Breaking the Cycle of Risk: Intervention for Mothers with Eating Disorders

描述(申请人提供)：虽然进食障碍，特别是神经性厌食症会影响生育，但许多有进食障碍和进食障碍病史的女性正在成为母亲。这些妇女中的许多人在怀孕期间难以获得足够的营养，难以开始和维持母乳喂养，难以充分滋养子女，难以调整子女对饮食的期望，也难以判断子女的正常饮食和病态饮食。这些母亲非常有动力寻求指导，以帮助降低孩子患饮食失调的风险。这项拟议的探索性研究拨款(R34)旨在为现在或过去患有饮食障碍的母亲开发一种称为育儿(网络、团结和伸手升级关系和饮食)的育儿干预措施。我们的干预是基于母亲患有饮食障碍的焦点小组的初步信息和现有的研究。我们将系统地为有阈值和阈值下饮食障碍病史的母亲开发一种手动干预措施，这些母亲的孩子在0-2岁之间。该R34的具体目标是：1)为患有饮食障碍的母亲开发并标准化模块化的手动干预措施，以促进治疗师的培训和治疗的传播；2)在一项小型、随机、延迟进入的对照试验中实施FORTURE，以确定可行性和可接受性；2)评估在提高目标结果方面，立即接受FORTURE治疗是否优于延迟进入对照治疗；以及4)确定潜在的治疗主持人和调解人。我们的主要结果将是对录制的母婴用餐时间互动的观察者评分，次要结果将包括对一般育儿自我效能感和促进孩子社交和情感成长的母亲行为的衡量。这项试验将明确地设计为收集初步结果数据，为后续更大规模的随机对照试验提供样本量和功率计算信息。这项调查的结果有可能开发出一种有效和可接受的干预措施，提高患有饮食障碍的母亲的喂养相关和一般养育效率。干预措施的扩展将包括为不同年龄段儿童的母亲提供适合发育的模块，以及基于网络的变体，以优化干预措施的传播。

DESCRIPTION (provided by applicant): Although eating disorders, particularly anorexia nervosa, can affect fertility, many women with eating disorders and eating disorder histories are becoming mothers. Many of these women have difficulty achieving adequate nutrition during pregnancy, initiating and maintaining breastfeeding, adequately nourishing their children, modulating expectations regarding eating in their children, and judging what is normative and what is pathological in their children. These mothers are highly motivated to seek guidance to help reduce their children's risk of eating disorders. This proposed Exploratory Research Grant (R34) aims to develop a parenting intervention for mothers with current or past eating disorders called NURTURE (Networking, Uniting, and Reaching out To Upgrade Relationships and Eating). Our intervention is based on preliminary information from focus groups with mothers with eating disorders and extant research. We will systematically develop a manualized intervention for mothers with histories of threshold and subthreshold eating disorders who have children between the ages of 0-2. The specific aims of this R34 are: 1) to develop and standardize a modular manualized intervention for mothers with eating disorders to facilitate therapist training and treatment dissemination; 2) to implement NURTURE in a small, randomized, delayed entry controlled trial to determine feasibility and acceptability; 2) to evaluate whether immediate treatment with NURTURE is superior to a delayed entry control for improving targeted outcomes, and 4) to identify potential moderators and mediators of treatment. Our primary outcome will be observer ratings of videotaped maternal-child mealtime interactions and secondary outcomes will include measures of general parenting self-efficacy and maternal behaviors that enhance the social and emotional growth of their children. 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. Results of this investigation have the potential to develop an effective and acceptable intervention that will improve both feeding-related and general parenting efficacy in mothers with eating disorders. Extensions of the intervention will include developmentally appropriate modules for mothers of children of various ages as well as web-based variants to optimize dissemination of the intervention.