Neuroscience-informed treatment to remotely target reward mechanisms in post-acute anorexia nervosa

基于神经科学的治疗可远程针对急性后神经性厌食症的奖励机制

• 批准号: 10680471
• 负责人: Ann Frances Haynos
• 金额: $ 23.53万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680471
• 关键词: Acute; Adult; Affect; Affective; Affective Symptoms; Ambulatory Care; Anorexia Nervosa; Anxiety; Anxiety Disorders; Behavior; Behavior Therapy; Behavioral; Biological; Body Weight decreased; Body mass index; Calories; Caring; Clinical; Cognitive Therapy; Control Groups; Cues; Data; Disease; Eating; Eating Disorders; Ecological momentary assessment; Excision; Exercise; Exhibits; Feeling suicidal; Food; Growth; Hospitals; Individual; Innovative Therapy; Interruption; Intervention; Investigation; Knowledge; Literature; Maintenance; Measures; Mental Depression; Mental disorders; Modeling; Mood Disorders; Morbidity - disease rate; National Institute of Mental Health; Neurocognitive; Neurosciences; Outcome; Participant; Patient Self-Report; Patients; Pattern; Persons; Pilot Projects; Play; Positive Valence; Process; Randomized; Randomized, Controlled Trials; Relapse; Research Domain Criteria; Residual state; Rewards; Role; Science; Social Interaction; Specialist; Starvation; Symptoms; System; Technology; Teletherapy; Testing; Time; Translating; Treatment outcome; Waiting Lists; Weight; active control; affective neuroscience; anxiety reduction; anxiety symptoms; associated symptom; biobehavior; cognitive task; comorbidity; comparison control; depressive symptoms; design; effective therapy; efficacious treatment; experience; follow-up; improved; indexing; innovation; mortality; multimodality; novel; pleasure; programs; psychoeducation; psychoeducational; psychosocial; rapid growth; relapse risk; remote delivery; suicidal; symptomatic improvement; therapy design; treatment as usual

PROJECT SUMMARY/ABSTRACT Anorexia nervosa (AN) is a serious illness with extremely high morbidity and mortality rates. Clearly efficacious treatments are lacking for adults with AN, especially during the post-acute stage following higher- level care (e.g., residential, partial-hospital program [PHP]). Most patients achieve symptom stability in intensive treatment, but up to 50% relapse and more experience residual or co-morbid (e.g., affective) symptoms after discharge. Appropriate outpatient treatment is often unavailable or inaccessible in this stage. Despite a rapid growth in the knowledge on the biobehavioral mechanisms promoting AN, this information has rarely been incorporated into treatment. One set of mechanistic targets increasingly acknowledged as relevant to AN are those of the reward system. The reward (a.k.a., positive affect or valence) system has been implicated in maintenance of myriad psychiatric disorders, including common AN co-morbidities (e.g., mood and anxiety disorders). A wealth of evidence, including our pilot data, suggests that individuals with AN show deficit reward sensitivity to experiences generally considered rewarding (e.g., social interactions, eating), similar to those with affective disorders. However, distinct from other psychiatric illnesses, individuals with AN also show elevated reward sensitivity to weight-loss experiences and cues (e.g., exercise, low-calorie foods). Starvation in acute AN appears to exacerbate these processes. However, these same problems affect weight- restored AN, suggesting they represent core illness mechanisms. Although reward anomalies have long been noted in the literature, currently no treatments for AN designate positive affect as a primary intervention target. To remedy this gap, we will test whether a remotely-deployed psychosocial treatment targeting positive affect, Positive Affect Treatment (PAT), can alter reward mechanisms and enhance treatment outcomes in post-acute AN. PAT is a cognitive-behavioral therapy originally designed to treat mood and anxiety disorders and adapted by our team to target reward anomalies in AN (PAT-AN). Our pilot data suggest that PAT-AN, delivered in person or via teletherapy, effectively targets positive affect and reward sensitivity to improve BMI and eating disorder, anxiety, depressive symptoms. We will extend this investigation to the post-acute period of AN, during which we expect to even more effectively engage the reward system, due to the removal of the biological constraints of starvation. Adults with broadly-defined AN (N = 70) leaving residential or PHP will be randomized to 24 weeks of PAT-AN or active control (psychoeducation and behavior therapy) as adjunctive to treatment as usual. Treatment will be delivered via the highly accessible and scalable format of teletherapy. Throughout treatment and follow-up, subjects will complete a novel multimodal battery (e.g., mobile-delivered and neurocognitive measures) assessing measuring reward sensitivity and clinical symptoms. This project will allow us to precisely test wither an innovative therapy informed by biobehavioral mechanistic science can, for the first time, directly target the reward disruptions long believed to contribute to post-acute AN.

项目摘要/摘要 神经性厌食症（AN）是一种严重的疾病，发病率和死亡率极高。清楚地 对于患有A的成年人，缺乏有效的治疗 水平护理（例如，住宅，部分医院计划[PHP]）。大多数患者达到症状稳定 强化治疗，但最高50％的复发和更多的经验残留或合并症（例如，情感） 出院后的症状。在此阶段，适当的门诊治疗通常无法获得或无法访问。 尽管关于促进生物行为机制的知识迅速增长，但这些信息 很少被纳入治疗。一组机械目标越来越被认为是 与一个奖励系统相关的是。奖励（又称为积极影响或价值）系统已经是 与维持无数的精神疾病有关，包括常见的合并症（例如，情绪 和焦虑症）。包括我们的飞行员数据在内的大量证据表明，有节目的个人 对经验的赤字奖励敏感性通常认为是奖励（例如，社交互动，饮食）， 与情感障碍的人相似。但是，与其他精神病不同，患有 还表现出对减肥体验和提示的奖励敏感性升高（例如运动，低热量食品）。 急性A中的饥饿似乎加剧了这些过程。但是，这些相同的问题会影响体重 - 恢复A，表明它们代表了核心疾病机制。虽然奖励异常长期以来一直是 在文献中注意到，目前尚未将积极影响作为主要干预目标的治疗方法。 为了弥补这一差距，我们将测试靶向阳性的遥不可及的社会心理治疗 情感，积极影响治疗（PAT）可以改变奖励机制并增强治疗结果 急性后PAT是一种最初旨在治疗情绪和焦虑症的认知行为疗法 并由我们的团队改编成（PAT-AN）中的奖励异常。我们的飞行员数据表明​​Pat-an， 亲自或通过远程疗法提供有效的靶向积极影响和奖励灵敏度以提高BMI 和饮食失调，焦虑，抑郁症状。我们将把这项调查扩展到急性后的时期 一个，在此期间，由于删除了奖励系统 饥饿的生物限制。具有广泛定义的A（n = 70）离开住宅或PHP的成年人将是 随机分配至24周的PAT-AN或主动对照（心理教育和行为疗法） 照常治疗。治疗将通过高度可访问且可扩展的远程疗法进行。 在整个治疗和随访过程中，受试者将完成新型的多式模式电池（例如，移动交付 和神经认知措施）评估测量奖励灵敏度和临床症状。这个项目将 允许我们精确测试由生物行为机械科学告知的创新疗法，可以 第一次，直接针对长期以来一直认为是急性后AN的奖励中断。

项目成果

Difficulties with positive emotion regulation in anorexia nervosa.

神经性厌食症患者的积极情绪调节困难。

• DOI: 10.1002/erv.2973
• 发表时间: 2023
• 期刊: European eating disorders review : the journal of the Eating Disorders Association
• 作者: Santos,BoladeM;Haynos,AnnF
• 通讯作者: Haynos,AnnF