Developing a Brief Cognitive-Behaviour Therapy for Underweight Eating Disorders

本项目将探索适应性认知行为疗法(CBT)干预治疗体重不足饮食障碍的可行性、可接受性和初步效果。它将通过将现有的心理治疗扩展到新的人群，改善患者结果和治疗机会，从而促进知识的传播。这与福祉、健康和社区(WHC)路径精神健康议程一致。简介针对体重不足的饮食障碍(尤其是神经性厌食症)的心理治疗选择效果有限，恢复率低，生活质量降低(Solmi等人，2021年)。神经性厌食症影响了英国125万饮食失调患者中的8%(北达科他州比特)。它涉及一系列的生理和心理特征，如低体重(典型的BMI&lt；18.5)以及围绕食物和身体形象的混乱的思想、感觉和行为。这使得它特别难治疗，与非体重不足的饮食障碍相比，结果很差(约25%对50%的恢复率)(Waller，2016)。对治疗的需求、长时间的治疗(超过一年)和糟糕的恢复率导致了漫长的等待名单，自新冠肺炎大流行以来，这种情况已经恶化(Robinson等人，2020年)。(2019)最近为非低体重饮食障碍(例如神经性暴食症)开发了一种基于CBT的简短干预(CBT-T)，为期10次，而不是NICE(NICE，2020)建议的20次。到目前为止的研究报告了中到大的效果规模(Rose等人，2021年；Tatham等人，2020年)，表明更简单的治疗方法可以既有效又高效。这种疗法强调循证因素(例如，饮食的早期变化；暴露疗法的使用；身体成像工作)。这些功能有可能被带到更简单的体重不足饮食障碍的工作中。然而，一种更简单的治疗神经性厌食症的方法是否有效仍有待确定。CBT-T的原则符合神经性厌食症患者的需求。早期体重恢复和暴露在对体重增加的焦虑中是必要的因素(Steinglass等人，2011年)，这是CBT-T的关键。然而，它们不是现有的神经性厌食症CBT推荐的一部分(Murphy等人，2010年)，这可能解释了现有治疗方法有限的结果。此外，这些方法往往被大多数从业者忽视(Waller等人，2012年)，通常是因为暴露在环境中对患者和从业者来说都可能是不舒服和引发焦虑的。提供这些诱导焦虑的治疗元素需要从业者在同理心的提供和遵守治疗指南之间取得平衡(Elliott等人，2011年)。CBT-T直接在患有非低体重饮食障碍的个体中解决这个问题，因此很可能适用于治疗神经性厌食症。然而，它还没有在这个临床群体中进行测试。因此，本项目将寻求开发和试验适用于体重不足饮食障碍的CBT-T-T(CBT-T-AN)，探索其可行性、可接受性和有效性。作为现有治疗神经性厌食症的CBT的一半，它具有提高效率和大幅减少等待名单的潜力，从而提高生活质量和患者的治疗体验。它将通过使现有的心理干预适应新的人群来满足博士要求。与西隧路径的精神健康议程相一致，该项目的总体目标是在解决治疗供不应求的经济和社会政治问题的同时，为改善患者的结果做出贡献。

This project will explore the feasibility, acceptability, and preliminary effectiveness of an adapted Cognitive Behavioural Therapy (CBT) intervention for treating underweight eating disorders. It will contribute to knowledge by extending an existing psychological treatment to a novel population, improving patient outcomes and treatment access. This aligns with the Wellbeing, Health, and Communities (WHC) Pathway mental health agenda.IntroductionPsychological treatment options for underweight eating disorders (particularly anorexia nervosa) have limited effectiveness, with low recovery rates and reduced life quality (Solmi et al., 2021). Anorexia nervosa affects 8% of the UK's 1.25m people with eating disorders (BEAT, n.d.). It involves a range of physiological and psychological characteristics, such as low weight (typically BMI<18.5) and disordered thoughts, feelings, and behaviours around food and body image. These make it particularly difficult to treat, with poor outcomes relative to non-underweight eating disorders (around 25% versus 50% recovery rate) (Waller, 2016). Demand for treatment, long treatments (over a year), and poor recovery rates result in long waiting lists, which have worsened since the COVID-19 pandemic (Robinson et al., 2020).Waller et al. (2019) recently developed a brief CBT-based intervention (CBT-T) for non-underweight eating disorders (e.g., bulimia nervosa), taking ten sessions rather than NICE's (NICE, 2020) recommended twenty. Research to date reports medium-to-large effect sizes (Rose et al., 2021; Tatham et al., 2020), showing briefer therapies can be both effective and efficient. This therapy stresses evidence-based elements (e.g., early changes in eating; use of exposure therapy; body image work). These features have the potential to be carried over to briefer work with underweight eating disorders. However, it remains to be established whether a briefer approach to anorexia nervosa can be effective.The principles of CBT-T are compatible with the needs of anorexia nervosa patients. Early weight restoration and exposure to anxiety about weight gain are necessary elements (Steinglass et al., 2011), key to CBT-T. However, they are not part of existing CBT recommendations for anorexia nervosa (Murphy et al., 2010), potentially explaining existing therapies' limited outcomes. Furthermore, these methods tend to be neglected by most practitioners (Waller et al., 2012), typically because typically because exposure can be uncomfortable and anxiety-provoking for both patients and practitioners. Delivering these anxiety-inducting elements of therapy require practitioners to balance empathic delivery with adhering to treatment guidelines (Elliott et al., 2011). CBT-T address this issue directly in individuals with non-underweight eating disorders and is therefore likely to be applicable to treating anorexia nervosa. However, it has not yet been tested with this clinical group.This project will therefore seek to develop and pilot an adapted version of CBT-T for underweight eating disorders (CBT-T-AN), exploring its feasibility, acceptability, and effectiveness. Being half the length of existing CBT for anorexia nervosa, it has the potential to enhance efficiency and reduce waiting lists substantially, thus enhancing quality of life and patients' therapeutic experience. It will meet PhD requirements by adapting an existing psychological intervention to a novel population. Aligned with the WHC Pathway's mental health agenda, this project's overall aim is to contribute to improved patient outcomes whilst addressing economic and socio-political problems of treatment demand outstripping supply.