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.

项目概要 小儿神经性厌食症 (AN) 影响着美国 400,000 名青少年，造成了灾难性后果 包括生长迟缓、骨密度下降、心动过缓以及所有精神疾病中死亡率最高的 情况（11.5%），一半的死亡原因是自杀。对青少年的早期干预可以挽救生命 儿科 AN 治疗是一个重要的公共卫生问题。儿科 AN 治疗的目标是恢复 青少年恢复健康体重并扭转营养不良的危险影响。以家庭为基础的治疗 (FBT) 是治疗儿童 AN 的金标准；然而，50%的患者没有反应。这 治疗无反应的后果是可怕的，这强调了通过以下方式改善治疗的重要性 增强以解决无响应问题。儿科 AN 治疗反应的一个障碍已明确 情绪（EE），被定义为家庭对病人的反应，其特征是敌意、批评 评论和情绪过度介入。多项研究强调，EE 较高的家庭 患有 AN 的青少年接受治疗的结果较差，包括较高的辍学率、缺乏 体重恢复，饮食失调症状改善较少。相反，父母的温暖，一个侧面 EE 与 FBT 的良好结果相关。最近的育儿干预措施侧重于情绪辅导 （EC）解决高 EE 问题已证明作为其他循证治疗的辅助手段取得了成功 儿科人群（例如 PTSD、ADHD），但尚未应用于儿科 AN。鉴于不利 高 EE 对再喂养过程的影响以及父母温暖、情绪辅导的好处 降低高 EE、增加父母的温暖以及改善青少年体重恢复的潜力 一个。 R34 试点有效性试验的目的是进行两阶段研究，以评估 R34 试点有效性试验的有效性 临床环境中的 FBT + EC 家长组干预。在第一阶段（可行性阶段；第一年），我们将 对 6 名患有此病的患者进行 EC 家长小组干预的初步可行性和可接受性测试 表现出 EE 升高的儿科 AN 及其家人。可行性阶段的数据将用于 修改会议内容以改善治疗实施和 EC 技能的吸收。一旦我们的手册完善 最终确定后，我们将对 50 名青少年及其青少年进行随机对照临床试验（第 2 阶段） 家长将 FBT+EC 家长组 (n=25) 与 FBT+支持 (n=25) 进行比较。 FBT+支持条件是 一般家长支持小组是我们临床饮食失调计划标准护理的一部分。 FBT 在治疗和控制条件下均相同，并且有 EC 家长组会议和 家长支持小组会议与 FBT 会议分开举行。如果该项目的目标是 取得的成果，这项研究将对儿科 AN 产生巨大影响，并有可能改善体重恢复 通过增加 EE 高家庭的 FBT 来取得成果。