Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa

描述(由申请人提供)：神经性厌食症(AN)是一种具有身体和心理后遗症的衰弱精神疾病。以严重营养不良为特征的AN通常出现在青春期，这是一个大脑快速发育和成熟的时期。在这一关键时期进行有效的干预可能会避免潜在的不可逆转的损害，并使青少年恢复到更正常的发展轨迹。最近在治疗青少年AN方面的进展支持了家庭参与的重要性。然而，融入家庭的最佳方式需要进一步研究，特别是考虑到家庭成员中报告的重大照顾者负担和频繁的精神病理。初步证据表明，分开的家庭治疗(SFT)，即对青少年和照顾者分别进行家庭干预，可能比联合干预更适合于情绪高度表达等困难的家庭。以家庭为基础的治疗针对与AN相关的特征特征，如行为和认知僵化、高度伤害避免和不良的内感意识，可能会防止症状复发，因为这些年轻人遇到了新的生活压力源。拟议研究的目的是开发一种治疗青少年AN的方法，以一种具有广泛吸引力和适用性的方式包括家庭(即使对于更多痛苦的家庭)，并采用行为疗法的新技术，这些技术可能非常适合于解决AN的特征。这些较新的技术以接受为基础，专门针对在存在困难的想法、感觉和身体感觉时的行为僵化而设计。该治疗开发项目的具体目标如下：1)开发和完善针对患有神经性厌食症(ASFT)的青少年的20疗程、24周接受的分居家庭治疗，将现有的最先进的父母治疗成分(Zucker，2008)与创新的青少年个体成分相结合；2)评估治疗计划的可接受性和可行性；3)提供有关治疗方法有效性的初步数据。治疗的开发将是迭代的，将分三个阶段进行。每个阶段都将实施日益完善的治疗版本，评估治疗的可信度和预期，坚持治疗，并从参与者那里获得定性和定量的反馈。将采用多模式评估；参与者将在基线、10周、治疗后和治疗后3个月进行评估。预计最终的数据和治疗手册将为将ASFT与更传统的家庭治疗相比较的大规模随机对照试验奠定基础。 公共卫生相关性：神经性厌食症(AN)是一种使人衰弱的精神疾病，有可能永久地将青少年从健康的发育轨迹中分离出来。家庭的参与对于有效的管理是必不可少的，然而，照顾者的负担是极端的。有家庭参与但以急性症状管理为目标的干预措施，减轻照顾者负担，并解决与疾病复发相关的特征，对于从这些威胁性疾病中持续康复至关重要。

DESCRIPTION (provided by applicant): Anorexia Nervosa (AN) is a debilitating psychiatric illness with physical and psychological sequelae. AN, which is characterized by significant malnourishment, often emerges in adolescence, a period of rapid brain development and maturation. Effectively intervening at this pivotal period may circumvent potentially irreversible damage and restore adolescents to a more normal developmental trajectory. Recent progress in treating adolescents with AN supports the importance of family involvement. However, the most optimal manner to incorporate the family requires further study, particularly given the significant caregiver burden and frequent psychopathology reported among AN family members. Preliminary evidence indicates that separated family treatment (SFT), in which a family intervention is delivered to adolescent and caregiver separately, may be more appropriate than conjoint interventions for families with difficulties such as high expressed emotion. Family-based treatments that target trait features associated with AN, such as behavioral and cognitive rigidity, high harm avoidance, and poor interoceptive awareness may prevent symptom relapse as these young people encounter new life stressors. The purpose of the proposed research is to develop a treatment for adolescent AN that includes the family in a way that has broad appeal and applicability (even with more distressed families) and incorporates newer technologies from behavior therapy which may be well-suited to address trait features of AN. These newer technologies are acceptance-based and specifically designed to target behavioral rigidity in the presence of difficult thoughts, feelings, and bodily sensations. The specific aims of this treatment development project are as follows: 1) develop and refine a 20 session, 24 week acceptance-based separated family treatment for adolescents with anorexia nervosa (ASFT) that combines an existing state-of-the- art parent therapy component (Zucker, 2008) with an innovative individual adolescent component, 2) evaluate the acceptability and feasibility of the treatment program, and 3) provide preliminary data regarding the efficacy of the treatment approach. Treatment development will be iterative, and will occur over three phases. Each phase will implement an increasingly refined version of the treatment, evaluate credibility and expectancy of treatment, adherence, and obtain qualitative and quantitative feedback from participants. Multimodal assessment will be employed; and participants will be assessed at baseline, 10 weeks, post-treatment, and three months post-treatment. It is anticipated that the resultant data and treatment manual will set the stage for a large scale RCT comparing ASFT to more traditional family treatments. PUBLIC HEALTH RELEVANCE: Anorexia nervosa (AN) is a debilitating mental illness with the potential to permanently dislodge adolescents from healthy developmental trajectories. Involvement of the family is essential for effective management, however, the degree of caregiver burden is extreme. Interventions that involve the family and yet target acute symptom management, ease caregiver burden, and address trait features associated with illness relapse are essential for sustained recovery from these threatening disorders.