Comparison of Integrative Response Therapy and Cognitive Behavioral Therapy Guide

描述（由申请人提供）：候选人的长期职业目标是建立自己作为一个独立的临床研究人员，专门从事饮食失调治疗结果的研究，并促进这种研究转化为临床实践。暴食症（BED）是DSM-IV中提出的诊断类别，是一种慢性疾病，其特征在于饮食障碍病理学，共同发生的身体和精神状况，心理社会功能受损以及与超重和肥胖相关的组合，是一种临床严重程度的饮食障碍，也是一个重要的公共卫生问题。引导自助治疗（GSH）床似乎有前途，可能更容易传播比有效的专业治疗，如认知行为疗法（CBT）和人际心理治疗（IPT），后者的管理成本和时间要求。这项拟议的研究使用了一种新的基于小组的指导自助BED治疗，称为综合反应疗法（IRT），候选人编写了初步治疗手册并对干预措施进行了试点测试。IRT主要基于暴饮暴食的情绪调节理论（例如，暴饮暴食是试图改变痛苦的情绪状态），同时增加认知重建技术。IRT教导有效的方法来科普厌恶情绪和重构错误的认知，同时减少可能导致有问题的情绪反应和认知的脆弱性，如身体需求（例如，饥饿、睡眠不足）、人际冲突，以及（如果可能的话）不愉快的外部事件。IRT的主要目标是显著减少暴饮暴食和相关饮食失调病理的发生。[The所提出的研究将采用随机设计来评估两种基于组的引导自助治疗的功效：IRT和CBT引导自助，一种已知功效的治疗，以组形式（CBT-gshG），并探索（1）治疗的调节剂和介导剂，]（2）两种治疗的相对成本效益，和（3）组间次要测量（例如，进食障碍和一般精神病理学）。这项拟议的研究将为确定在随后的更大规模的试验中应研究哪种GSH治疗奠定基础，该试验将评估治疗BED的临床相关算法。候选人获得K23奖的目标是：（1）参与工具性进食障碍研究和成本效益分析培训，（2）积极与导师和顾问合作并向其学习，（3）参与随机临床试验的主要研究者责任（即，制定、实施、监测和评估研究方案），（4）为有效的BED治疗文献做出有意义的贡献，（5）准备成为一名成功的独立研究者，能够获得未来的RO 1支持，以患者为导向的进食障碍研究。该奖项代表了培训和应用的理想成熟和推进候选人的当前职业阶段的关键组合。 公共卫生相关性：BED是一种慢性疾病，其特征是进食障碍、精神病理学以及身体和社会残疾，是一个重要的公共卫生问题。引导式自助（GSH）治疗BED看起来很有前途，可能更容易传播给精神卫生保健提供者，患者可以获得，并且比现有的有效的BED专业治疗更具成本效益，这些治疗在公共卫生效用和影响方面有限，因为它们的时间和费用要求。本研究旨在比较两种GSH治疗方法，IRT（一种基于暴食情绪调节模型的新的、基于群体的方法）（已知疗效的治疗，以小组形式，并基于暴食的约束模型），以确定哪种治疗更有效或建立其等效性，并探索（a）治疗的调节剂和介导剂，（B）治疗的相对成本效益，（c）组间次要指标的差异（例如，进食障碍和一般精神病理学）。

DESCRIPTION (provided by applicant): The candidate's long-term career goal is to establish herself as an independent clinical researcher specializing in eating disorder treatment outcome research and facilitating the translation of such research into clinical practice. Binge Eating Disorder (BED), a proposed diagnostic category in DSM-IV and a chronic condition characterized by a combination of eating disorder pathology, co-occurring physical and psychiatric conditions, impaired psychosocial functioning, and association with overweight and obesity, is an eating disorder of clinical severity and a significant public health problem. Guided self-help treatments (GSH) for BED appear promising and may be more readily disseminable than efficacious specialty treatments such as Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) given the latter's administration costs and time requirements. The proposed study uses a new group-based, guided self-help BED treatment called Integrative Response Therapy (IRT), an approach for which the candidate wrote the preliminary treatment manual and pilot tested the intervention. IRT is primarily based upon the affect regulation theory of binge eating (e.g., binge eating is an attempt to alter distressing emotional states), while adding cognitive restructuring techniques. IRT teaches effective ways to cope with aversive emotions and reframe faulty cognitions while reducing vulnerabilities that are likely to lead to problematic emotional responding & cognitions such as physical needs (e.g., hunger, sleep deprivation), interpersonal conflict, and, when possible, unpleasant external events. IRT's primary goal is to significantly decrease episodes of binge eating and associated eating disorder pathology. [The proposed study will employ a randomized design to evaluate the efficacy of two group-based guided self- help treatments: IRT and CBT Guided Self-Help, a treatment of known efficacy, in group-format (CBT-gshG), and explore (1) moderators and mediators of treatment,] (2) the relative cost-effectiveness of the two treatments, and (3) between group differences on secondary measures (e.g., eating disorder and general psychopathology). The proposed study will lay the groundwork for identifying which GSH treatment should be investigated in a subsequent, larger trial that would evaluate a clinically relevant algorithm for the treatment of BED. The candidate's aims for this K23 award are to: (1) participate in instrumental eating disorder research and cost-effectiveness analysis training, (2) actively collaborate with and learn from mentor and consultants, (3) engage in Principal Investigator responsibilities for a randomized clinical trial (i.e., develop, implement, monitor, and evaluate study protocol), (4) contribute meaningfully to the literature on efficacious BED treatments, and (5) prepare to become a successful and independent investigator capable of obtaining future RO1 support for patient-oriented eating disorder research. This award represents a critical combination of training and application ideal for maturing and advancing the candidate's current career stage. PUBLIC HEALTH RELEVANCE: BED, a chronic condition characterized by eating disorder psychopathology and physical and social disability, represents a significant public health problem. Guided Self Help (GSH) treatments for BED appear promising and may be more readily disseminable to mental health care providers, accessible to patients, and cost- effective than existing, efficacious BED specialty treatments which are limited in public health utility and impact given their time and expense demands. This study proposes to compare two GSH treatments, IRT (a new, group-based approach based on the affect regulation model of binge eating) to CBT-gshG (a treatment of known efficacy, in group format, and based on the restraint model of binge eating) to ascertain which treatment is more efficacious or establish their equivalence, and explore (a) moderators and mediators of treatment, (b) the relative cost-effectiveness of the treatments, (c) between group differences on secondary measures (e.g., eating disorder and general psychopathology).