Neural response to food stimuli: fMRI changes following cognitive behavioral therapy for binge eating disorder

项目摘要 暴饮暴食症（BED）是一种与肥胖密切相关的使人衰弱的疾病， 在美国常见的饮食失调。对BED的潜在机制知之甚少，阻碍了 开发更有效的治疗方法。特别是，很少有研究检查神经 与BED相关的机制，以及治疗如何影响神经活动。根据Ariana Chao博士的 以前的研究和培训经验，这个K23应用程序准备候选人成为一个 独立的，以病人为导向的护理研究人员。她的长期目标是为减少 通过调查与BED和肥胖相关的生物行为途径， 预防和治疗的目标明确和创新的干预措施。从短期来看，目前 建议将允许赵博士获得新的知识和技能， 研讨会， （导师： 里士满 量身定制的正式课程， 研讨会和体验式学习由一个有成就的，跨学科的导师团队指导 博士托马斯瓦登;共同导师：鲁本古尔博士和卡洛斯格里洛博士;顾问：Therese博士 Russell Shinohara博士）。此外，赵博士将 , 一 进行随机对照试验（RCT） 评估CBT对暴食刺激的神经反应的影响。肥胖伴卧床的女性 将被随机分配到16周的一对一CBT干预组（n=20）或等待名单对照组（WL; n=20）。 两组患者都将接受血氧水平依赖性（BOLD）功能性磁共振成像（fMRI）检查 在基线和16周干预后进行扫描。在扫描过程中，参与者将完成两项任务： 一种用于评估对食物的抑制（即，食物特异性停止信号任务（SST））和一个评估奖励反应 为了召回暴饮暴食（即，脚本驱动的图像）。本研究的主要目的是：1）比较 第16周时，CBT组和WL组在BOLD fMRI对食物特异性刺激的反应变化方面的差异 SST; 2）比较第16周时CBT组和WL组在BOLD fMRI反应变化方面的差异 脚本驱动的暴饮暴食的图像;和3）确定是否治疗前的SST神经激活 和脚本驱动的图像任务预测CBT反应者和非反应者之间的差异（>1狂欢 在过去的28天里吃东西）。我们的探索性目标是：4）评估术前与术后之间的关联， 报告的暴饮暴食事件的治疗行为变化（减少百分比和分类反应）， 奖励性进食驱动、饮食抑制以及治疗前后SST的神经变化 和脚本驱动的想象任务。本研究为进一步提高测量精度提供了重要前景 BED和肥胖症的预防和治疗策略。研究和培训计划是针对 国家护理研究所的目标是整合生物和行为科学，以促进 个性化的健康战略和应用新技术，以促进自我管理干预措施， 改善健康和患者结果。

PROJECT SUMMARY Binge eating disorder (BED) is a debilitating condition that is strongly associated with obesity and is the most common eating disorder in the US. Little is known about mechanisms underlying BED, hampering development of more efficacious treatment approaches. In particular, few studies have examined neural mechanisms related to BED, and how treatment effects neural activity. Building upon Dr. Ariana Chao's previous research and training experiences, this K23 application prepares the candidate to become an independent,patient-oriented nurse researcher. Her long-term goal is to contribute to efforts to reduce the obesity epidemic by investigating biobehavioral pathways associated with BED and obesity, and developing precisely targeted and innovative interventions for prevention and treatment. In the short-term, the current proposal will allow Dr. Chao to obtain new knowledge and skills through a seminars, (Mentor: Richmond tailored set of formal courses, workshops and experiential learning guided by an accomplished, interdisciplinary mentorship team Dr. Thomas Wadden; Co-Mentors: Dr. Ruben Gur nd Dr. Carlos Grilo; Consultants: Dr. Therese and Dr. Russell Shinohara). In addition, Dr. Chao will , a conduct a randomized controlled trial (RCT) assessing the impact of CBT on neural responses to binge eating stimuli. Females who are obese with BED will be randomized to either a 16-week, one-on-one CBT intervention (n=20) or a waitlist control (WL; n=20). Both groups will have blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) scans at baseline and after the 16-week intervention. During the scans, participants will complete two tasks: one to assess inhibition to food (i.e., food-specific stop signal task (SST)) and one to evaluate reward response to recall of binge foods (i.e., script-driven imagery). The primary aims of the study are to: 1) compare differences between the CBT and WL groups at week 16 in changes in BOLD fMRI response to food-specific SST; 2) compare differences between the CBT and WL groups at week 16 in changes in BOLD fMRI response to script-driven imagery of binge foods; and 3) determine whether pre-treatment neural activation on the SST and script-driven imagery task predict differences between CBT responders and non-responders (>1 binge eating episode in the past 28 days). Our exploratory aim is to: 4) assess the associations between pre- to post- treatment behavioral changes in reported binge eating episodes (percent reduction and categorical response), in reward-based eating drive, and in dietary inhibition, and pre- to post-treatment neural changes on the SST and script-driven imagery task. This study will provide an important foreground to improve the precision of prevention and treatment strategies for BED and obesity. The research and training plans are responsive to the National Institute of Nursing Research's goals of integrating biological and behavioral sciences to promote personalized health strategies and applying new technologies to promote self-management interventions that improve health and patient outcomes.