Fear, gastrointestinal distress, and interoception: Physiological and psychological mechanisms in eating disorders

恐惧、胃肠道不适和内感受：饮食失调的生理和心理机制

• 批准号: 10358991
• 负责人: Katherine Jean Forney
• 金额: $ 45.07万
• 依托单位: OHIO UNIVERSITY ATHENS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10358991
• 关键词: Academic Research Enhancement Awards; Address; Adherence; Affect; American; Award; Behavior; Brain; Cessation of life; Cholecystokinin; Crossover Design; Disease remission; Distress; Eating; Eating Behavior; Eating Disorders; Ensure; Evidence based treatment; Fasting; Fatty acid glycerol esters; Food; France; Fright; Galvanic Skin Response; Homeostasis; Individual; Interoception; Intervention; Link; Maintenance; Mediating; Mediation; Mediator of activation protein; Mental disorders; Modeling; Nausea; Ohio; Participant; Patients; Peptide YY; Peptides; Perception; Physiological; Psychophysiology; Reporting; Research; Research Personnel; Symptoms; Testing; Training; Treatment outcome; Weight; Weight Gain; Woman; Yogurt; base; causal model; clinical practice; cost; design; eating pathology; experience; food consumption; gastrointestinal; improved; insight; next generation; novel; psychoeducation; psychologic; response; restrictive eating; success; university student

7. Project Summary/Abstract Eating disorders are prevalent, costly, and deadly psychiatric illnesses. Current empirically-supported interventions fail to achieve symptom remission in the majority of patients. Gastrointestinal (GI) distress (e.g., nausea, stomachache) is one barrier that contributes to poor adherence to the meal-related interventions that comprise evidence-based treatments. The proposed R15 Academic Research Enhancement Award seeks to test a causal model of GI distress in eating disorder maintenance. In this model, fear of food, eating, and weight gain are hypothesized to cause GI distress through two direct mechanisms (i.e., by increasing cholecystokinin and peptide YY gut peptide responses and by increasing perceived fullness due to biased interoception) as well as through an indirect mechanism of fear-related increases in fullness via enhanced gut peptide response. Specific Aim 1 will test fear as a contributor to GI distress using a within-subject test meal paradigm wherein participants consume foods that they are told contains high or low fat content, but which are actually identical. Specific Aim 2 will test the proposed direct and indirect mechanisms of GI distress. In addition, a serial multiple mediation model will be conducted to explore fear as a cause of enhanced gut peptide response and in turn, increases in fullness, GI distress, and urges to restrict food intake. To address these aims, 152 women with eating disorders in the normal weight range who report postprandial GI distress will participate in a test meal paradigm. Using a within-subjects crossover design, on two separate mornings, participants will eat yogurt described as “high fat” and “low fat.” Although the “high fat” meal is designed to activate fear of food, eating, and weight gain relative to the “low fat” meal, in actuality the meals will not differ and will each contain 67% fat. Efficacy of this manipulation will be assessed using subjective ratings of fear and skin conductance. In addition, gut peptide levels and subjective ratings of GI distress, fullness, and urges to restrict food intake will be assessed before, during, and after the test meal. This study fills a fundamental gap by being the first to experimentally test an integration of fear, enhanced gut peptide response, and biased interoception in an eating disorder maintenance model. This study will make a significant contribution by examining fear as a cause of GI distress. This will provide specific insight into how to adapt empirically- supported interventions (i.e., exposure) for eating disorder patients who experience GI distress. Identifying enhanced gut peptide response as the cause of fullness and GI distress will facilitate tailoring psychoeducation and interoceptive exposures for eating disorder patients based upon symptoms. This study will shift current clinical practice by identifying fear, gut peptide response, and fullness as potential symptom-based treatment targets, with the potential to improve treatment outcomes by tailoring interventions to the symptom experience of individual eating disorder patients. Consistent with the aims of the R15, this study will enhance the research experiences of Ohio University students.

7. 项目总结/摘要 饮食失调是一种普遍存在、代价高昂且致命的精神疾病，目前得到了实证支持。 大多数患者的胃肠道 (GI) 不适（例如， 恶心、胃痛）是导致膳食相关干预措施依从性差的一个障碍， 拟议的 R15 学术研究增强奖旨在包括循证治疗。 测试维持饮食失调的胃肠道不适的因果模型，在该模型中，对食物、饮食和恐惧的恐惧。 体重增加通过两种直接机制（即通过增加 胆囊收缩素和肽 YY 肠肽反应以及由于偏向而增加的饱腹感 内感受）以及通过增强肠道来增加与恐惧相关的饱腹感的间接机制 具体目标 1 将使用受试者体内的测试餐来测试恐惧是否会导致胃肠道不适。 范式参与者食用他们被告知脂肪含量高或低的食物，但这些食物 具体目标 2 将测试所提出的胃肠道应激的直接和间接机制。 此外，将进行一系列多重中介模型来探索恐惧作为增强肠道的原因 肽反应反过来会增加饱腹感、胃肠道不适，并要求限制食物摄入。 这些目标是 152 名体重正常但患有饮食失调且报告餐后胃肠道不适的女性 将在两个不同的早晨使用受试者内交叉设计参加测试膳食范例， 参与者将吃被描述为“高脂肪”和“低脂肪”的酸奶。 激发对食物、饮食和体重相对于“低脂”膳食的恐惧，实际上膳食不会有什么不同 每个都含有 67% 的脂肪，将使用恐惧的主观评级来评估这种操纵的效果。 此外，肠道肽水平和胃肠道不适、饱腹感和冲动的主观评分。 这项研究填补了测试餐前、餐中和餐后限制食物摄入量的基础。 差距是第一个通过实验测试恐惧、增强的肠道肽反应和偏见的整合 这项研究将在饮食失调维持模型中做出重大贡献。 研究恐惧是胃肠道不适的一个原因，这将为如何根据经验进行适应提供具体的见解。 支持对经历胃肠道不适的饮食失调患者进行干预（即暴露）。 增强肠道肽反应作为饱腹感和胃肠道不适的原因将有助于调整心理教育 这项研究将改变当前的饮食失调患者的症状。 通过识别恐惧、肠肽反应和饱腹感作为潜在的基于症状的治疗来进行临床实践 目标，有可能通过根据症状经历定制干预措施来改善治疗结果 与 R15 的目标一致，本研究将加强研究。 俄亥俄大学学生的经历。