Reward Re-Training: A new treatment to address reward imbalance during the COVID-19 pandemic

项目总结 减少新冠肺炎传播的公共卫生方法，如社会距离、就地避难 订单、隔离、远程工作和远程学习对社会造成了突然而广泛的破坏 网络。观察到的社交网络中断正在导致社交孤立和孤独的增加 从日常生活活动中获得足够回报的机会有限。减少日常接触- 一天的奖励来源可以导致对常规奖励刺激的低奖励反应，并减少 个人参与他们通常认为令人愉快的活动的动机。当快感不足时 从日常生活活动中体验到的一些人可能更有可能寻找能够 立即并有力地激活神经奖赏通路。对特定障碍的高奖赏反应 当个体寻求更大数量或更频繁地接触有限范围的 强烈刺激的奖励来源。总体而言，这可能会产生报酬不平衡，从而使个人 从通常令人愉快的日常生活活动中获得很少的回报，而不是实现他们的大部分 从具有高潜在不良后果的行为或物质中获得奖励。虽然奖赏 不平衡很可能是许多精神健康状况的相关维持因素，有强大的身体 有文献表明，以暴饮暴食为主要特征的饮食失调(ED)患者 吃东西会有不平衡的回报。 在新冠肺炎大流行之前，我们的团队开始开发一种新的基于群体的治疗方法 跨诊断的暴饮暴食，我们称之为奖励再培训(RRT)。RRT旨在间接改变 通过直接专注于建立更有价值的生活来扰乱饮食行为。RRT假设 随着生活变得更有意义，暴饮暴食的现象将会减少，因为个人将不再需要 依靠暴饮暴食作为短暂奖励的主要来源。RRT指出，为了过上令人满意的生活， 个人需要在两个重叠但可区分的领域体验到足够的回报： 短暂的奖励(即对当下快乐的积极体验)和持续的奖励(即更深层次的奖励 以及更持久的满足感和意义，这源于建立个人有价值的生活)。一把钥匙 RRT的一个方面是强调建立持久和有意义的社会关系，因为有明确的证据 社会活动和社会关系可以提高短期奖励和持续奖励。在 目前的研究，我们将修改我们现有的10节组RRT治疗手册，以具体解决 在新冠肺炎大流行期间，在提高瞬时和持续奖励方面的挑战。我们会 进行一项小型试验性随机对照试验，随机选择接受10次随机对照试验的个体(n=30)或 支持性治疗(n=30)，均通过视频会议软件作为小组治疗提供，以评估 随机对照试验的可行性、可接受性、目标参与度和初步疗效估计。

PROJECT SUMMARY Public health approaches to reducing the spread of COVID-19 such as social distancing, shelter-in-place orders, quarantine, telework, and remote learning have produced a sudden and widespread disruption to social networks. The observed disruptions to social networks are leading to increases in social isolation and loneliness and limited opportunities to obtain sufficient reward from day-to-day life activities. Reduced exposure to day-to- day sources of reward can lead to a hypo-reward response to conventionally rewarding stimuli and reduce an individual’s motivation to engage in activities that they usually find pleasurable. When insufficient pleasure is experienced from day-to-day life activities, some individuals may be more likely to seek out stimuli that can immediately and powerfully activate neural reward pathways. A hyper-reward response to disorder specific stimuli may develop as individuals seek out larger quantities or more frequent exposure to a limited range of intensely stimulating sources of reward. Collectively, this may produce a reward imbalance such that individuals achieve very little reward from typically enjoyable day-to-day life activities and instead achieve most of their reward from behaviors or substances that have high potential for adverse consequences. While the reward imbalance is likely a relevant maintenance factor for numerous mental health conditions, there is a strong body of literature suggesting that individuals with an eating disorders (ED) characterized predominately by binge eating experience a reward imbalance. Prior to the COVID-19 pandemic, our team began to develop a novel group-based treatment approach for transdiagnostic binge eating that we call Reward Re-Training (RRT). RRT is designed to indirectly change disordered eating behaviors by directly focusing on building a more rewarding life. RRT hypothesizes that reductions in binge eating will occur as life becomes more rewarding because individuals will no longer need to rely on binge eating as a primary source of momentary reward. RRT notes that in order to live a satisfying life, individuals need to experience an adequate amount of reward in two overlapping yet distinguishable domains: momentary reward (i.e., the active experience of pleasure in the moment) and sustained reward (i.e., a deeper and more long-lasting sense of fulfillment and meaning that arises from building a personally valued life). A key aspect of RRT is an emphasize on building lasting and meaningful social relationships given the clear evidence that social activities and social connection can enhance both momentary reward and sustained reward. In the current study, we will revise our existing 10-session group RRT treatment manual to specifically address the challenges in enhancing both momentary and sustained reward during the COVID-19 pandemic. We will conduct a small pilot RCT that will randomize individuals to receive either 10-sessions of RRT (n=30) or supportive therapy (n=30), both delivered as group-treatments via videoconferencing software, to evaluate the feasibility, acceptability, target engagement and preliminary estimates of efficacy for RRT.