Neuroscience-informed treatment to remotely target reward mechanisms in post-acute anorexia nervosa

基于神经科学的治疗可远程针对急性后神经性厌食症的奖励机制

• 批准号: 10680471
• 负责人: Ann Frances Haynos
• 金额: $ 23.53万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680471
• 关键词: Acute; Adult; Affect; Affective; Affective Symptoms; Ambulatory Care; Anorexia Nervosa; Anxiety; Anxiety Disorders; Behavior; Behavior Therapy; Behavioral; Biological; Body Weight decreased; Body mass index; Calories; Caring; Clinical; Cognitive Therapy; Control Groups; Cues; Data; Disease; Eating; Eating Disorders; Ecological momentary assessment; Excision; Exercise; Exhibits; Feeling suicidal; Food; Growth; Hospitals; Individual; Innovative Therapy; Interruption; Intervention; Investigation; Knowledge; Literature; Maintenance; Measures; Mental Depression; Mental disorders; Modeling; Mood Disorders; Morbidity - disease rate; National Institute of Mental Health; Neurocognitive; Neurosciences; Outcome; Participant; Patient Self-Report; Patients; Pattern; Persons; Pilot Projects; Play; Positive Valence; Process; Randomized; Randomized, Controlled Trials; Relapse; Research Domain Criteria; Residual state; Rewards; Role; Science; Social Interaction; Specialist; Starvation; Symptoms; System; Technology; Teletherapy; Testing; Time; Translating; Treatment outcome; Waiting Lists; Weight; active control; affective neuroscience; anxiety reduction; anxiety symptoms; associated symptom; biobehavior; cognitive task; comorbidity; comparison control; depressive symptoms; design; effective therapy; efficacious treatment; experience; follow-up; improved; indexing; innovation; mortality; multimodality; novel; pleasure; programs; psychoeducation; psychoeducational; psychosocial; rapid growth; relapse risk; remote delivery; suicidal; symptomatic improvement; therapy design; treatment as usual

PROJECT SUMMARY/ABSTRACT Anorexia nervosa (AN) is a serious illness with extremely high morbidity and mortality rates. Clearly efficacious treatments are lacking for adults with AN, especially during the post-acute stage following higher- level care (e.g., residential, partial-hospital program [PHP]). Most patients achieve symptom stability in intensive treatment, but up to 50% relapse and more experience residual or co-morbid (e.g., affective) symptoms after discharge. Appropriate outpatient treatment is often unavailable or inaccessible in this stage. Despite a rapid growth in the knowledge on the biobehavioral mechanisms promoting AN, this information has rarely been incorporated into treatment. One set of mechanistic targets increasingly acknowledged as relevant to AN are those of the reward system. The reward (a.k.a., positive affect or valence) system has been implicated in maintenance of myriad psychiatric disorders, including common AN co-morbidities (e.g., mood and anxiety disorders). A wealth of evidence, including our pilot data, suggests that individuals with AN show deficit reward sensitivity to experiences generally considered rewarding (e.g., social interactions, eating), similar to those with affective disorders. However, distinct from other psychiatric illnesses, individuals with AN also show elevated reward sensitivity to weight-loss experiences and cues (e.g., exercise, low-calorie foods). Starvation in acute AN appears to exacerbate these processes. However, these same problems affect weight- restored AN, suggesting they represent core illness mechanisms. Although reward anomalies have long been noted in the literature, currently no treatments for AN designate positive affect as a primary intervention target. To remedy this gap, we will test whether a remotely-deployed psychosocial treatment targeting positive affect, Positive Affect Treatment (PAT), can alter reward mechanisms and enhance treatment outcomes in post-acute AN. PAT is a cognitive-behavioral therapy originally designed to treat mood and anxiety disorders and adapted by our team to target reward anomalies in AN (PAT-AN). Our pilot data suggest that PAT-AN, delivered in person or via teletherapy, effectively targets positive affect and reward sensitivity to improve BMI and eating disorder, anxiety, depressive symptoms. We will extend this investigation to the post-acute period of AN, during which we expect to even more effectively engage the reward system, due to the removal of the biological constraints of starvation. Adults with broadly-defined AN (N = 70) leaving residential or PHP will be randomized to 24 weeks of PAT-AN or active control (psychoeducation and behavior therapy) as adjunctive to treatment as usual. Treatment will be delivered via the highly accessible and scalable format of teletherapy. Throughout treatment and follow-up, subjects will complete a novel multimodal battery (e.g., mobile-delivered and neurocognitive measures) assessing measuring reward sensitivity and clinical symptoms. This project will allow us to precisely test wither an innovative therapy informed by biobehavioral mechanistic science can, for the first time, directly target the reward disruptions long believed to contribute to post-acute AN.

项目概要/摘要 神经性厌食症（AN）是一种发病率和死亡率极高的严重疾病。清楚地 对于成人 AN 缺乏有效的治疗，特别是在急性期后 级别护理（例如，住院、部分医院计划 [PHP]）。大多数患者的症状稳定 强化治疗，但高达 50% 的复发率，更多人会出现残留或共病（例如情感） 出院后出现症状。在此阶段，通常无法或无法获得适当的门诊治疗。 尽管关于促进 AN 的生物行为机制的知识迅速增长，但这些信息 很少被纳入治疗。一组机械目标越来越被认为是 与AN相关的是奖励制度。奖励（又名，积极影响或效价）系统已经 与多种精神疾病的维持有关，包括常见的 AN 合并症（例如，情绪 和焦虑症）。大量证据，包括我们的试点数据，表明患有 AN 的个体表现出 对通常被认为是有益的经历（例如社交互动、饮食）的赤字奖励敏感性， 与情感障碍患者类似。然而，与其他精神疾病不同的是，AN 患者 还表现出对减肥经历和线索（例如运动、低热量食物）的奖励敏感性升高。 急性 AN 中的饥饿似乎会加剧这些过程。然而，这些同样的问题也会影响体重—— AN 恢复，表明它们代表了核心疾病机制。尽管奖励异常早已存在 文献中指出，目前没有任何治疗方法将积极情绪指定为主要干预目标。 为了弥补这一差距，我们将测试远程部署的心理社会治疗是否能针对积极的 积极情感治疗（PAT）可以改变奖励机制并增强治疗效果 急性 AN 后。 PAT 是一种认知行为疗法，最初旨在治疗情绪和焦虑障碍 并由我们的团队进行调整，以针对 AN (PAT-AN) 中的奖励异常。我们的试点数据表明 PAT-AN， 亲自或通过远程治疗提供，有效地瞄准积极的情感和奖励敏感性，以改善体重指数 以及饮食失调、焦虑、抑郁症状。我们将把这项调查延伸到急性期后 AN，在此期间，由于取消了 饥饿的生物限制。患有广义 AN (N = 70) 的成年人离开住宅或 PHP 将 随机接受 24 周的 PAT-AN 或主动对照（心理教育和行为治疗）作为辅助治疗 照常治疗。治疗将通过高度可及且可扩展的远程治疗形式进行。 在整个治疗和随访过程中，受试者将完成新型多模式电池（例如，移动传输 和神经认知测量）评估奖励敏感性和临床症状。该项目将 让我们能够精确地测试一种由生物行为机制科学提供的创新疗法， 第一次，直接针对长期被认为会导致急性 AN 的奖励中断。

项目成果

Difficulties with positive emotion regulation in anorexia nervosa.

神经性厌食症患者的积极情绪调节困难。

• DOI: 10.1002/erv.2973
• 发表时间: 2023
• 期刊: European eating disorders review : the journal of the Eating Disorders Association
• 作者: Santos,BoladeM;Haynos,AnnF
• 通讯作者: Haynos,AnnF