Behavioral and Momentary Assessment of Fear-based Mechanisms underlying Remission in Weight-restored Anorexia Nervosa

体重恢复神经性厌食症缓解过程中基于恐惧的机制的行为和瞬时评估

• 批准号: 10386020
• 负责人: Caroline Christian
• 金额: $ 3.72万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10386020
• 关键词: Address; Adult; Affective; Anorexia Nervosa; Anxiety; Anxiety Disorders; Award; Behavior; Behavior assessment; Behavioral; Behavioral Paradigm; Caring; Cellular Phone; Cessation of life; Clinical; Cognitive; Cognitive Therapy; Computers; Consultations; Dangerousness; Data; Data Collection; Development; Disease; Disease remission; Eating Disorders; Empirical Research; Environment; Exposure to; Extinction (Psychology); Food; Fright; Future; Goals; Gold; Impairment; Individual; Intake; Intervention; Investigation; Lead; Learning; Literature; Maintenance; Mental disorders; Modeling; Nutritional; Partial Remission; Participant; Pathology; Persons; Play; Population; Population Intervention; Prevalence; Procedures; Process; Recovery; Relapse; Research; Research Design; Resources; Role; Sampling; Self-Examination; Series; Stimulus; Symptoms; Testing; Time; Training; Treatment outcome; United States; Weight; Weight Gain; approach avoidance behavior; approach behavior; avoidance behavior; base; behavior test; career; cognitive enhancement; comorbidity; conditioned fear; cost; critical period; disorder later incidence prevention; experience; food restriction; healthy weight; improved outcome; interest; meetings; mortality; personalized approach; personalized intervention; prevent; preventive intervention; prospective; reduce symptoms; relapse risk; response; standard care; statistics; theories; treatment optimization; trend; vector; weight restoration

Project Summary/Abstract Anorexia nervosa (AN) is a psychiatric illness characterized by low weight, extreme food restriction, intense fear of weight gain, and disturbance in body self-evaluation. AN is markedly persistent, and there are no empirically supported treatments for adults with this deadly illness. Indeed, over half of individuals with AN do not reach full remission during treatment, and approximately one third of individuals experience at least one relapse after discharge. There is great need for identifying remission-promoting targets to adapt and create optimized interventions for this population. The period of partial remission in AN (i.e., weight- restored individuals who continue to endorse significant cognitive-affective AN pathology) represents a critical time for identifying mechanisms underlying remission. Specifically, unaddressed cognitive-affective AN symptoms (e.g., extreme fear of weight gain) at this stage represent the greatest barrier to achieving lasting full remission, and thus, mechanisms underlying the persistence vs. reduction of these symptoms are critical to study at this stage. AN is highly comorbid with anxiety disorders and shares several maintenance factors, including high levels of fear, anxiety, and harm avoidance. Despite considerable overlap with anxiety disorders, fear and avoidance have not been tested as mechanisms inhibiting remission in weight- restored AN. The proposed study will test how fear-based learning (e.g., fear extinction, fear renewal, fear approach, fear avoidance) relates to AN pathology in the naturalistic environment in a sample of 45 individuals meeting criteria for AN in partial remission. This study will use both behavioral assessment (i.e., Approach- Avoidance Task, Behavioral Approach Task, associative fear-learning paradigm) and momentary assessment (i.e., smartphone-based intensive longitudinal data collection) of fear, avoidance, and approach behaviors to conceptualize how these mechanisms of interest operate in the ‘real world’. First, we will test whether behavioral approach, avoidance, fear extinction, and fear renewal are correlated with real-time approach, avoidance, fear, and AN symptoms (Aim 1). Second, vector autoregressive models using the intensive time- series data will elucidate prospective associations across fear-based processes and AN symptoms between subjects (Aim 2) and within individuals (Aim 3) to identify group-level and intraindividual targets for care during this critical stage in recovery. In the between-subjects models, we will test behavioral fear extinction and renewal as moderators (Aim 2). The opportunities, resources, and expert consultation afforded by this award would support my training goals to collect and analyze behavioral data, learn new analytic approaches with intensive longitudinal data, and gain experience working with clinical AN participants. Overall, this proposed study will implement advanced statistics and multimethod research design, conducted fully remotely, at an important stage of AN. These results will inform precision relapse prevention interventions and step-down care, improving outcomes for this impairing, persistent, and costly disorder.

项目概要/摘要 神经性厌食症 (AN) 是一种精神疾病，其特征是体重过轻、极度限制食物、 对体重增加的强烈恐惧，并且身体自我评价障碍明显持续存在。 对于患有这种致命疾病的成年人，没有经验支持的治疗方法。事实上，超过一半的人患有这种致命疾病。 AN 在治疗期间未达到完全缓解，大约三分之一的人会经历 出院后至少有一次复发，非常需要确定促进缓解的目标以适应。 并为该人群制定优化的干预措施 AN 的部分缓解期（即体重）。 继续认可显着的认知情感 AN 病理学的恢复个体）代表了一个关键的 是时候确定缓解的机制了，特别是未解决的认知情感 AN。 此阶段的症状（例如，对体重增加的极度恐惧）是实现持久全面目标的最大障碍。 缓解，因此，这些症状的持续与减轻的机制对于 现阶段的研究表明，AN 与焦虑症高度共存，并且有几个共同的维持因素， 包括高度的恐惧、焦虑和避免伤害，尽管与焦虑有很大的重叠。 疾病、恐惧和回避尚未被测试为抑制体重缓解的机制。 拟议的研究将测试基于恐惧的学习（例如，恐惧消失、恐惧更新、恐惧）如何恢复。 方法，恐惧回避）与 45 名个体样本中自然环境中的病理学相关 达到部分缓解的 AN 标准 本研究将使用两种行为评估（即方法- 回避任务、行为方法任务、联想恐惧学习范​​式）和瞬时评估 （即基于智能手机的密集纵向数据收集）的恐惧、回避和接近行为 首先，我们将测试这些利益机制如何在“现实世界”中运作。 行为接近、回避、恐惧消除和恐惧更新与实时接近相关， 回避、恐惧和 AN 症状（目标 1）。 系列数据将阐明基于恐惧的过程和 AN 症状之间的前瞻性关联 受试者（目标 2）和个人内部（目标 3）以确定群体层面和个人内部的护理目标 在恢复的这个关键阶段，我们将测试行为恐惧消退和 该奖项提供的机会、资源和专家咨询。 将支持我的培训目标，收集和分析行为数据，学习新的分析方法 密集的纵向数据，并获得与临床 AN 参与者合作的经验。 研究将实施先进的统计和多方法研究设计，完全远程进行， 在 AN 的一个重要阶段，这些结果将为精准的复发预防干预措施提供信息。 降级护理，改善这种损害性、持续性和昂贵疾病的治疗结果。