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：
8569906
负责人：
JAMES D LOCK
金额：
$ 19.63万
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/8569906
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，是一种严重的精神疾病，具有高发病率、死亡率和经济成本。尽管基于家庭的治疗 (FBT) 可使约 50% 的短期 AN 青少年完全稳定康复，但对于那些没有反应的青少年，没有基于证据的干预措施，因此，他们面临约 33% 的风险因为患上慢性病。因此，在有合理成功机会的情况下，必须进行干预，改变有慢性病风险的年轻患者的轨迹。该申请针对 PA-12-279 (R34) 提出研究将认知矫正疗法 (CRT) 与 FBT 相结合的可行性，以便将来在充分有力的随机对照试验中使用，以降低青少年发展为持续性 AN 的风险。两项研究表明，较高水平的强迫特征会导致 FBT 的结果较差。有人提出，CRT 通过促进更灵活和更少持续性的思维来解决强迫思维的认知基础。这些变化反过来可能会导致人们接受改变维持 AN 的行为和思想的需要的能力得到提高。两个小型病例系列报道了成人 AN 的显着改善。此外，患有 AN 的青少年的病例系列数据发现 CRT 是可以接受的，并且可以改善认知过程。我们提出以下具体目标：目标 1：研究将 CRT 纳入 FBT 的可行性。我们将审查FBT加CRT的可接受性、招募、评估程序和工具的可行性以及对比治疗（FBT加艺术治疗）的可接受性。目标 2：探讨与 FBT 加艺术治疗相比，接受 FBT 加 CRT 的患者的认知方式、体重、饮食相关认知和心理社会功能的变化。为了实现目标 1，我们将招募 30 名在 YBC-ED 上具有 AN 和 OC 特征证据的青少年（12-18 岁）（分数 >14）。这些参与者将被随机分配接受为期 6 个月的 FBT（15 节课）加艺术练习（15 节课）或为期 6 个月的 FBT 加 CRT（15 节课）。我们的主要成果是：招聘的可行性、保留率和评估程序的可行性。次要结果（目标 2）是神经心理功能、体重、饮食相关的精神病理学和心理社会功能的变化。评估将在四个时间点进行：基线、4 周、8 周和治疗结束 (EOT)。