Family-Based Interoceptive Exposure for Avoidant Restrictive Food Intake Disorder

项目摘要/摘要 回避性/限制性食物摄取障碍通常与严重营养缺乏、年龄和性别体重/增长过低和严重痛苦有关，并可导致严重的心理和医学后遗症以及终生功能障碍。ARFID的核心特征是一种普遍存在的回避食物的模式，与对食物或食物缺乏兴趣、食物的感官特征或对进食的不良后果的担忧有关。检查ARFID干预措施的研究有限，还需要更多的干预选择。心身干预与ARFID患者很好地匹配，因为他们对食物暗示的生理驱动的厌恶，与互感体验压倒了食物的回报(自然增强)特性，并减少了接近行为。我们小组最近为患有神经性厌食症和相关疾病的患者家属开发并测试了一种基于正念的短暂的6次感觉间暴露干预。干预的重点是家庭支持青少年达到提高对厌恶情绪的容忍度的门槛，并在喂养期间更多地参与接近行为。虽然避免食物是不同情况下的共同特征，但患有ARFID的青少年和那些有其他饮食障碍的青少年是不同的人群。我们在先前的机械性研究中的成功为使用内感暴露提供了一个框架。鉴于临床表现的不同，该项目将确定对患有ARFID的青少年进行全面的身心家庭干预的可行性和可接受性的基本信息；特别是以正念为基础的相互感觉暴露(MBIE)，以获得健康恢复和情绪健康的高度优先结果。共有57名ARFID青少年(年龄12-18岁)将被招募接受MBIE，采用创新的剂量优化方法，以评估何时达到具有临床意义的结果，并评估耐受性和治疗特征，目的是在40名完成者中提取最有效的MBIE形式。我们将：(1)探索在治疗结束时招募、保留和收集患有ARFID的青少年的可行性，(2)建立MBIE干预的可接受性和坚持性，以及(3)评估观察避免进食的数量和正念技能的变化所需的MBIE会议的次数。这些数据有助于了解更大规模、更明确的研究的效用，这些研究有可能对患有ARFID的青少年的健康和功能产生重大影响。

Project Summary/Abstract Avoidant/restrictive food intake disorder is commonly associated with severe nutritional deficiencies, low weight/growth for age and sex, and significant distress, and can cause serious psychological and medical sequelae and functional impairment across the lifespan. The core feature of ARFID is a pervasive pattern of food avoidance, related to a lack of interest in eating or food, sensory characteristics of food, or concern about the aversive consequences of eating. Studies examining interventions for ARFID are limited, and additional options for intervention are needed. Mind-body interventions are well-matched to individuals with ARFID because of their physiologically driven aversion to food-cues, with interoceptive experiences overwhelming the rewarding (natural reinforcing) properties of food and reduce approach behavior. Our group recently developed and tested a brief 6-session mindfulness-based interoceptive exposure intervention for families of patients with anorexia nervosa and related conditions. The intervention focused on families supporting adolescents to reach a threshold of increased tolerance of the aversive emotion of disgust and greater engagement in approach behavior during feeding. Although food avoidance is a shared feature across conditions, adolescents with ARFID and those with other eating disorders are distinct populations. Our success with this prior mechanistic study provides a framework for the use of interoceptive exposure. Given differences in the clinical presentations, this project will establish essential information about the feasibility and acceptability of a comprehensive mind and body family intervention for youth with ARFID; specifically a mindfulness-based interoceptive exposure (MBIE) for the high priority outcomes of health restoration and emotional well-being. A total of 57 adolescents with ARFID (aged 12-18) will be recruited to receive MBIE in an innovative dose-optimization approach to assess when a clinically-meaningful outcome is achieved, and assess tolerability and treatment characteristics, with the aim to distilling the most potent form of MBIE in 40 completers. We will: (1) explore the feasibility of recruitment, retention, and data collection procedures with youth with ARFID at end of treatment, (2) establish the acceptability and adherence of the MBIE intervention, and (3) evaluate the number of MBIE sessions required to observe changes in the number of foods avoided and mindfulness skills. These data can help to inform the utility of larger more definitive studies that have the potential to make a significant impact on the health and functioning of adolescents with ARFID.