Addressing Fear of Food in Anorexia Nervosa

描述（由申请人提供）：神经性厌食症（AN）是一种严重的疾病，其发病率和死亡率在任何精神疾病中都是最高的。该疾病的核心是一种显著的行为障碍——避免进食——目前对患有AN的老年青少年和成人的治疗方法不能令人满意地解决这一问题。急性体重恢复后一年再次住院是常见的。目前预防复发的心理治疗和药物治疗是不够的。显然需要新的和创新的治疗方法。AN患者的食物摄入量减少，特别是高热量/高脂肪含量的食物，与高水平的焦虑和进餐时的回避行为以及有限的改变动机有关。这些特征——预期性焦虑、刺激相关焦虑、恐惧后果和回避仪式——与焦虑症的核心紊乱非常相似，包括恐惧症和强迫症。成功用于治疗焦虑症的技术尚未系统地应用于AN的治疗。通过明确地解决对食物的恐惧，这些技术可以大大改变患者的饮食行为，使他们能够增加饮食的灵活性，从而提高他们保持体重的能力。使用一种新的治疗方法，利用这些技术来减少对饮食的回避，同时增强改变的动机，目前的应用旨在研究一种新的心理治疗和行为治疗，用于老年青少年和成人AN，我们将其命名为食物暴露疗法和仪式预防与动机增强预防AN复发（AN- ex /RP）。AN-EX/RP包括在会话中暴露于令人恐惧的饮食情况，而不采用回避行为，以及正式的动机访谈技术。在初始阶段，我们将完成AN-EX/RP的手动操作和8名参与者的试点测试。在接下来的2.5年里，30名在我们的住院项目中成功恢复到正常体重的患者将被随机分配接受AN- ex /RP或认知行为疗法（CBT-AN），为期6个月的门诊治疗。这项初步研究将确定AN-EX/RP是否会减少对高脂肪/高热量食物的回避，并将评估这种治疗对减少复发的影响。神经性厌食症是一种毁灭性的疾病，发病率和死亡率估计为每十年5%，是所有精神疾病中最高的。复发率很高，高达50%的患者在体重恢复成功后一年内再次住院。这项拨款为神经性厌食症患者提出了一种新的创新治疗方法，如果成功，将降低这种高复发率，并可能对神经性厌食症的急性治疗产生影响。

DESCRIPTION (provided by applicant): Anorexia Nervosa (AN) is a serious illness associated with substantial morbidity and a mortality rate among the highest of any psychiatric disorder. At the core of the illness is a salient behavioral disturbance - avoidance of eating - which is not satisfactorily addressed by currently available treatments for older adolescents and adults with AN. Re-hospitalization with a year after acute weight restoration is common. Current psychotherapeutic and pharmacological treatments for relapse prevention are inadequate. New and innovative treatments are clearly needed. The diminished food intake by patients with AN, especially of foods with high caloric/high fat content, is associated with high levels of anxiety and avoidance behaviors around meals and with limited motivation to change. These characteristics - anticipatory anxiety, stimulus-related anxiety, feared consequences, and avoidance rituals - strongly resemble core disturbances of anxiety disorders, including phobias and OCD. Techniques successfully employed in the treatment of anxiety disorders have not been systematically employed in the treatment of AN. By addressing fear of food specifically, these techniques may substantially alter patient's eating behavior such that they are able to have increased eating flexibility, thereby improving their ability to maintain weight. Using a new treatment that utilizes such techniques to reduce avoidance of eating while simultaneously enhancing motivation to change, the current application aims to study a novel psychotherapeutic and behavioral treatment for older adolescents and adults with AN, which we have entitled Food Exposure Therapy and Ritual Prevention with Motivational Enhancement for Relapse Prevention in AN (AN-EX/RP). AN-EX/RP consists of in session exposures to feared eating situations without employing avoidance behaviors, as well as formal motivational interviewing techniques. In the initial phase, we will complete manualization of AN-EX/RP and pilot testing with 8 participants. In the subsequent 2.5 years, 30 patients who have successfully re-gained to a normal body weight in our inpatient program will be randomly assigned to receive AN-EX/RP or cognitive behavioral therapy for AN (CBT-AN) in a 6 month, outpatient treatment. This pilot study will determine whether AN-EX/RP reduces avoidance of high fat/high calorie foods and will estimate the impact of this treatment on reducing relapse. Anorexia nervosa is a devastating illness with substantial morbidity and a mortality rate estimated to be 5% per decade of illness, among the highest of any psychiatric illness. Relapse rates are high, with up to 50% of patients re-hospitalized within a year after successful weight restoration. This grant proposes a new and innovative treatment for patients with anorexia nervosa, which if successful, will reduce this high relapse rate and could have implications for acute treatment of anorexia nervosa, as well.