Emotion coaching skills as an augmentation to family based therapy for adolescents with anorexia nervosa: A pilot study

项目摘要 小儿神经性厌食症（AN）影响了美国40万青少年，造成了毁灭性的后果 包括生长迟缓、骨密度下降、心动过缓，以及所有精神疾病中最高的死亡率。 死亡率为11.5%，其中一半是自杀。对青少年的早期干预可以挽救生命， 儿科AN治疗是一个重要的公共卫生问题。儿童AN治疗的目标是恢复 青少年恢复到健康的体重，扭转营养不良的危险影响。家庭治疗 (FBT)是治疗小儿AN的金标准;然而，50%的患者没有反应。的 治疗无反应的后果是可怕的，强调了通过以下途径改善治疗的重要性： 加强措施，以解决无答复问题。儿科AN治疗反应的一个障碍是 情绪（EE），其定义为家庭对患者的反应，其特征是敌意，批评 评论和情绪化的过度参与。一些研究强调，高EE的家庭 接受治疗的青少年AN的结果较差，包括较高的辍学率，缺乏 体重恢复，饮食失调症状改善较少。相反，父母的温暖， 在FBT中，EE与良好结局相关。最近的育儿干预集中在情绪辅导 (EC)已经证明，在其他治疗中， 儿科群体（例如，PTSD，ADHD），但尚未应用于儿科AN。考虑到有害的 高EE对再喂养过程的影响以及父母温暖的好处，情绪辅导 降低高EE，增加父母温暖，并改善青少年体重恢复的潜力 一个.这项R34试点有效性试验的目的是进行两阶段研究来评估的有效性 在临床环境中进行FBT + EC父母组干预。在第一阶段（可行性阶段;第一年），我们将 在6名患者中进行EC父母组干预的初步可行性和可接受性测试， 表现出EE升高的儿童AN及其家庭。可行性阶段的数据将用于 修改会话内容，以改善治疗交付和EC技能的吸收。一旦我们的手册被完善 并最终确定，我们将进行一项随机对照临床试验（第2阶段）的50名青少年和他们的 比较FBT+EC父母组（n=25）与FBT+支持（n=25）。FBT+支持条件是 一般的父母支持小组，作为我们临床饮食失调计划标准护理的一部分。 FBT在治疗和对照条件下相同，EC父母组会议和 与FBT会话分开发生的父母支持组会话。如果项目的目标是 实现，这项研究将有很大的影响，儿科AN的潜力，以改善体重恢复 结果，增加FBT的家庭高EE。

Project Summary Pediatric anorexia nervosa (AN) affects 400,000 adolescents in the US with devastating consequences including growth delay, bone density loss, bradycardia, and the highest mortality rate of any psychiatric condition (11.5%), with half of all deaths due to suicide. Early intervention in adolescents is life-saving, making pediatric AN treatment an important public health concern. The goal of pediatric AN treatment is to restore the adolescent back to a healthy weight and reverse the dangerous effects of malnutrition. Family based therapy (FBT) is the gold standard of treatment for pediatric AN; however, 50% of patients do not respond. The consequences of treatment non-response are dire, underscoring the importance of improving treatment via augmentations to address non-response. One barrier to treatment response in pediatric AN is expressed emotion (EE), which is defined as a family's response to an ill patient that is characterized by hostility, critical comments, and emotional overinvolvement. Several studies have highlighted that families with high EE undergoing treatment for their adolescent with AN have poorer outcomes, including higher drop-out rates, lack of weight restoration, and less improvement in eating disorder symptoms. Conversely, parental warmth, a facet of EE, is associated with good outcomes in FBT. Recent parenting interventions focused on emotion coaching (EC) to address high EE have demonstrated success as adjuncts to evidence-based treatments in other pediatric populations (e.g., PTSD, ADHD) but have not been applied to pediatric AN. Given the detrimental effects that high EE has on the re-feeding process and the benefits of parental warmth, emotion coaching has the potential to reduce high EE, increase parental warmth, and improve weight restoration in adolescents with AN. The aim of this R34 pilot effectiveness trial is to conduct a two-stage study to evaluate the effectiveness of a FBT + EC parent group intervention within a clinical setting. In Stage 1 (Feasibility Stage; Year 1), we will conduct preliminary feasibility and acceptability testing of an EC parent group intervention in 6 patients with pediatric AN and their families who exhibit elevated EE. The data from the Feasibility Stage will be used to modify session content to improve treatment delivery and the uptake of EC skills. Once our manual is refined and finalized, we will conduct a randomized controlled clinical trial (Stage 2) of 50 adolescents and their parents to compare FBT+EC parent group (n=25) versus FBT+support (n=25). The FBT+support condition is a general parent support group that is offered as part of standard care in our clinical Eating Disorders Program. FBT will be identical in both the treatment and control conditions, with the EC parent group sessions and parent support group sessions occurring separately from the FBT sessions. If the aims of the project are achieved, this study would have a large impact on pediatric AN with the potential to improve weight restoration outcomes by augmenting FBT for families high in EE.