Breaking the Cycle of Risk: Intervention for Mothers with Eating Disorders

描述（由申请人提供）：虽然饮食失调，特别是神经性厌食症，会影响生育能力，但许多有饮食失调和饮食失调史的女性正在成为母亲。这些妇女中的许多人在怀孕期间难以获得足够的营养，开始和维持母乳喂养，充分滋养子女，调节子女对饮食的期望，以及判断子女哪些是规范的，哪些是病态的。这些母亲非常积极地寻求指导，以帮助减少孩子患饮食失调的风险。这项探索性研究拨款（R34）旨在为目前或过去患有饮食失调症的母亲开发一种育儿干预措施，称为NURTURE（联网、团结和伸出手来提升关系和饮食）。我们的干预是基于有饮食失调母亲的焦点小组和现有研究的初步信息。我们将系统地为有阈值和亚阈值饮食障碍病史且孩子年龄在0-2岁之间的母亲开发一种人工干预。本R34的具体目标是：1)为患有饮食失调的母亲开发和标准化模块化人工干预措施，以促进治疗师培训和治疗传播；2)在一项小型、随机、延迟进入的对照试验中实施NURTURE，以确定其可行性和可接受性；2)评估立即使用NURTURE治疗是否优于延迟进入对照治疗，以改善目标结果；4)确定治疗的潜在调节因子和调节因子。我们的主要结果将是观察者对母子用餐时间互动录像的评分，次要结果将包括一般父母自我效能和母亲行为的测量，这些行为促进了孩子的社会和情感成长。该试验将明确设计为收集初步结果数据，为后续更大的随机对照试验的样本量和功效计算提供信息。这项调查的结果有可能开发出一种有效和可接受的干预措施，以改善饮食失调母亲的喂养相关和一般育儿效果。干预措施的扩展将包括适合不同年龄儿童的母亲的发展模块以及基于网络的变体，以优化干预措施的传播。

DESCRIPTION (provided by applicant): Although eating disorders, particularly anorexia nervosa, can affect fertility, many women with eating disorders and eating disorder histories are becoming mothers. Many of these women have difficulty achieving adequate nutrition during pregnancy, initiating and maintaining breastfeeding, adequately nourishing their children, modulating expectations regarding eating in their children, and judging what is normative and what is pathological in their children. These mothers are highly motivated to seek guidance to help reduce their children's risk of eating disorders. This proposed Exploratory Research Grant (R34) aims to develop a parenting intervention for mothers with current or past eating disorders called NURTURE (Networking, Uniting, and Reaching out To Upgrade Relationships and Eating). Our intervention is based on preliminary information from focus groups with mothers with eating disorders and extant research. We will systematically develop a manualized intervention for mothers with histories of threshold and subthreshold eating disorders who have children between the ages of 0-2. The specific aims of this R34 are: 1) to develop and standardize a modular manualized intervention for mothers with eating disorders to facilitate therapist training and treatment dissemination; 2) to implement NURTURE in a small, randomized, delayed entry controlled trial to determine feasibility and acceptability; 2) to evaluate whether immediate treatment with NURTURE is superior to a delayed entry control for improving targeted outcomes, and 4) to identify potential moderators and mediators of treatment. Our primary outcome will be observer ratings of videotaped maternal-child mealtime interactions and secondary outcomes will include measures of general parenting self-efficacy and maternal behaviors that enhance the social and emotional growth of their children. This trial will be designed explicitly to gather preliminary outcome data to inform sample size and power calculations for a subsequent larger randomized controlled trial. Results of this investigation have the potential to develop an effective and acceptable intervention that will improve both feeding-related and general parenting efficacy in mothers with eating disorders. Extensions of the intervention will include developmentally appropriate modules for mothers of children of various ages as well as web-based variants to optimize dissemination of the intervention.