Facing Eating Disorder Fears for Anorexia Nervosa: A Virtual Relapse Prevention Program Targeted at Approach and Avoidance Behaviors

面对饮食失调对神经性厌食症的恐惧：针对接近和回避行为的虚拟复发预防计划

• 批准号: 10611448
• 负责人: Cheri Alicia Levinson
• 金额: $ 19.56万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10611448
• 关键词: Acute; Admission activity; Aftercare; Anorexia Nervosa; Anxiety; Behavior; Behavior assessment; Behavioral; Caring; Cessation of life; Chronic; Clinical; Cognitive; Cognitive Therapy; Communities; Data; Disease remission; Eating Disorders; Educational process of instructing; Ensure; Environment; Extinction; Face; Feedback; Focus Groups; Food; Fright; Goals; Hospitalization; Hospitals; Individual; Inpatients; Interoception; Intervention; Lead; Literature; Medical; Methods; Morbidity - disease rate; Neurobehavioral Manifestations; Outcome; Outpatients; Pathology; Patient Discharge; Patient Self-Report; Patients; Play; Preparation; Prevention program; Provider; Randomized, Controlled Trials; Recovery; Relapse; Research; Role; Service delivery model; Services; Stimulus; Symptoms; System; Technology; Testing; Time; Translating; Translations; United States National Institutes of Health; Weight; Weight Gain; Work; acceptability and feasibility; acute care; approach behavior; avoidance behavior; behavior change; care systems; clinical efficacy; cognitive benefits; cognitive function; cognitive skill; cost; cost outcomes; critical period; evidence base; experience; feasibility testing; habituation; hospital readmission; improved outcome; innovation; medical specialties; mortality; outpatient facility; prevent; psychoeducation; psychoeducational; public health relevance; relapse prediction; relapse prevention; skills training; social; social situation; symptomatology; therapy design; treatment as usual; treatment center; user-friendly; virtual; virtual delivery; virtual platform; virtual therapy; weight restoration

PROJECT SUMMARY/ABSTRACT Anorexia nervosa (AN) is chronic and disabling; most individuals never achieve full remission, even after acute treatment, and 50% of those who access acute treatment will relapse within 6- months of discharge. AN relapse-prevention treatments are urgently needed that can disrupt the persistent cycle of admission and discharge from acute treatment. Importantly, existing treatments do not differ from control treatments in the ability to alter cognitive-behavioral AN pathology, which is the primary remaining symptomatology at discharge from acute care. The inability to alter cognitive-behavioral pathology is a function of the limited availability of treatments that include skills training to promote behavior change in a “real-world” context, outside of treatment facilities. As such, relapse-prevention treatments should explicitly target core cognitive-behavioral pathology to facilitate approach behaviors (e.g., facing fear foods) in the real-world. Our scientific premise, developed from our past work, is that the application of a virtual format of Facing Eating Disorder Fears (FED-F) for AN will facilitate engagement in approach behaviors and minimize avoidance behaviors - improving outcomes, enhancing full recovery, and decreasing the likelihood of relapse. FED-F is a modular treatment that enhances exposure therapy with psychoeducation and cognitive skills teaching how to face fears of (a) food, (b) weight gain, (c) interoception/body, and (d) social situations. Our study goals are to (1) refine and test the acceptability and feasibility of FED-F delivered post-acute treatment as adjunctive to step-down specialty care, (2) test if this treatment outperforms treatment as usual (TAU), and (3) to examine if treatment targets our hypothesized mechanism of action: approach behaviors. These goals will lead to a highly deployable and accessible virtual treatment targeted at core AN mechanisms that predict relapse. The proposed research uses highly innovative methods; we will use an all-remote technology-based approach, combining a virtual, non- therapist assisted treatment with remote behavioral and momentary assessment of approach/avoidance behaviors. Specific aims are to (1) refine FED-F into a fully virtual format with input from patients and stakeholders and collect preliminary data (N=10) on its feasibility and acceptability, (2) conduct a small pilot RCT of FED-F (n=30) as compared to TAU (n=30), and (3) examine if FED-F targets approach/avoidance behaviors and test if this mechanism is associated with clinical outcomes. Ultimately, this proposal will lead to the creation and dissemination of a highly user-friendly, easily accessible and deployable intervention, delivered during a critical period of care, that can prevent AN relapse, which will decrease mortality, morbidity, and the high costs associated with chronic treatment.

项目概要/摘要 神经性厌食症 (AN) 是慢性的且会导致患者丧失能力；大多数人从未获得完全缓解； 即使经过急性治疗，接受急性治疗的患者中 50% 会在 6 年内复发 出院几个月后迫切需要预防复发的治疗。 重要的是，现有的急性治疗入院和出院周期。 在改变认知行为 AN 的能力方面，治疗与对照治疗没有差异 病理学，这是急性护理出院时剩下的主要症状。 无法改变认知行为病理学是由于可用的能力有限 治疗方法包括技能培训，以促进“现实世界”环境中的行为改变， 因此，预防复发治疗应明确针对治疗设施之外的情况。 核心认知行为病理学，以促进接近行为（例如，面对恐惧食物） 我们的科学前提是从我们过去的工作中发展出来的，它的应用是 AN 的“面对饮食失调恐惧”(FED-F) 的虚拟形式将促进参与 处理行为并避免最小化行为 - 改善结果，增强充分 FED-F 是一种增强康复效果的模块化治疗。 暴露疗法结合心理教育和认知技能，教授如何面对恐惧（a） 食物，(b) 体重增加，(c) 内感受/身体，以及 (d) 社交场合，我们的研究目标是 (1)。 完善并测试 FED-F 提供的急性后治疗的可接受性和可行性 辅助降级专业护理，(2) 测试该治疗是否优于常规治疗 （TAU）和（3）检查治疗是否针对我们所挖掘的作用机制：方法 这些目标将导致高度可部署和可访问的虚拟治疗目标。 所提出的研究采用了高度创新的核心 AN 机制。 方法；我们将使用基于全远程技术的方法，结合虚拟、非 治疗师通过远程行为和瞬时评估来协助治疗 具体目标是 (1) 将 FED-F 细化为完全虚拟的格式。 收集患者和利益相关者的意见并收集有关其可行性的初步数据（N = 10） 和可接受性，(2) 与 TAU (n=30) 相比，进行 FED-F (n=30) 的小型试点 RCT， (3) 检查 FED-F 是否针对接近/回避行为，并测试该机制是否有效 最终，该提案将导致创建和实施。 传播高度用户友好、易于获取和部署的干预措施 在护理的关键时期，可以防止 AN 复发，从而降低死亡率， 发病率以及与长期治疗相关的高费用。