Optimizing Relapse Prevention and Changing Habits (REACH+) in Anorexia Nervosa

神经性厌食症是一种严重的精神疾病，具有显著的发病率和死亡率，并且复发。 急性治疗后的发病率从40%到80%不等。AN中的一个中心行为障碍是对 食物摄入，这是由根深蒂固的思想、感觉和惯例推动的。虽然许多方法都是为了 减少复发在尝试了医院护理后，关于哪些治疗元素的信息很少 授予福利。复发预防和改变习惯(REACH+)的目标是对适应不良的习惯性控制 支持AN患者在急性治疗后6个月内的行为，这是AN的高危时期 旧病复发。REACH+建立在初步数据的基础上，这些数据表明，针对 可以导致在急性治疗环境中根深蒂固的行为的改变。这种方法还没有被 专为预防复发而开发。我们将测试治疗组件是否可以中断 习惯性地控制不适应行为，并通过针对这种疾病机制，减少复发和 改善结果。我们将使用多阶段优化策略(MOST)框架，这是一种理想的方法 通过同时有效地评估多种可能的干预措施来提高治疗效果 各组成部分，以确定哪些有助于积极的治疗结果，因此应列入 一套强有力的预防复发的治疗方案。REACH+的每个组件都解决一个问题，即 关键是要回答，以确定和优化复发预防治疗方案，平衡 功效和负担。我们将测试共同针对习惯的5个组件的竞争版本：1) 行为，2)认知，3)动机，4)食物监控，5)技能巩固。首先，我们将进行 准备阶段的最后阶段(包括重点小组)，以最大限度地提高以下项目的可行性和可接受性 干预组件。第二，使用最终的治疗手册进行优化阶段试验 (包括一个在线平台)将在急性后测试每个组件对体重保持的贡献 治疗。我们将为60个人提供6个月的伸展+，通过我们的饮食恢复体重 精神障碍项目。通过远程健康进行的课程将增加心理教育、家庭作业 通过一个在线平台进行任务分配和监测。参与者将被随机分配到不同的 每个治疗组件的版本。优化标准侧重于组件对 体重维持(主要效果)，并将另外考虑效果大小、治疗依从性和结束 治疗状态。这将确保最终的一揽子治疗方案包括最有效和最可行的 在未来的随机对照试验中用于最终测试的组件。这种系统的治疗方法 发展对于最快、最有效地实现最佳结果至关重要。

Anorexia nervosa (AN) is a serious mental illness with significant morbidity and mortality rates, and relapse rates ranging from 40-80% after acute treatment. A central behavioral disturbance in AN is the restriction of food intake, which is promoted by entrenched thoughts, feelings, and routines. While many approaches to reducing relapse after hospital care have been tried, there is little information about which treatment elements confer benefit. Relapse Prevention and Changing Habits (REACH+) targets the habitual control of maladaptive behavior to support patients with AN in the 6 months after acute treatment, a time of high vulnerability to relapse. REACH+ builds on preliminary data that indicate that behavioral interventions that target habits in AN can lead to changes in entrenched behaviors in the acute treatment setting. This approach has not yet been developed for the relapse prevention setting. We will test whether treatment components can interrupt the habitual control of maladaptive behavior and, by targeting this illness mechanism, decrease relapse and improve outcomes. We will use a Multiphase Optimization STrategy (MOST) framework an ideal means for improving treatment efficacy by simultaneously and efficiently evaluating multiple possible intervention components, to determine which contribute to positive treatment outcomes and should therefore be included in a robust treatment package for relapse prevention. Each component of REACH+ addresses a question that is critical to answer in order to identify and optimize a relapse prevention treatment package that balances efficacy and burden. We will test competing versions of 5 components that together target habits: 1) Behavioral, 2) Cognitive, 3) Motivation, 4) Food Monitoring, and 5) Skill Consolidation. First, we will conduct the final stages of the Preparation Phase (including Focus Groups) to maximize feasibility and acceptability of the intervention components. Second, an Optimization Phase experiment with a finalized treatment manual (including an online platform) will test each component's contribution to weight maintenance after acute treatment. We will provide 6 months of REACH+ for 60 individuals with AN, weight-restored via our Eating Disorders Program. Sessions, conducted via telehealth, will be augmented with psychoeducation, homework assignments, and monitoring through an online platform. Participants will be randomly assigned to different versions of each treatment component. Optimization criteria focus on the contribution of the component to weight maintenance (main effect), and will additionally consider effect sizes, treatment adherence, and end-of- treatment status. This will ensure that the finalized treatment package includes the most effective and feasible components for definitive testing in a future randomized controlled trial. This systematic approach to treatment development is critical for achieving the best outcomes most quickly and efficiently.