Target Engagement of a Novel Dissonance-Based Treatment for DSM-5 Eating Disorders R33 Phase

DSM-5 饮食失调 R33 阶段基于失调的新型治疗的目标参与

基本信息

批准号：
10868785
负责人：
ERIC M STICE
金额：
$ 56.29万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-10 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10868785
关键词：
Address Ambulatory Care Attitude Beauty Behavior Behavior Control Behavior Disorders Behavior assessment Behavioral Binge Eating Biological Blinded Caloric Restriction Calories Clinical DSM-V Data Dimensions Disease remission Diuretics Dose Eating Disorders Evidence based treatment Expectancy Food Functional Magnetic Resonance Imaging Individual Intervention Interviewer Investigational Therapies Knowledge Maintenance Measures Mediating Modality Modeling Outcome Participant Persons Persuasive Communication Phase Process Public Health Research Rewards Risk Site Specific qualifier value Standardization Surveys Symptoms Testing Therapeutic Thinness Time Translating Vomiting Waiting Lists Weight maintenance regimen Woman Writing alternative treatment arm clinical effect cost evidence base excessive exercise expectation follow-up functional disability intervention effect laxative novel pilot trial randomized trial response theories treatment as usual treatment duration treatment group verbal

项目摘要

ABSTRACT Only 3-20% of people with eating disorders (EDs) receive treatment, and they often do not receive evidence- based treatments because they are intensive and costly, and few clinicians deliver them. These factors have hindered broad implementation, implying that a brief frontline outpatient treatment for a range of EDs that could be easily, cheaply, and widely implemented would address a key public health problem. There are also limited experimental data regarding factors that maintain EDs and mechanisms of action for ED treatments. We hypothesize that EDs are maintained by (1) excessive valuation of the thin ideal, which prompts caloric restriction and other unhealthy weight control behaviors (vomiting, laxative/diuretic use, excessive exercise) that increase risk for binge eating, and (2) excessive valuation of high-calorie foods, which maintains binge eating. We propose to evaluate a group treatment that efficiently targets these 2 maintenance factors. We created a novel 8-session dissonance-based treatment (Counter Attitudinal Therapy; CAT) wherein women with any ED complete verbal, written, and behavioral activities in which they discuss costs of pursuing the thin ideal and the ED behaviors they use to purse this ideal, which putatively creates dissonance about engaging in these behaviors that reduces valuation of the thin ideal and high-calorie binge foods. In two pilot trials CAT reduced behaviorally-assessed valuation of thin models and binge foods, and blinded interviewer-assessed ED symptoms versus unstandardized (d=.94) and standardized usual care (d=.53), resulting in a 70% remission by 2-6 month follow-up across the two trials. Effect sizes compare favorably to those produced by 20-session individual therapies for EDs. Women who completed the dissonance-inducing activities regarding pursuit of the thin ideal showed a reduction in fMRI-assessed reward region response to thin models (Stice et al., 2015) providing further evidence of target engagement. The R61 randomized trial (N=60) will (1) validate whether CAT produces larger pre-post reductions in objective fMRI-assessed reward region response to thin models and binge foods (intervention target measures) versus waitlist controls in women with DSM-5 EDs; (2) generate preliminary data regarding the clinical effects of reducing the targets on ED symptom domains and functioning (outcomes); and (3) test whether reductions in targets and outcomes show a linear decrease over the 8 sessions or plateau earlier and correlate with greater session attendance and homework completion, to examine dose-response relations. If the R61 confirms that CAT sufficiently engages intervention targets and that the 8-session format produces optimal response, the fully-powered R33 randomized trial (N=120) will test whether (4) CAT produces greater reductions in the two fMRI-assessed targets than a usual care group treatment; (5) CAT produces greater reductions in ED symptoms and functional impairment than the usual care treatment through 6-month follow-up; and (6) change in targets correlates with change in ED symptoms and functioning, and mediates intervention effects on outcomes.

抽象的只有3-20％的饮食失调患者（ED）接受治疗，他们通常没有得到证据 - 基于良好的治疗方法是密集且昂贵的，很少有临床医生将其提供。这些因素有阻碍了广泛的实施，这意味着对一系列ED的短暂前线门诊治疗容易，便宜且被广泛实施将解决关键的公共卫生问题。也有限有关维持ED和ED治疗作用机制的因素的实验数据。我们假设EDS通过（1）薄层理想的过度估值维护，这促使热量限制和其他不健康的体重控制行为（呕吐，泻药/利尿剂，过度运动）这增加了暴饮暴食的风险，以及（2）高热量食品的过度估值吃。我们建议评估有效针对这两个维护因素的小组治疗。我们创建了一种新颖的基于8节不和谐的治疗（反态度疗法； CAT）通过任何ED完全的口头，书面和行为活动，他们讨论了追求薄薄的成本理想和他们用来属于这个理想的ED行为，这是对参与的理想的不和谐这些行为可以降低稀薄的理想和高热量暴饮暴食的估值。在两个试验试验中猫降低了对薄型和暴饮暴食的行为评估估值，并评估了盲目的访调员症状与非标准化（D = .94）和标准化的常规护理（D = .53），导致70％的缓解两次试验的2-6个月随访。效应尺寸与20条经验产生的效果相比 ED的个人疗法。完成有关追求不和谐活动的妇女薄理想表明，FMRI评估的奖励区域对薄模型的反应有所减少（Stice等，2015）提供目标参与的进一步证据。 R61随机试验（n = 60）将（1）验证是否是否 CAT在目标fmri评估的奖励区域对薄模型的响应中产生较大的前post减少 DSM-5 EDS女性的狂欢食品（干预目标措施）与候补列表对照；（2）生成有关减少靶标对ED症状域和的临床影响的初步数据功能（结果）; （3）测试目标和结果的减少是否显示出线性减少较早的8个会议或高原，并与更大的会议出勤和完成作业相关检查剂量反应关系。如果R61确认猫足够接合干预目标，并且 8条格式产生最佳响应，全功率的R33随机试验（n = 120）将测试（4）CAT是否在两个FMRI评估的目标中产生比平常的护理组更大的减少治疗; （5）CAT与通常的护理相比，CAT产生的ED症状和功能障碍更大通过6个月的随访治疗；（6）目标变化与ED症状的变化相关功能，并介导干预对结果的影响。