Behavioral and Momentary Assessment of Fear-based Mechanisms underlying Remission in Weight-restored Anorexia Nervosa

体重恢复神经性厌食症缓解过程中基于恐惧的机制的行为和瞬时评估

• 批准号: 10614378
• 负责人: Caroline Christian
• 金额: $ 3.51万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10614378
• 关键词: Address; Adult; Affective; Anorexia Nervosa; Anxiety; Anxiety Disorders; Award; Behavior; Behavior assessment; Behavioral; Behavioral Paradigm; Caring; Cellular Phone; Cessation of life; Clinical; Cognitive; Cognitive Therapy; Computers; Consultations; Dangerousness; Data; Data Collection; Development; Diagnostic; Disease; Disease remission; Eating Disorders; Empirical Research; Environment; Exposure to; Extinction; Food; Fright; Future; Goals; Impairment; Individual; Intake; Intervention; Investigation; Lead; Learning; Literature; Maintenance; Mental disorders; Modeling; Nutritional; Partial Remission; Participant; Pathology; Persons; Play; Population; Population Intervention; Prevalence; Procedures; Process; Recovery; Relapse; Research; Research Design; Research Methodology; Resources; Role; Sampling; Self-Examination; Series; Stimulus; Symptoms; Testing; Time; Training; Treatment outcome; United States; Weight; Weight Gain; approach behavior; avoidance behavior; behavior test; career; cognitive enhancement; comorbidity; conditioned fear; cost; critical period; experience; food restriction; healthy weight; improved outcome; interest; meetings; mortality; personalized approach; personalized intervention; prevent; preventive intervention; prospective; reduce symptoms; relapse prevention; relapse risk; response; standard care; statistics; theories; treatment optimization; trend; vector; weight restoration

Project Summary/Abstract Anorexia nervosa (AN) is a psychiatric illness characterized by low weight, extreme food restriction, intense fear of weight gain, and disturbance in body self-evaluation. AN is markedly persistent, and there are no empirically supported treatments for adults with this deadly illness. Indeed, over half of individuals with AN do not reach full remission during treatment, and approximately one third of individuals experience at least one relapse after discharge. There is great need for identifying remission-promoting targets to adapt and create optimized interventions for this population. The period of partial remission in AN (i.e., weight- restored individuals who continue to endorse significant cognitive-affective AN pathology) represents a critical time for identifying mechanisms underlying remission. Specifically, unaddressed cognitive-affective AN symptoms (e.g., extreme fear of weight gain) at this stage represent the greatest barrier to achieving lasting full remission, and thus, mechanisms underlying the persistence vs. reduction of these symptoms are critical to study at this stage. AN is highly comorbid with anxiety disorders and shares several maintenance factors, including high levels of fear, anxiety, and harm avoidance. Despite considerable overlap with anxiety disorders, fear and avoidance have not been tested as mechanisms inhibiting remission in weight- restored AN. The proposed study will test how fear-based learning (e.g., fear extinction, fear renewal, fear approach, fear avoidance) relates to AN pathology in the naturalistic environment in a sample of 45 individuals meeting criteria for AN in partial remission. This study will use both behavioral assessment (i.e., Approach- Avoidance Task, Behavioral Approach Task, associative fear-learning paradigm) and momentary assessment (i.e., smartphone-based intensive longitudinal data collection) of fear, avoidance, and approach behaviors to conceptualize how these mechanisms of interest operate in the ‘real world’. First, we will test whether behavioral approach, avoidance, fear extinction, and fear renewal are correlated with real-time approach, avoidance, fear, and AN symptoms (Aim 1). Second, vector autoregressive models using the intensive time- series data will elucidate prospective associations across fear-based processes and AN symptoms between subjects (Aim 2) and within individuals (Aim 3) to identify group-level and intraindividual targets for care during this critical stage in recovery. In the between-subjects models, we will test behavioral fear extinction and renewal as moderators (Aim 2). The opportunities, resources, and expert consultation afforded by this award would support my training goals to collect and analyze behavioral data, learn new analytic approaches with intensive longitudinal data, and gain experience working with clinical AN participants. Overall, this proposed study will implement advanced statistics and multimethod research design, conducted fully remotely, at an important stage of AN. These results will inform precision relapse prevention interventions and step-down care, improving outcomes for this impairing, persistent, and costly disorder.

项目总结/摘要 神经性厌食症（AN）是一种精神疾病，其特征是低体重，极度食物限制， 对体重增加的强烈恐惧，以及身体自我评价的障碍。有明显的持续性， 对于患有这种致命疾病的成年人没有经验支持的治疗方法。事实上，超过一半的人 AN在治疗期间没有达到完全缓解，大约三分之一的人经历 出院后至少复发一次。非常需要确定缓解促进目标以适应 并为这一人群创造优化的干预措施。AN的部分缓解期（即，重量- 恢复的个体继续支持显著的认知情感AN病理）代表了一个关键的 时间来确定缓解的机制。具体而言，未处理的认知情感AN 症状（例如，极端恐惧的体重增加）在这个阶段代表了最大的障碍，以实现持久的充分 缓解，因此，这些症状的持续与减少的潜在机制对于 在这个阶段学习。AN与焦虑症高度共病，并有几个共同的维持因素， 包括高度的恐惧、焦虑和避免伤害。尽管与焦虑有相当大的重叠 障碍、恐惧和回避还没有被测试为抑制体重减轻的机制， 恢复AN。这项拟议中的研究将测试基于恐惧的学习（例如，恐惧消退，恐惧重生，恐惧 方法，恐惧回避）与45个个体的样本中自然环境中的AN病理学有关 符合AN部分缓解的标准。本研究将使用行为评估（即，方法- 回避任务、行为方法任务、联想恐惧学习范式）和瞬间评估 (i.e.,基于智能手机的密集纵向数据收集）的恐惧，回避和接近行为， 概念化这些利益机制如何在“真实的世界”中运作。首先，我们将测试 行为接近、回避、恐惧消退和恐惧更新与实时接近相关， 回避、恐惧和AN症状（目标1）。第二，向量自回归模型使用密集的时间- 系列数据将阐明基于恐惧的过程和AN症状之间的前瞻性关联， 受试者（目标2）和个体内（目标3），以确定治疗期间的组水平和个体内目标 这是恢复的关键阶段在受试者间模型中，我们将测试行为恐惧消退， 更新为版主（目标2）。该奖项提供的机会、资源和专家咨询 我将支持我的培训目标，收集和分析行为数据，学习新的分析方法， 密集的纵向数据，并获得与临床AN参与者合作的经验。总的来说，这一提议 研究将采用先进的统计和多方法研究设计，完全远程进行， 在一个重要的阶段。这些结果将为精确的复发预防干预提供信息， 逐步减少护理，改善这种损害性、持续性和昂贵的疾病的结果。