Comparison of two guided self-help treatments for binge eating disorder

描述(由申请人提供)：应聘者的长期职业目标是成为一名独立的临床研究人员，专门从事进食障碍治疗结果研究，并促进将此类研究转化为临床实践。暴饮暴食障碍(Bed)是DSM-IV中建议的诊断类别，是一种慢性疾病，其特征是进食障碍病理、共生的身体和精神疾病、心理社会功能受损以及与超重和肥胖有关，是一种临床严重的饮食障碍，是一个重大的公共卫生问题。由于认知行为疗法(CBT)和人际心理疗法(IPT)等有效的专业疗法的管理成本和时间要求，引导的床上自助疗法(GSH)似乎更有希望，而且可能比有效的专业疗法更容易传播。这项拟议的研究使用了一种新的基于群体的、有指导的自助床上治疗方法，称为综合反应治疗(IRT)，候选人为这种方法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，暴饮暴食是一种试图改变痛苦情绪状态的尝试)，同时增加了认知重组技术。IRT教授应对不良情绪和重新构建错误认知的有效方法，同时减少可能导致有问题的情绪反应的脆弱性&认知，如身体需求(例如，饥饿、睡眠不足)、人际冲突，以及在可能的情况下，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的饮食失调病理事件。[拟议的研究将采用随机设计来评估两种以小组为基础的指导自助治疗的疗效：IRT和CBT指导自助，一种疗效已知的小组形式的治疗(CBT-GshG)，并探索(1)治疗的调节剂和媒介，](2)这两种治疗的相对成本-效果，以及(3)两组之间在辅助措施(例如，进食障碍和一般精神病理学)上的差异。这项拟议的研究将为确定在随后的更大规模的试验中应该调查哪种GSH疗法奠定基础，该试验将评估临床上相关的BED治疗算法。候选人的K23奖项的目标是：(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他们学习，(3)参与随机临床试验的首席研究员责任(即开发、实施、监测和评估研究方案)，(4)对有效床上治疗的文献做出有意义的贡献，以及(5)准备成为一名成功的独立研究员，能够获得未来以患者为导向的进食障碍研究的RO1支持。这一奖项代表了培训和应用的关键结合，是候选人成熟和提升当前职业阶段的理想选择。

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.