Feasibility of Combining Family and Cognitive Therapy to Prevent Chronic Anorexia

描述(由申请人提供)：神经性厌食症(AN)通常始于青春期，是一种严重的精神障碍，与高发病率、死亡率和经济成本有关。虽然以家庭为基础的治疗(FBT)能使大约50%的青少年在短期内完全稳定地康复，但对于那些没有反应并因此面临大约33%的慢性病风险的人，没有基于证据的干预措施。因此，在有合理的成功机会的情况下，有必要进行干预，改变有慢性病风险的年轻患者的轨迹。针对PA-12-279(R34)的这项申请建议研究将认知补救疗法(CRT)与FBT相结合的可行性，以便将来在充分支持的RCT中使用，以降低青少年发展为持续性AN的风险。两项研究表明，强迫症特征水平越高，FBT的结局越差。研究认为，CRT通过促进更灵活和更少持之以恒的思维来解决强迫症思维的认知基础。这些变化反过来可以提高接受保持健康的行为和思想改变的需要的能力。两个小病例系列报告了患有AN的成年人的显著改善。此外，患有FIND CRT的青少年的病例系列数据是可以接受的，并改善了认知过程。我们提出了以下具体目标：目标1：研究将CRT纳入FBT的可行性。我们将检查FBT加CRT的可接受性、招募、评估程序和工具的可行性以及对照治疗(FBT加ART疗法)的可接受性。目的：探讨接受FBT加CRT与FBT加ART治疗的患者在认知方式、体重、饮食相关认知和心理社会功能方面的变化。为了实现目标1，我们将招募30名青少年(年龄12-18岁)，他们在YBC-Ed(Score&Gt；14)上有一个有OC特征的证据。这些参与者将被随机分为FBT(15个疗程)+ART练习(15个疗程)或FBT+CRT(15个疗程)，为期6个月。我们的主要结果是：招聘的可行性、保留率和评估程序的可行性。次要结果(目标2)是神经心理功能、体重、与进食有关的精神病理学和心理社会功能的变化。评估将在四个时间点进行：基线、4周、8周和治疗结束(EOT)。

DESCRIPTION (provided by applicant): Anorexia Nervosa (AN) usually begins during adolescence and is a serious psychiatric disorder associated with high morbidity, mortality, and economic cost. Although Family-Based Treatment (FBT) leads to full and stable recovery in about 50% of adolescents with short duration AN, there are no evidence based interventions for those who do not respond and who, as a result, are at approximately 33% risk for becoming chronically ill. Therefore, it is imperative to intervene to change the trajectory of young patient at risk for becoming chronically ill while there is a reasonable opportunity for success. This application in response to PA-12-279 (R34) proposes to study the feasibility of combining Cognitive Remediation Therapy (CRT) with FBT for future use in an adequately powered RCT to reduce the risk of adolescents developing persistent AN. Two studies suggest that higher levels of obsessional features lead to poorer outcome in FBT. It is proposed that CRT addresses the cognitive underpinnings of obsessional thought by promoting more flexible and less perseverative thinking. These changes could in turn lead to an improved ability to accept the need for change in the behaviors and thoughts that maintain AN. Two small case series report significant improvement in adults with AN. In addition, case series data in adolescents with AN find CRT is acceptable and improves cognitive processes. We propose the following Specific Aims: Aim 1: To examine the feasibility of incorporating CRT in FBT. We will examine acceptability, recruitment, feasibility of assessment procedures and instruments of FBT plus CRT and the acceptability of the comparison treatment (FBT plus art therapy). Aim 2: To explore changes in cognitive style, weight, eating related cognitions, and psychosocial functioning in those who received FBT plus CRT compared to FBT plus art therapy. To accomplish Aim 1, we will recruit 30 adolescents (ages 12-18) with AN and evidence of OC features on the YBC-ED (score >14). These participants will be randomized to either FBT (15 sessions) plus art exercises (15 sessions) for 6 months or FBT plus CRT (15 sessions) for 6 months. Our primary outcomes are: feasibility of recruitment, retention rates, and viability of assessment procedures. Secondary outcomes (Aim 2) are changes in neuropsychological functioning, weight, eating related psychopathology and psychosocial functioning. Assessments will occur at four time points: baseline, 4 weeks, 8 weeks, and end of treatment (EOT).