Optimizing Mindfulness and Acceptance-Based Treatments for Bulimia Nervosa and Binge Eating Disorder using a Factorial Design

使用析因设计优化针对神经性贪食症和暴食症的正念和基于接受的治疗

基本信息

批准号：
10356884
负责人：
ADRIENNE SARAH JUARASCIO
金额：
$ 70.44万
依托单位：
DREXEL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-01 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10356884
关键词：
Aftercare Attention Awareness Behavior Behavior Therapy Behavioral Binge Eating Binge eating disorder Bulimia Clinical Clinical Trials Cognitive Cognitive Therapy Complement Decision Making Disease Disease remission Eating Eating Disorders Elements Emotional Emotions Fright Future Goals Gold Hunger Individual Informal Social Control Intervention Lead Literature Manuals Manuscripts Meta-Analysis Motivation Outcome Participant Patients Pattern Population Recurrence Reporting Research Research Personnel Research Support Science Series Symptoms Techniques Testing Treatment Efficacy Treatment outcome Weight Gain Work active method arm base behavior change clinical practice clinically significant common treatment design dietary restriction distress tolerance eating pathology efficacy testing experience improved improved outcome interest mindfulness psychologic randomized trial systematic review therapy outcome treatment optimization

项目摘要

PROJECT SUMMARY Cognitive Behavioral Therapy (CBT) is typically considered the current gold standard and first line treatment for disorders characterized by recurrent binge eating such as bulimia nervosa (BN) and binge eating disorder (BED). Outcomes, while clinically significant, leave substantial room for improvement with recent systematic reviews and meta-analyses finding that 40-50% of patients with BED and nearly 70% of patients with BN remain at least partially symptomatic after a full course of CBT. In an effort to improve outcomes, a growing number of researchers have begun to evaluate the use of mindfulness and acceptance-based behavioral treatments (MABTs) for BN and BED and preliminary evidence suggests such treatments can be effective for this population. Although the research on MABTs for binge eating remains nascent, MABTs are frequently used in clinical practice for BN and BED, with one recent study showing that patients are more likely to report that their therapist has used mindfulness-based techniques than CBT-specific techniques. Given the widespread clinical interest in MABTs and the growing body of research supporting the preliminary efficacy of these treatments, a fully powered tests of the efficacy, mechanisms of action, and moderators of outcome for MABT appears warranted. In particular, rather than testing any specific MABT treatment package (e.g. acceptance and commitment therapy, dialectical behavioral therapy, mindfulness-based eating interventions) in a large clinical trial, we believe that a study that can isolate and evaluate the independent and synergistic efficacy of the most commonly used MABT components has the highest potential for impact. A review of MABTs for BN and BED suggests that there are four commonly used MABT components: (1) Mindful Awareness, (2) Distress Tolerance, (3) Emotion Modulation, and (4) Values-Based Decision Making. MABT treatment packages have vary widely in which of these components they incorporated and which they emphasized. By identifying which components of MABTs are most effective (and for whom they are effective), we can emphasize the powerful elements of MABTs and deemphasize or eliminate inert components. A traditional RCT would not provide the power necessary to evaluate the independent and synergistic efficacies of four distinct treatment components compared to an active treatment approach such as CBT. Instead, the proposed study will use a Multiphasic Optimization Strategy (MOST) approach (including a full factorial design) in which 256 individuals with transdiagnostic binge eating pathology are assigned to one of sixteen behavioral treatments, i.e., representing each permutation of the MABT component described above being included or excluded from the base treatment (a version of CBT that emphasizes the key behavioral ingredients of this treatment approach). Results of the component analysis set up future work to evaluate an optimized treatment containing only effective components (which can be expected to have superior efficacy, efficiency and disseminability) against current gold-standard CBT.

项目摘要认知行为疗法（CBT）通常被认为是当前的金标准和第一行治疗以复发性暴饮暴食为特征的疾病，例如神经性贪食症（BN）和暴饮暴食障碍（床）。结果虽然具有临床意义，但仍有很大的改进空间，最近的系统性评论和荟萃分析发现，有40-50％的床和近70％的BN患者仍然存在 CBT完整疗程后，至少部分有症状。为了改善结果，越来越多的研究人员已经开始评估正念和基于接受的行为治疗的使用（MABTS）BN和BED和初步证据表明，此类治疗可能对此有效人口。尽管关于暴饮暴食的MABT的研究仍然很新生，但MABT经常用于 BN和BED的临床实践，最近的一项研究表明，患者更有可能报告他们与CBT特异性技术相比，治疗师使用的是基于正念的技术。鉴于对MABT的广泛临床兴趣和支持初步的研究体系这些治疗的功效，对功效，作用机理的完全动力测试以及主持人的主持人 MABT的结果似乎有必要。特别是，而不是测试任何特定的MABT治疗套件（例如接受和承诺疗法，辩证行为疗法，基于正念的饮食干预措施）在一项大型临床试验中，我们认为一项可以隔离和评估独立和评估的研究最常用的MABT组件的协同功效具有影响最高的影响。一个 BN和BED的MABT的评论表明，有四个常用的MABT组件：（1）正念意识，（2）遇险宽容，（3）情绪调制和（4）基于价值的决策。 mabt 处理套件的差异很大强调。通过确定哪些MABT的组成部分是最有效的（并且它们有效），我们可以强调MABT的强大要素，并认为强调或消除惰性组成部分。传统的RCT不会提供评估独立和协同功效所需的能力与CBT等主动治疗方法相比，四种不同的治疗成分相反，拟议的研究将使用多相优化策略（大多数）方法（包括完整的阶乘设计）其中256名经诊断暴饮暴食病理学的人分配给了十六个行为之一处理，即表示上述MABT组件的每个置换在基本处理中排除（CBT的一种强调关键行为成分的版本治疗方法）。组件分析的结果设置了未来的工作以评估优化的治疗仅包含有效组件（可以预期具有较高的功效，效率和分配性）针对当前金色标准CBT。