Emotion coaching skills as an augmentation to family based therapy for adolescents with anorexia nervosa: A pilot study

情绪辅导技能作为神经性厌食症青少年家庭治疗的增强：一项试点研究

• 批准号: 10133473
• 负责人: Claire Marie Aarnio-Peterson
• 金额: $ 23.63万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10133473
• 关键词: Address; Adolescent; Affect; Age; Anorexia Nervosa; Anxiety; Attention deficit hyperactivity disorder; Back; Behavior; Behavioral; Bone Density; Bradycardia; Cessation of life; Charge; Child; Child Rearing; Childhood; Clinical; Communication; Control Groups; Dangerousness; Data; Depression and Suicide; Disease remission; Distress; Dropout; Early Intervention; Eating; Eating Disorders; Educational process of instructing; Emotional; Emotions; Evidence based treatment; Exhibits; Expressed Emotion; Family; Family member; Family psychotherapy; Feedback; Food; Goals; Gold; Growth; Height; Hostility; Individual; Intervention; Life; Malnutrition; Manuals; Medical; Meta-Analysis; National Institute of Mental Health; Newly Diagnosed; Outcome; Parents; Participant; Patients; Phase; Pilot Projects; Population; Post-Traumatic Stress Disorders; Process; Public Health; Published Comment; Randomized Controlled Clinical Trials; Recovery; Savings; Schizophrenia; Suicide; Support Groups; Symptoms; Testing; Training; Treatment Failure; Treatment Protocols; Treatment outcome; Weight; Work; acceptability and feasibility; arm; barrier to care; base; bone mass; comorbidity; coping; design; effectiveness evaluation; effectiveness trial; empowered; feasibility testing; feeding; group intervention; healthy weight; improved; mortality; physical conditioning; primary outcome; programs; psychoeducation; relapse prediction; response; sex; skills; standard care; success; tool; treatment response; uptake; weight restoration

Project Summary Pediatric anorexia nervosa (AN) affects 400,000 adolescents in the US with devastating consequences including growth delay, bone density loss, bradycardia, and the highest mortality rate of any psychiatric condition (11.5%), with half of all deaths due to suicide. Early intervention in adolescents is life-saving, making pediatric AN treatment an important public health concern. The goal of pediatric AN treatment is to restore the adolescent back to a healthy weight and reverse the dangerous effects of malnutrition. Family based therapy (FBT) is the gold standard of treatment for pediatric AN; however, 50% of patients do not respond. The consequences of treatment non-response are dire, underscoring the importance of improving treatment via augmentations to address non-response. One barrier to treatment response in pediatric AN is expressed emotion (EE), which is defined as a family's response to an ill patient that is characterized by hostility, critical comments, and emotional overinvolvement. Several studies have highlighted that families with high EE undergoing treatment for their adolescent with AN have poorer outcomes, including higher drop-out rates, lack of weight restoration, and less improvement in eating disorder symptoms. Conversely, parental warmth, a facet of EE, is associated with good outcomes in FBT. Recent parenting interventions focused on emotion coaching (EC) to address high EE have demonstrated success as adjuncts to evidence-based treatments in other pediatric populations (e.g., PTSD, ADHD) but have not been applied to pediatric AN. Given the detrimental effects that high EE has on the re-feeding process and the benefits of parental warmth, emotion coaching has the potential to reduce high EE, increase parental warmth, and improve weight restoration in adolescents with AN. The aim of this R34 pilot effectiveness trial is to conduct a two-stage study to evaluate the effectiveness of a FBT + EC parent group intervention within a clinical setting. In Stage 1 (Feasibility Stage; Year 1), we will conduct preliminary feasibility and acceptability testing of an EC parent group intervention in 6 patients with pediatric AN and their families who exhibit elevated EE. The data from the Feasibility Stage will be used to modify session content to improve treatment delivery and the uptake of EC skills. Once our manual is refined and finalized, we will conduct a randomized controlled clinical trial (Stage 2) of 50 adolescents and their parents to compare FBT+EC parent group (n=25) versus FBT+support (n=25). The FBT+support condition is a general parent support group that is offered as part of standard care in our clinical Eating Disorders Program. FBT will be identical in both the treatment and control conditions, with the EC parent group sessions and parent support group sessions occurring separately from the FBT sessions. If the aims of the project are achieved, this study would have a large impact on pediatric AN with the potential to improve weight restoration outcomes by augmenting FBT for families high in EE.

项目摘要 小儿神经性厌食症（AN）影响美国的40万名青少年 包括生长延迟，骨密度损失，心动过缓以及任何精神病的死亡率最高 病情（11.5％），自杀造成的所有死亡的一半。早期干预青少年是挽救生命的，使 小儿治疗是一个重要的公共卫生问题。小儿治疗的目的是恢复 青少年回到健康的体重，并扭转营养不良的危险作用。基于家庭的治疗 （FBT）是小儿AN治疗的金标准；但是，有50％的患者没有反应。这 治疗无反应的后果是可怕的，强调了通过 增强以解决无响应。小儿A表达治疗反应的一个障碍 情感（EE），定义为家庭对以敌意，关键为特征的病患者的反应 评论和情感过度参与。几项研究表明，EE高的家庭 接受其青春期的治疗效果较差，包括较高的辍学率，缺乏 体重恢复，饮食失调症状的改善较少。相反，父母温暖，一个方面 EE的fbt中的良好结果有关。最近的育儿干预措施集中于情感教练 （ec）解决高EE已证明成功作为基于证据的治疗的辅助手段 小儿种群（例如PTSD，ADHD），但尚未应用于小儿。考虑到有害 高EE对重新喂养过程的影响以及父母温暖的好处，情感教练有 减少高EE，增加父母温暖并改善青少年体重恢复的潜力 一个。这项R34试验有效性试验的目的是进行两阶段的研究以评估 FBT + EC母体群体干预在临床环境中。在第1阶段（可行性阶段； 1年）中，我们将 对6例患者进行EC母体群体干预的初步可行性和可接受性测试 儿科A及其家人表现出EE的升高。可行性阶段的数据将用于 修改会话内容以改善治疗交付和EC技能的吸收。一旦我们的手册完善了 并最终确定，我们将进行50名青少年的随机对照临床试验（第2阶段）及其 父母比较FBT+EC父母组（n = 25）与FBT+支持（n = 25）。 FBT+支持条件是 作为我们临床饮食失调计划中标准护理的一部分提供的一般家长支持小组。 在治疗和控制条件下，FBT与EC母体群体和控制条件都相同 父支持组会话与FBT会话分开。如果该项目的目的是 达到的，这项研究将对小儿A产生很大的影响，并有可能改善体重恢复 通过增强FBT为EE的家庭增强FBT的结果。