Facing Eating Disorder Fears for Anorexia Nervosa: A Virtual Relapse Prevention Program Targeted at Approach and Avoidance Behaviors

面对饮食失调对神经性厌食症的恐惧：针对接近和回避行为的虚拟复发预防计划

• 批准号: 10425019
• 负责人: Cheri Alicia Levinson
• 金额: $ 31.39万
• 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: 2022-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425019
• 关键词: Acute; Admission activity; Aftercare; Anorexia Nervosa; Anxiety; Behavior; Behavior assessment; Behavioral; Caring; Cessation of life; Chronic; Clinical; Cognitive; Cognitive Therapy; Communities; Data; Disease remission; Eating Disorders; Educational process of instructing; Ensure; Extinction (Psychology); Face; Feedback; Focus Groups; Food; Fright; Goals; Hospitalization; Hospitals; Individual; Inpatients; Interoception; Intervention; Lead; Literature; Medical; Methods; Morbidity - disease rate; Neurobehavioral Manifestations; Outcome; Outpatients; Pathology; Patient Discharge; Patient Self-Report; Patients; Play; Preparation; Prevention program; Provider; Randomized Controlled Trials; Recovery; Relapse; Research; Role; Service delivery model; Services; Stimulus; Symptoms; System; Technology; Testing; Time; Translating; Translations; United States National Institutes of Health; Weight; Weight Gain; Work; acceptability and feasibility; acute care; approach avoidance behavior; approach behavior; avoidance behavior; base; behavior change; behavior test; care systems; clinical efficacy; cognitive benefits; cognitive function; cognitive skill; cost; cost outcomes; critical period; disorder later incidence prevention; evidence base; experience; feasibility testing; habituation; hospital readmission; improved outcome; innovation; medical specialties; mortality; outpatient facility; prevent; psychoeducation; public health relevance; relapse prediction; skills training; social; social situation; symptomatology; therapy design; treatment as usual; treatment center; user-friendly; virtual; virtual delivery; virtual platform; weight restoration

PROJECT SUMMARY/ABSTRACT Anorexia nervosa (AN) is chronic and disabling; most individuals never achieve full remission, even after acute treatment, and 50% of those who access acute treatment will relapse within 6- months of discharge. AN relapse-prevention treatments are urgently needed that can disrupt the persistent cycle of admission and discharge from acute treatment. Importantly, existing treatments do not differ from control treatments in the ability to alter cognitive-behavioral AN pathology, which is the primary remaining symptomatology at discharge from acute care. The inability to alter cognitive-behavioral pathology is a function of the limited availability of treatments that include skills training to promote behavior change in a “real-world” context, outside of treatment facilities. As such, relapse-prevention treatments should explicitly target core cognitive-behavioral pathology to facilitate approach behaviors (e.g., facing fear foods) in the real-world. Our scientific premise, developed from our past work, is that the application of a virtual format of Facing Eating Disorder Fears (FED-F) for AN will facilitate engagement in approach behaviors and minimize avoidance behaviors - improving outcomes, enhancing full recovery, and decreasing the likelihood of relapse. FED-F is a modular treatment that enhances exposure therapy with psychoeducation and cognitive skills teaching how to face fears of (a) food, (b) weight gain, (c) interoception/body, and (d) social situations. Our study goals are to (1) refine and test the acceptability and feasibility of FED-F delivered post-acute treatment as adjunctive to step-down specialty care, (2) test if this treatment outperforms treatment as usual (TAU), and (3) to examine if treatment targets our hypothesized mechanism of action: approach behaviors. These goals will lead to a highly deployable and accessible virtual treatment targeted at core AN mechanisms that predict relapse. The proposed research uses highly innovative methods; we will use an all-remote technology-based approach, combining a virtual, non- therapist assisted treatment with remote behavioral and momentary assessment of approach/avoidance behaviors. Specific aims are to (1) refine FED-F into a fully virtual format with input from patients and stakeholders and collect preliminary data (N=10) on its feasibility and acceptability, (2) conduct a small pilot RCT of FED-F (n=30) as compared to TAU (n=30), and (3) examine if FED-F targets approach/avoidance behaviors and test if this mechanism is associated with clinical outcomes. Ultimately, this proposal will lead to the creation and dissemination of a highly user-friendly, easily accessible and deployable intervention, delivered during a critical period of care, that can prevent AN relapse, which will decrease mortality, morbidity, and the high costs associated with chronic treatment.

项目摘要/摘要 厌食症（AN）是慢性和致残的；大多数人从未完全缓解， 即使经过急性治疗，以及50％的接受急性治疗的人也将在6-之内中继 出院月。迫切需要进行救济预防治疗，以破坏 急性治疗的入院和出院持续周期。重要的是，存在 治疗与控制治疗的能力没有什么不同 病理学，这是急性护理出院时剩余的主要症状。 无法改变认知行为病理学是有限的函数 包括技能培训以在“现实世界”背景下促进行为改变的治疗方法， 在治疗设施之外。因此，预防措施应明确针对 核心认知行为的病理学，以促进进近行为 现实世界。我们过去工作开发的科学前提是应用 面对饮食失调症恐惧的虚拟格式（FED-F）将有助于参与 接近行为并最大程度地减少回避行为 - 改善结果，增强完整 恢复并降低退休的可能性。 Fed-F是一种模块化处理，可增强 具有心理教育和认知能力的曝光疗法教学如何面对（a）的恐惧 食物，（b）体重增加，（c）拦截/身体和（d）社交情况。我们的学习目标是（1） 完善并测试Fed-F提供后急性治疗的可接受性和可行性 （2）测试这种治疗是否像往常一样优于治疗，（2）测试 （tau）和（3）检查治疗是否针对我们假设的作用机理：方法 行为。这些目标将导致针对性的高度可部署且可访问的虚拟治疗 在核心中，一种预测继电器的机制。拟议的研究使用了高度创新的 方法;我们将使用一种基于杰出技术的全远重技术方法，结合虚拟的，非 - 非 - 治疗师协助治疗对远程行为和瞬时评估 方法/回避行为。具体目的是（1）将Fed-F改进为完全虚拟格式 随着患者和利益相关者的投入，并收集其可行性的初步数据（n = 10） （2）与tau（n = 30）相比，进行Fed-f（n = 30）的小试验RCT（n = 30）， （3）检查Fed-F目标是否接近/避免行为，并测试此机制是否为 与临床结果相关。最终，该提议将导致创建和 传播高度用户友好，易于访问和可部署的干预措施 在关键时期，可以防止继电器，从而降低死亡率， 发病率以及与慢性治疗相关的高成本。