Guided Self-Help for Eating Disorders

描述（由申请人提供）：神经性贪食症（BN）和与暴饮暴食相关的饮食失调（例如，未另行说明的饮食失调，EDNOS；暴饮暴食失调，BED）是严重的心理健康问题，特别是在年轻成年女性中，但也越来越多地出现在男性中。BN及其谱变异与不良的长期健康和精神健康结果有关。这些疾病也与较高的卫生服务利用率有关，但这些服务很少专门针对饮食失调（ED）。认知行为疗法（CBT）由训练有素的专业人员提供，具有特定的专业知识，被认为是治疗BN的选择，也被证明对治疗BED有效。然而，研究发现，这种基于证据的治疗方法只适用于少数ED患者：很少有人接受专门针对ED的治疗，即使他们接受了治疗，大多数治疗师也会使用CBT以外的治疗方法。专家们呼吁开发一种更容易传播的CBT形式，作为从最小干预到日益复杂治疗的治疗模式的重要一步。一些研究报道了基于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、患者范围有限和随访时间短的限制。最后，鉴于寻求治疗的比率较低，阶梯式护理方法应包括主动尝试接触ED患者。本研究的总体目的是确定CBT-GSH在大规模外展（筛查）后对社区严重暴食症男女人群的可接受性和有效性。具体而言，本研究旨在确定CBT-GSH治疗BN、BED及相关EDNOS的临床疗效；辅助目的是检查潜在参与者对CBT-GSH干预的可接受性，以及在健康维护组织中，CBT-GSH相对于常规临床护理的成本效益。我们建议随机筛选30,000名患有暴食症的成年人（年龄在18至35岁之间），并在CBT-GSH的随机临床试验中招募大约285名患有BN、BED或EDNOS的女性和男性。主要的结果将是暴饮暴食的改变。次要结局将包括相关饮食病理（如身体形象障碍）、相关精神病理（如抑郁）、功能障碍、体重指数和卫生服务使用的变化。拟议的研究将回答CBT- GSH是否是治疗暴食症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.