Feasibility of Combining Family and Cognitive Therapy to Prevent Chronic Anorexia

结合家庭和认知疗法预防慢性厌食症的可行性

基本信息

批准号：
8701414
负责人：
JAMES D LOCK
金额：
$ 27.48万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-15 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8701414
关键词：
Address Adolescence Adolescent Adult Aftercare Age Anorexia Anorexia Nervosa Art Therapy Arts Behavior Case Series Chronic Chronic Disease Chronically Ill Cognition Cognitive Cognitive Therapy Cognitive remediation Data Development Disease Eating Eating Disorders Evidence based intervention Exercise Family Family psychotherapy Feasibility Studies Future Impairment Inpatients Intervention Lead Link Mental disorders Morbidity - disease rate Obsessive-Compulsive Disorder Outcome Outpatients Participant Patients Procedures Process Psychopathology Randomized Recovery Recruitment Activity Relapse Reporting Resistance Risk Schizophrenia Symptoms Thinking Time Underweight Weight Youth age group base central coherence economic cost executive function flexibility follow-up improved instrument mortality neuropsychological prevent primary outcome psychosocial psychosocial development public health relevance response secondary outcome skills success therapy development trait

项目摘要

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).

描述（由申请人提供）：神经性厌食症（AN）通常在青春期开始，是一种严重的精神病，与高发病，死亡率和经济成本相关。尽管基于家庭的治疗（FBT）会导致约50％的持续时间AN的青少年的恢复完全，稳定，但对于那些没有反应的人，因此，没有证据的干预措施，因此，患有大约33％的慢性病风险。因此，必须干预以改变有合理的成功机会的年轻患者的轨迹。该应用于PA-12-279（R34）提议研究将认知补救疗法（CRT）与FBT相结合的可行性，以便将来在足够功能的RCT中使用，以降低青少年发展持久性A的风险。两项研究表明，更高水平的痴迷特征导致FBT的结果较差。有人提出，CRT通过促进更灵活，更持久的思维来解决痴迷思想的认知基础。这些变化反过来又可能导致能力提高接受维持一个行为和思想的改变。两个小型案例系列报告了An的成年人的显着改善。此外，具有发现CRT的青少年的病例串联数据是可以接受的，并改善了认知过程。我们提出以下具体目标：目标1：检查将CRT纳入FBT的可行性。我们将检查FBT Plus CRT的可接受性，招聘，评估程序的可行性以及比较治疗的可接受性（FBT Plus Art Therapy）。 AIM 2：与FBT Plus CRT相比，与FBT Plus Art Therapy相比，在接受FBT Plus CRT的人中，认知风格，体重，相关认知的变化以及心理社会功能的变化。为了完成AIM 1，我们将招募30名青少年（12-18岁），并在YBC-ED上具有OC特征的证据（得分> 14）。这些参与者将被随机分配给6个月的FBT（15次会议）加上艺术练习（15次），或者FBT加上CRT（15个会话），持续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（AIM 2）是神经心理功能，体重，饮食相关的心理病理学和社会心理功能的变化。评估将在四个时间点进行：基线，4周，8周和治疗结束（EOT）。