Effectiveness of Psychological Treatments for BED

描述(申请人提供)：暴食症(床) 以频繁和持续的暴饮暴食和 与进食障碍相关的精神病理学以及普通精神病学 共病、心理社会障碍和肥胖。尽管一个不同的临床 在核心进食障碍上，床与神经性贪食症没有什么区别 饮食、体重和体型等特征。到目前为止还没有 关于什么是床上最有效的治疗，有明确的答案。 专科治疗(例如，人际心理治疗)有 显示出在短期和长期内暴饮暴食和 相关的精神病理，但不是体重。行为减肥(BWL) 干预措施在临床上产生了显著的短期体重减轻和 肥胖者暴饮暴食的减少，但长期的 对暴饮暴食和其他结果的影响尚不清楚。引导式自助 (GSH)在短期内也证明了对床上的疗效。总体目标 这项研究的目的是从概念上比较三种方法的长期效果 以及程序上不同的床上治疗：IPT、BWL和GSH。一个主要问题 Posited是指床上参与者是否需要特殊治疗(即IM或 BWL本身是否足够。BWL具有以下潜在优势 至少在短期内实现减肥，并更容易传播 作为一种广泛应用于肥胖者的非专科治疗。上一首 床上BWL的测试缺乏足够的样本量，有效测量 暴饮暴食，并有足够的长期随访。建议的研究补救措施 这些方法上的缺陷，同时也评估IPT或BWL 有比可信的最低限度的治疗(GSH)更具体的效果 比专业版更简短、成本更低、可传播性更广 给予IPT和BWL治疗。此外，拟议的研究还测试了 不同程度的阴性患者床上治疗的不同效果 影响，这是一个维度，床上参与者可靠地分型。因为IPT 目标负面影响，我们预测IPT将被证明比 对于具有高负面情绪的参与者子集，BWL或GSH。210 超重的床位参与者将被招募，并被分为低负值 影响和高负面影响亚型。参赛者将按以下顺序进行分层 消极情绪亚型和随机化接收三个24周之一 干预：IPT、BWL或GSH。需要两个治疗地点才能招募 所需的大样本，并建立结论的概括性。三分之一 现场将发挥数据协调和评估/处理的功能 疏忽。暴饮暴食和相关结果将在治疗前进行评估， 治疗后，以及6、12和24个月的随访。此外，很可能 将在治疗期间评估变化的调解人。这项研究承诺 不仅阐明了对患有疾病的患者进行最有效的全面治疗 Bed，但也是为了确定针对哪些亚群进行特定治疗 已注明。

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.