UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa

描述(由申请人提供)：本R01是对RFA-MH-07-090治疗青春期晚期和成年期神经性厌食症的创新试验的回应。我们特别关注成人神经性厌食症(AN)，建议将一个熟练治疗AN的团队的专业知识与世界各国领导人结合起来，开发基于夫妇的干预措施，为一名成员患有AN的夫妇开发一种创新的干预措施。干预《UCAN：团结夫妻(治疗)厌食症》承认，厌食症发生在人际环境中，既受个人社会环境的影响，也影响重要的人际关系。此外，家庭治疗对患有支气管炎的年轻人的成功证明了在治疗支气管炎时利用家庭支持的重要性。UCAN定制了基于认知行为的夫妇干预措施，已成功用于治疗抑郁症、焦虑症、戒烟和癌症，以解决AN的核心精神病理问题，同时也解决了AN对亲密关系施加的独特和具有挑战性的压力。我们对干预的初步构想首先侧重于在与焦点的关系的背景下解决问题，例如改变围绕饮食和体重的互动，正常化活动和健康行为、身体形象、身体情感和性行为，其次着眼于解决更广泛的关系，以维持治疗成果，防止复发，并培养关系满意度。具体目标是：1)开发和标准化针对一名成员患有AN的夫妇的机械化干预；2)确定公开试验中UCAN的测试版作为常规治疗(TAU)的补充的可行性和可接受性，并根据初步试验的反馈改进UCAN；3)在24对夫妇的随机对照试验中测试UCAN TAU和TAU，其中一名成员患有AN；以及4)调整观察性夫妇评估措施，最终目标是纳入联系和压力的生物学措施。我们的主要患者结果将是体重指数和全球改善，我们的次要患者结果将是抑郁、焦虑、关系调整和沟通。合作伙伴的成果还将包括照顾措施。这项试验将明确地设计为收集初步结果数据，为后续更大规模的随机对照试验提供样本量和功率计算信息。这项研究的结果有可能导致创建一种有效的、可接受的、为发育量身定做的干预措施，将改善核心和病理以及夫妇功能。未来的干预范围将包括针对神经性暴食症和暴饮暴食等饮食障碍的夫妇干预。我们建议为患有神经性厌食症的成年人开发一种以夫妇为基础的干预措施，名为“UCAN：团结夫妇(在治疗)神经性厌食症中”。我们将创建一种有效的、可接受的、为发展量身定做的干预措施，利用合作伙伴的支持来改善核心神经性厌食症病理以及夫妇功能。

DESCRIPTION (provided by applicant): This R01 is submitted in response to RFA-MH-07-090 Innovative Trials for the Treatment of Anorexia Nervosa in Late Adolescence and Adulthood. With a specific focus on adult anorexia nervosa (AN), we propose to unite the expertise of a team skilled in the treatment of AN with world leaders in the development of couple-based interventions to develop an innovative intervention for couples in which one member is suffering from AN. The intervention "UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa" acknowledges that AN occurs in an interpersonal context, both being affected by the person's social environment and impacting important interpersonal relationships. Moreover, the demonstrated success of family therapy for younger individuals with AN underscores the importance of leveraging family support in the treatment of AN. UCAN tailors cognitive-behavioral couple-based interventions that have been employed successfully for the treatment of depression, anxiety disorders, smoking cessation, and cancer to address the core psychopathology of AN, while also addressing the unique and challenging stresses that AN places on intimate relationships. Our initial conceptualization of the intervention focuses first on addressing AN within the context of the relationship with foci such as altering interactions around eating and weight, normalizing activity and health behaviors, body image, physical affection, and sexuality and second on addressing the broader relationship to maintain treatment gains, prevent relapse, and foster relationship satisfaction. The specific aims are: 1) to develop and standardize a manualized intervention for couples in which one member suffers from AN; 2) to determine feasibility and acceptability of a beta- version of UCAN in an open trial as an augmentation to treatment as usual (TAU) and to refine UCAN based on feedback from the preliminary trial; 3) to test UCAN+TAU versus TAU in a randomized controlled trial of 24 couples in which one member has AN; and 4) to adapt an observational couples assessment measure with the eventual goal of incorporating biological measures of affiliation and stress. Our primary patient outcomes will be BMI and global improvement, and our secondary patient outcomes will be depression, anxiety, and relationship adjustment and communication. Partner outcomes will also include caregiving measures. This trial will be designed explicitly to gather preliminary outcome data to inform sample size and power calculations for a subsequent larger randomized controlled trial. Findings from this investigation have the potential to result in the creation of an effective, acceptable, developmentally tailored intervention that will improve both core AN pathology as well as couple functioning. Future extensions of the intervention will include couple-based interventions for eating disorders such as bulimia nervosa and binge eating disorder. We propose to develop a couple-based intervention for adults with anorexia nervosa entitled "UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa." We will create an effective, acceptable, developmentally tailored intervention that leverages the support of partners to improve both core anorexia nervosa pathology as well as couple functioning.