Optimizing Technology in the Treatment of Bulimia Nervosa

描述（由申请人提供）：神经性贪食症（BN）是一种严重的精神疾病，以大量的医学和精神疾病为特征。虽然认知行为疗法（CBT）是治疗BN的选择，但这种循证方法的传播并不理想，大多数需要护理的个体从未接受过治疗。此外，多达三分之一的个体在CBT后复发，表明需要维持干预。因此，评估CBT传播的新策略和开发新的干预措施以最大限度地维持治疗效益对于提高我们治疗BN的能力至关重要。优化技术是推动该领域向前发展和扩大公共卫生覆盖面的合乎逻辑的下一步。因此，在本应用中，为了响应PA-07-295：信息技术和互联网在健康服务和干预交付中的作用（R01），我们试图确定通过有调节的聊天小组支持的互联网提供的CBT是否与面对面的小组CBT一样有效。我们建议在一项为期20周的两站急性治疗试验中，将180名患者随机分配到标准面对面组CBT（金标准）或通过互联网（CBT.net）进行CBT。治疗将在损耗、依从性、可接受性、暴食和清除频率、戒断和成本效益方面进行比较。具体地说，我们假设CBT网络在主要结果测量上不会劣于群体CBT，并且更具成本效益。所有参与者将在急性治疗结束后的3、6和12个月进行随访。该试验将利用Bulik博士开发的基于网络的BN程序（R21MH070781“基于网络的神经性贪食认知疗法”）。该项目的成功完成将为无法获得循证护理的患者提供有关通过互联网提供治疗的关键信息。如果通过互联网提供的CBT与以标准的面对面小组形式提供的CBT同样有效，那么提议的结果将有可能产生一种具有成本效益的策略，以传播基于证据的治疗BN。本研究的目的是比较网络认知行为治疗（CBT）与标准组CBT治疗对神经性贪食的影响。如果有效，通过互联网进行的CBT可能是一种具有成本效益的策略，可以传播基于证据的BN治疗方法。

DESCRIPTION (provided by applicant): Bulimia nervosa (BN) is a serious mental illness marked by substantial medical and psychiatric morbidity. Although cognitive-behavioral therapy (CBT) is the treatment of choice for BN, dissemination of this evidence-based approach has been suboptimal, with the majority of individuals requiring care never receiving treatment. Moreover, up to one-third of individuals relapse after CBT, indicating the need for maintenance interventions. Thus the evaluation of new strategies for dissemination of CBT and the development of novel interventions to maximize maintenance of treatment benefits are critical to improve our ability to treat BN. Optimizing technology is a logical next step to move the field forward and enhance public health reach. Thus in this application, in response to PA-07-295: Information Technologies and the Internet in Health Services and Intervention Delivery (R01), we seek to determine whether CBT delivered via the internet with moderated chat-group support is as effective as is face-to-face group CBT. We propose to randomize 180 patients to either standard face to face group CBT (the gold standard) or CBT via the internet (CBT.net) in a two-site, 20 week acute treatment trial. Treatments will be compared on measures of attrition, adherence, acceptability, binge and purge frequency, abstinence, and cost effectiveness. Specifically, we hypothesize that CBT.net will not be inferior to group CBT on primary outcome measures and that it will be more cost-effective. All participants will be followed up at three, six, and twelve months following completion of the acute treatment. This trial will utilize an internet based program for BN developed by Dr. Bulik (R21MH070781 "Web-based Cognitive Therapy for Bulimia Nervosa"). Successful completion of this project will provide critical information about the provision of treatment via the internet for patients who do not have access to evidence-based care. If CBT delivered via the internet is similarly efficacious to that delivered in the standard face to face group format, results of the proposed would have the potential to yield a cost- effective strategy to disseminate evidence-based treatments for BN. The purpose of this study is to compare an internet-delivered cognitive-behavioral treatment (CBT) program for bulimia nervosa with standard group CBT. If effective, CBT via the internet could be a cost-effective strategy to disseminate evidence-based treatments for BN.