disorder Fears for Anorexia Nervosa: A Virtual Relapse Prevention Program Targeted at Approach and Avoidance Behaviors

面对饮食失调对神经性厌食症的恐惧：针对接近和回避行为的虚拟复发预防计划

• 批准号: 10425019
• 负责人: Cheri Alicia Levinson
• 金额: $ 31.39万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425019
• 关键词: Acute; Admission activity; Aftercare; Anorexia Nervosa; Anxiety; Behavior; Behavior assessment; Behavioral; Caring; Cessation of life; Chronic; Clinical; Cognitive; Cognitive Therapy; Communities; Data; Disease remission; Eating Disorders; Educational process of instructing; Ensure; Extinction (Psychology); Face; Feedback; Focus Groups; Food; Fright; Goals; Hospitalization; Hospitals; Individual; Inpatients; Interoception; Intervention; Lead; Literature; Medical; Methods; Morbidity - disease rate; Neurobehavioral Manifestations; Outcome; Outpatients; Pathology; Patient Discharge; Patient Self-Report; Patients; Play; Preparation; Prevention program; Provider; Randomized Controlled Trials; Recovery; Relapse; Research; Role; Service delivery model; Services; Stimulus; Symptoms; System; Technology; Testing; Time; Translating; Translations; United States National Institutes of Health; Weight; Weight Gain; Work; acceptability and feasibility; acute care; approach avoidance behavior; approach behavior; avoidance behavior; base; behavior change; behavior test; care systems; clinical efficacy; cognitive benefits; cognitive function; cognitive skill; cost; cost outcomes; critical period; disorder later incidence prevention; evidence base; experience; feasibility testing; habituation; hospital readmission; improved outcome; innovation; medical specialties; mortality; outpatient facility; prevent; psychoeducation; public health relevance; relapse prediction; skills training; social; social situation; symptomatology; therapy design; treatment as usual; treatment center; user-friendly; virtual; virtual delivery; virtual platform; weight restoration

PROJECT SUMMARY/ABSTRACT Anorexia nervosa (AN) is chronic and disabling; most individuals never achieve full remission, even after acute treatment, and 50% of those who access acute treatment will relapse within 6- months of discharge. AN relapse-prevention treatments are urgently needed that can disrupt the persistent cycle of admission and discharge from acute treatment. Importantly, existing treatments do not differ from control treatments in the ability to alter cognitive-behavioral AN pathology, which is the primary remaining symptomatology at discharge from acute care. The inability to alter cognitive-behavioral pathology is a function of the limited availability of treatments that include skills training to promote behavior change in a “real-world” context, outside of treatment facilities. As such, relapse-prevention treatments should explicitly target core cognitive-behavioral pathology to facilitate approach behaviors (e.g., facing fear foods) in the real-world. Our scientific premise, developed from our past work, is that the application of a virtual format of Facing Eating Disorder Fears (FED-F) for AN will facilitate engagement in approach behaviors and minimize avoidance behaviors - improving outcomes, enhancing full recovery, and decreasing the likelihood of relapse. FED-F is a modular treatment that enhances exposure therapy with psychoeducation and cognitive skills teaching how to face fears of (a) food, (b) weight gain, (c) interoception/body, and (d) social situations. Our study goals are to (1) refine and test the acceptability and feasibility of FED-F delivered post-acute treatment as adjunctive to step-down specialty care, (2) test if this treatment outperforms treatment as usual (TAU), and (3) to examine if treatment targets our hypothesized mechanism of action: approach behaviors. These goals will lead to a highly deployable and accessible virtual treatment targeted at core AN mechanisms that predict relapse. The proposed research uses highly innovative methods; we will use an all-remote technology-based approach, combining a virtual, non- therapist assisted treatment with remote behavioral and momentary assessment of approach/avoidance behaviors. Specific aims are to (1) refine FED-F into a fully virtual format with input from patients and stakeholders and collect preliminary data (N=10) on its feasibility and acceptability, (2) conduct a small pilot RCT of FED-F (n=30) as compared to TAU (n=30), and (3) examine if FED-F targets approach/avoidance behaviors and test if this mechanism is associated with clinical outcomes. Ultimately, this proposal will lead to the creation and dissemination of a highly user-friendly, easily accessible and deployable intervention, delivered during a critical period of care, that can prevent AN relapse, which will decrease mortality, morbidity, and the high costs associated with chronic treatment.

项目摘要/摘要 神经性厌食症(AN)是一种慢性和致残的疾病；大多数人永远不会完全缓解， 即使在急性治疗之后，50%接受急性治疗的人将在6- 几个月的退伍。迫切需要一种预防复发的治疗方法，这种治疗可能会扰乱 持续的急性治疗的入院和出院周期。重要的是，现有的 治疗与对照治疗在改变认知行为和 病理学，这是急性护理出院时的主要残留症状。这个 无法改变认知行为病理是由于有限的可获得性 包括技能培训在内的治疗，以促进“真实世界”背景下的行为改变， 在治疗设施之外。因此，预防复发的治疗应明确针对 核心认知-行为病理学，以促进接近行为(例如，面对恐惧食物) 真实的世界。我们从过去的工作中发展出来的科学前提是，应用一种 面对进食障碍恐惧(FED-F)的虚拟形式将促进参与 接近行为并最大限度地减少回避行为--改善结果，增强全面性 恢复，并降低复发的可能性。FED-F是一种模块化治疗，可增强 暴露疗法结合心理教育和认知技能教授如何面对(A)恐惧 食物，(B)体重增加，(C)内部感觉/身体，和(D)社交情况。我们的研究目标是(1) 完善和测试FED-F提供的急性后治疗的可接受性和可行性 作为逐步减少的专科护理的补充，(2)测试这种治疗是否优于通常的治疗 (Tau)，以及(3)检查治疗是否针对我们假设的作用机制：方法 行为。这些目标将导致高度可部署和可访问的虚拟治疗目标 核心是一种预测复发的机制。拟议的研究使用了高度创新的 方法；我们将使用基于全远程技术的方法，将虚拟、非 治疗师辅助治疗，远程行为和瞬间评估 接近/回避行为。具体目标是(1)将FED-F提炼成完全虚拟的格式 收集患者和利益相关者的意见，并收集关于其可行性的初步数据(N=10) 和可接受性，(2)与TAU(n=30)相比，进行FED-F(n=30)的小规模试点RCT， 以及(3)检查FED-F目标是否接近/回避行为，并测试该机制是否 与临床结果相关。最终，这项提议将导致创建和 传播高度用户友好、易于访问和可部署的干预措施 在关键的护理期间，这可以防止复发，这将降低死亡率， 发病率，以及与慢性治疗相关的高昂费用。