Guided Self-Help for Eating Disorders

描述（由申请人提供）：神经性贪食症（BN）和涉及暴饮暴食的相关进食障碍（例如，未特别说明的饮食失调症（EDNOS;暴食症，BED）是严重的心理健康问题，特别是在年轻成年妇女中，但也越来越多地出现在男子中。BN及其频谱变体与不良的长期健康和心理健康结果相关。这些疾病也与提高卫生服务利用率有关，但这些服务很少专门针对进食障碍（艾德）。认知-行为疗法（CBT），由受过训练的专业人员提供特定的专业知识，被认为是治疗BN的选择，也被证明是有效的治疗床。然而，研究发现，这种基于证据的治疗方法只适用于少数艾德患者：很少有人接受专门针对艾德的治疗，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具传播性的CBT形式，作为从最小干预到日益复杂的治疗模式的重要一步。几项研究报告了成功使用基于CBT的引导自助（GSH）治疗BN和BED，但数据受到样本量小，患者范围有限和随访时间非常短的限制。最后，鉴于寻求治疗的比率较低，分级护理方法应包括主动尝试接触艾德患者。拟议研究的总体目标是确定CBT-GSH的可接受性和有效性时，提供给社区人口的妇女和男子严重暴食症后，大规模的推广（筛选）的努力。具体而言，本研究旨在确定CBT-GSH在治疗BN、BED和相关EDNOS中的临床有效性;辅助目的是检查CBT-GSH干预对潜在参与者的可接受性以及CBT-GSH相对于健康维护组织中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至35岁之间）的随机样本进行暴食症筛查，并在CBT-GSH的随机临床试验中招募285名BN，BED或EDNOS女性和男性的估计样本。主要结果将是暴饮暴食的变化。次要结果将包括相关饮食病理学的变化（例如，体像障碍），相关的精神病理学（例如，抑郁症），功能障碍，身体质量指数和卫生服务的使用。这项拟议的研究将回答这个问题，即CBT- GSH是否是治疗暴食症的有效早期干预措施。

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.