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成为一名独立的临床研究人员，专门从事饮食失调治疗结果的研究，并促进该研究转化为临床实践。暴食症（BED）是DSM-IV中提出的一个诊断类别，是一种慢性疾病，其特征是饮食失调病理、共同发生的身体和精神状况、社会心理功能受损以及与超重和肥胖相关，是一种临床严重的饮食失调和重大的公共卫生问题。鉴于认知行为疗法（CBT）和人际心理治疗（IPT）的管理成本和时间要求，引导自助治疗（GSH）对BED似乎很有希望，而且可能比有效的专业治疗（如CBT）和人际心理治疗（IPT）更容易推广。拟议的研究使用了一种新的基于群体的、有指导的自助BED治疗方法，称为综合反应疗法（IRT），该方法由候选人编写初步治疗手册，并对干预进行试点测试。IRT主要基于暴饮暴食的影响调节理论（例如，暴饮暴食是一种改变痛苦情绪状态的尝试），同时增加了认知重组技术。IRT教授有效的方法来应对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（如饥饿、睡眠剥夺）、人际冲突，以及可能时不愉快的外部事件。IRT的主要目标是显著减少暴饮暴食的发作和相关的饮食失调病理。[拟议的研究将采用随机设计来评估两种基于小组的指导自助治疗的疗效：IRT和CBT指导自助，一种已知疗效的治疗方法，以小组形式（CBT- gshg），并探索(1)治疗的调节因子和中介因子，](2)两种治疗的相对成本效益，以及(3)组间在次要测量（例如，饮食失调和一般精神病理学）上的差异。拟议的研究将为确定在随后的更大规模的试验中应该研究哪种谷胱甘肽治疗奠定基础，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)参与工具性饮食失调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)在随机临床试验中担任首席研究员（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，能够获得未来以患者为导向的饮食失调研究的RO1支持。该奖项代表了培训和应用的理想结合，使候选人在当前的职业生涯阶段成熟和进步。

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).