Effectiveness of Psychological Treatments for BED

描述（由申请人提供）：暴食症（BED）是 以频繁和持续的暴饮暴食为特征， 相关的进食障碍精神病理学以及一般精神病学 共病、心理社会障碍和肥胖。虽然一个独特的临床 综合征，BED与核心进食障碍的神经性贪食症难以区分 特征，如饮食，体重和形状的关注。迄今为止还没有 关于什么是最有效的治疗BED的确切答案。 专业治疗（例如，人际心理治疗（IPT） 显示出短期和长期的暴饮暴食显著减少， 与精神病理学有关但体重无关行为减肥（BWL） 干预产生临床上显著的短期体重减轻， 减少肥胖的BED个体的暴饮暴食，但长期 对暴饮暴食和其他结果的影响尚不清楚。引导自助 (GSH)在短期内也证明了对BED的有效性。总体目标 这项研究的目的是比较三种概念性的长期有效性， 以及程序上不同的BED治疗：IPT、BWL和GSH。一个首要问题 提出的问题是BED参与者是否需要专业治疗（即，顶或 BWL本身是否足够。BWL具有以下潜在优势： 至少在短期内， 作为广泛用于肥胖个体的非专业治疗。先前 BWL对BED的测试缺乏足够的样本量， 暴饮暴食和足够的长期随访。拟议的研究补救措施 这些方法上的缺陷，同时也评估是否IPT或BWL 具有超出可信的最低限度治疗（GSH）的特定效果， 更简短，成本更低，比专业人士更广泛地传播 给予IPT和BWL治疗。此外，拟议的研究测试了 这些BED治疗在不同水平的阴性 影响，一个维度沿着，BED参与者可靠地分类型。因为IPT 针对负面影响，我们预测IPT将证明比 无论是BWL或GSH的参与者的子集与高负面影响。210 超重的BED参与者将被招募并分为低阴性 情感和高消极情感亚型。受试者将按以下因素分层： 消极情感亚型，并随机接受三种24周 干预措施：IPT、BWL或GSH。需要两个治疗中心进行招募 所需的大样本，并建立调查结果的普遍性。第三 研究中心将发挥数据协调和评估/处理的功能 上级要员将在治疗前评估暴饮暴食和相关结局， 治疗后以及6个月、12个月和24个月随访时。此外，可能 将在治疗期间评估变化介质。这项研究承诺， 不仅阐明了对患有 BED，但也要确定特定治疗的亚组， 指出了

Description (provided by applicant): Binge Eating Disorder (BED) is characterized by frequent and persistent episodes of binge eating and associated eating disorder psychopathology as well as general psychiatric comorbidity, psychosocial impairment, and obesity. Although a distinct clinical syndrome, BED is indistinguishable from bulimia nervosa on core eating disorder features such as eating, weight, and shape concerns. To date there is no definitive answer as to what constitutes the most efficacious treatment of BED. Specialty treatments (e.g., interpersonal psychotherapy [IPT]) have demonstrated significant short- and long-term reductions in binge eating and associated psychopathology, but not body weight. Behavioral weight loss (BWL) interventions produce clinically significant short-tem weight loss and reductions in binge eating among obese BED individuals, but the long-term impact on binge eating and other outcomes remains unclear. Guided self-help (GSH) has also demonstrated efficacy for BED in the short-term. The overall aim of this study is to compare the long-term effectiveness of three conceptually and procedurally distinct BED treatments: IPT, BWL, and GSH. A primary question posed is whether BED participants require a specialty treatment (i.e., IM, or whether BWL by itself is sufficient. BWL has the potential advantages of producing weight loss, at least in the short term and being more disseminable as a non-specialty treatment widely administered to obese individuals. Previous tests of BWL for BED have lacked adequate sample sizes, valid measurement of binge eating, and sufficient long-term follow-up. The proposed study remedies these methodological shortcomings, while also evaluating whether IPT or BWL have specific effects beyond that of a credible, minimal treatment (GSH) that is briefer, less costly, and more broadly disseminable than the professionally administered therapies of IPT and BWL. Further, the proposed study tests the differential effectiveness of these BED treatments across levels of negative affect, a dimension along which BED participants reliably subtype. Because IPT targets negative affect, we predict that IPT will prove more effective than either BWL or GSH for the subset of participants with high negative affect. 210 overweight BED participants will be recruited and divided into low negative affect and high negative affect subtypes. Participants will be stratified by negative affect sub-type and randomized to receive one of the three 24-week interventions: IPT, BWL, or GSH. Two treatment sites are required to recruit the large sample needed and to establish generalizability of findings. A third site will serve the function of data coordination and assessment/treatment oversight. Binge eating and associated outcomes will be assessed pre-treatment, post-treatment, and at 6-, 12-, and 24-month follow-up. In addition, likely mediators of change will be assessed during treatment. This study promises to not only clarify the most efficacious overall treatment for individuals with BED, but also to identify sub-groups for whom specific treatments are indicated.