UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa

描述（由申请方提供）：本R 01是为响应RFA-MH-07-090治疗青春期后期和成年期神经性厌食症的创新试验而提交的。特别关注成人神经性厌食症（AN），我们建议将一个擅长治疗AN的团队的专业知识与世界领先者结合起来，开发基于夫妇的干预措施，为其中一名成员患有AN的夫妇开发创新干预措施。干预“UCAN：联合夫妇（治疗）神经性厌食症“承认AN发生在人际环境中，既受到人的社会环境的影响，又影响重要的人际关系。此外，家庭治疗对年轻AN患者的成功证明强调了在AN治疗中利用家庭支持的重要性。UCAN定制了基于认知行为的夫妇干预措施，这些干预措施已成功用于治疗抑郁症，焦虑症，戒烟和癌症，以解决AN的核心精神病理学，同时还解决AN对亲密关系的独特和具有挑战性的压力。我们对干预的初步概念化首先侧重于在与焦点的关系背景下解决AN，例如改变围绕饮食和体重的相互作用，使活动和健康行为正常化，身体形象，身体情感和性行为，其次是解决更广泛的关系，以保持治疗收益，防止复发，并培养关系满意度。具体目标是：1）为其中一方患有AN的夫妇开发和标准化手动干预; 2）在开放试验中确定UCAN的β版本作为常规治疗（TAU）的增强的可行性和可接受性，并根据初步试验的反馈改进UCAN; 3）在24对夫妇中，其中一人患有AN的随机对照试验中测试UCAN+TAU与TAU;以及4）采用观察性夫妇评估措施，最终目标是纳入亲密关系和压力的生物措施。我们的主要患者结果将是BMI和整体改善，我们的次要患者结果将是抑郁，焦虑，关系调整和沟通。合作伙伴的成果还将包括支持措施。本试验将明确设计为收集初步结局数据，为后续更大规模的随机对照试验提供样本量和把握度计算信息。这项研究的结果有可能导致创建一个有效的，可接受的，发育定制的干预，将改善核心AN病理以及夫妇功能。未来的干预扩展将包括以夫妇为基础的饮食失调干预，如神经性贪食症和暴食症。我们建议为患有神经性厌食症的成年人制定一项以夫妇为基础的干预措施，名为“UCAN：联合夫妇（治疗）神经性厌食症。“我们将创造一种有效的，可接受的，发展定制的干预措施，利用合作伙伴的支持，以改善核心神经性厌食症的病理以及夫妇的功能。

DESCRIPTION (provided by applicant): This R01 is submitted in response to RFA-MH-07-090 Innovative Trials for the Treatment of Anorexia Nervosa in Late Adolescence and Adulthood. With a specific focus on adult anorexia nervosa (AN), we propose to unite the expertise of a team skilled in the treatment of AN with world leaders in the development of couple-based interventions to develop an innovative intervention for couples in which one member is suffering from AN. The intervention "UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa" acknowledges that AN occurs in an interpersonal context, both being affected by the person's social environment and impacting important interpersonal relationships. Moreover, the demonstrated success of family therapy for younger individuals with AN underscores the importance of leveraging family support in the treatment of AN. UCAN tailors cognitive-behavioral couple-based interventions that have been employed successfully for the treatment of depression, anxiety disorders, smoking cessation, and cancer to address the core psychopathology of AN, while also addressing the unique and challenging stresses that AN places on intimate relationships. Our initial conceptualization of the intervention focuses first on addressing AN within the context of the relationship with foci such as altering interactions around eating and weight, normalizing activity and health behaviors, body image, physical affection, and sexuality and second on addressing the broader relationship to maintain treatment gains, prevent relapse, and foster relationship satisfaction. The specific aims are: 1) to develop and standardize a manualized intervention for couples in which one member suffers from AN; 2) to determine feasibility and acceptability of a beta- version of UCAN in an open trial as an augmentation to treatment as usual (TAU) and to refine UCAN based on feedback from the preliminary trial; 3) to test UCAN+TAU versus TAU in a randomized controlled trial of 24 couples in which one member has AN; and 4) to adapt an observational couples assessment measure with the eventual goal of incorporating biological measures of affiliation and stress. Our primary patient outcomes will be BMI and global improvement, and our secondary patient outcomes will be depression, anxiety, and relationship adjustment and communication. Partner outcomes will also include caregiving measures. This trial will be designed explicitly to gather preliminary outcome data to inform sample size and power calculations for a subsequent larger randomized controlled trial. Findings from this investigation have the potential to result in the creation of an effective, acceptable, developmentally tailored intervention that will improve both core AN pathology as well as couple functioning. Future extensions of the intervention will include couple-based interventions for eating disorders such as bulimia nervosa and binge eating disorder. We propose to develop a couple-based intervention for adults with anorexia nervosa entitled "UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa." We will create an effective, acceptable, developmentally tailored intervention that leverages the support of partners to improve both core anorexia nervosa pathology as well as couple functioning.