Guided Self-Help for Eating Disorders

描述(由申请人提供)：神经性暴食症(BN)和与暴食有关的饮食障碍(例如，未指明的饮食障碍，EDNOS；暴食障碍，床)是严重的精神健康问题，特别是在年轻的成年女性中，但在男性中也越来越多。BN及其光谱变异与不良的长期健康和精神健康结果相关。这些疾病也与卫生服务利用率的提高有关，但这些服务很少专门针对进食障碍(ED)。认知-行为疗法(CBT)由训练有素的具有特定专业知识的专业人员提供，被认为是治疗BN的首选方法，也被证明在治疗BED方面是有效的。然而，研究发现，这种循证治疗只适用于少数患有ED的人：很少有人接受专门针对ED的护理，而且当他们接受治疗时，大多数治疗师使用CBT以外的治疗方法。专家们呼吁开发一种更易传播的CBT形式，作为从最小干预到越来越复杂的治疗模式中的重要一步。一些研究已经报道了基于CBT的引导自助(GSH)治疗BN和BED的成功应用，但数据受到样本量小、患者范围有限和非常短的随访的限制。最后，鉴于寻求治疗的比率很低，分级护理方法应包括主动尝试接触ED患者。这项拟议研究的总体目标是确定CBT-GSH在大规模外展(筛查)努力后用于患有严重暴饮暴食障碍的社区人群时的可接受性和有效性。具体地说，这项研究旨在确定CBT-GSH治疗BN、BED和相关EDNOS的临床有效性；辅助目的是检查CBT-GSH干预措施对潜在参与者的可接受性，以及CBT-GSH相对于健康维护组织的常规临床护理的成本效益。我们建议对30,000名成年人(年龄在18岁到35岁之间)进行暴饮暴食障碍的随机样本筛查，并在BN、BED或EDNOS患者中招募约285名男性和女性参加CBT-GSH的随机临床试验。主要结果将是改变暴饮暴食的状况。次要结果将包括与进食相关的病理变化(例如，身体形象障碍)、相关的精神病理(例如，抑郁症)、功能障碍、身体质量指数和卫生服务使用情况。这项拟议的研究将回答CBT-GSH是否是治疗暴饮暴食障碍的有效早期干预措施的问题。

DESCRIPTION (provided by applicant): Bulimia nervosa (BN) and related eating disorders involving binge eating (e.g., Eating Disorder not Otherwise Specified, EDNOS; Binge Eating Disorder, BED) are serious mental health problems, particularly among young adult women but increasingly also among men. BN and its spectrum variants are associated with adverse long-term health and mental health outcomes. These disorders also are associated with elevated health services utilization, yet these services rarely target the eating disorder (ED) specifically. Cognitive- Behavioral Therapy (CBT), offered by trained professionals with specific expertise, is considered the treatment of choice f or BN and has also been shown to be effective in treating BED. Studies have found, however, that this evidence-based treatment reaches only a minority of individuals with an ED: few individuals receive care specifically for an ED, and when they do, most therapists use treatments other than CBT. Experts have called for the development of a more disseminable form of CBT as an important step within a model of treatment that progresses from minimal interventions to increasingly complex treatments. Several studies have reported the successful use of CBT-based Guided Self-Help (GSH) treatments for BN and BED, but the data are limited by small sample sizes, a restricted range of patients, and very brief follow-up. Finally, in light of the low rates of treatment seeking, the stepped care approach should include a proactive attempt to reach ED patients. The overall aim of t he proposed study is to determine the acceptability and effectiveness of CBT-GSH when delivered to a community population of women and men with a severe binge eating disorder following a large-scale outreach (screening) effort. Specifically, the study aims to determine the clinical effectiveness of CBT-GSH in the treatment of BN, BED and related EDNOS; subsidiary aims are to examine the acceptability of the CBT-GSH intervention t o potential participants and the cost-effectiveness of CBT-GSH relative to usual clinical care in a health maintenance organization. We propose to screen a random sample of 30,000 adults (ages 18 to 35) for binge eating disorders, and enroll an estimated sample of 285 of those women and men with BN, BED or EDNOS in a randomized clinical trial of CBT-GSH. The primary outcome will be change in binge eating. Secondary outcomes will include changes in associated eating pathology (e.g., body image disturbance), associated psychopathology (e.g., depression), functional impairment, body mass index, and health services use. The proposed study will answer the question whether CBT- GSH is an effective early step intervention for the treatment of binge eating disorders.