FAMILY BASED TREATMENT FOR YOUNG ADULTS WITH ANOREXIA NERVOSA
Yu Eunice
University Of Chicagocity: Chicago country: United States (us)
Grant 5R34MH083914-03 from National Institute Of Mental Health
Abstract: Anorexia Nervosa (AN) is a serious psychiatric illness with the highest mortality rate of any other psychiatric disorder. There is no established efficacious treatment for adult AN. Promising outcomes are seen in family- based treatment (FBT) for adolescents. FBT has undergone significant development in the past 10 years; delivered in conjoint and separated format, manualized for adolescent AN, dosage requirements investigated, adapted and manualized for adolescent bulimia nervosa and evaluated for older adolescents. Given the success of FBT with adolescents and high treatment retention rates for this age group, the absence of FBT for young adults with AN is surprising given the comparable dependence upon family between late adolescence and young adulthood. Our preliminary findings suggest that enlisting the family in treatment for this older age group may be efficacious. This is a proposal for a Stage I treatment development program to develop and test FBT to promote weight restoration in young adults (18-25 yrs) with AN (FBT-Y). Important adaptations of 6- month, 18 session FBT-Y are these. First, broadening the notion of family of origin (parents) to also include family of ´choice´ (e.g., spouse/cohabiting partner, aunts/uncles, grandparent/s), i.e., adult family members who have an emotional investment in the patient, which may include emotional (e.g. marriage) and/or financial leverage (e.g., paying college tuition, rent, etc., for the patient). Second, FBT-Y fosters collaboration between the young adult and the family of choice; and third, FBT-Y addresses in an up-to-date way young adult developmental concerns. This study involves 2 Phases. Phase 1 is to develop and refine the FBT-Y manual, utilizing an iterative case series approach, using initial and ongoing meetings of the expert treatment development team, video-taping and analysis of sessions, weekly case conferences, and on-going assessments of patient, family and therapist. These assessments will be used to make necessary changes to the treatment manual. Up to two case series of 5 patients each will be utilized to develop the manual. Phase 2 of the study will assess the feasibility, acceptability and preliminary efficacy of FBT-Y using an open trial (n=20). Feasibility and acceptability will be assessed using questionnaires and qualitative interviews and examining recruitment and dropout rates. Effect-size and effect-size variability estimates of FBT-Y on our primary outcome measure, i.e., body mass index will be assessed. In addition, exploratory outcome examining secondary AN symptoms and psychosocial functioning will be examined. These calculations will inform a future full-scale clinical trial. Anorexia Nervosa (AN) has the highest mortality rate compared to any other psychiatric disorder, yet there is no established treatment for adult AN. The most promising treatment is family-based treatment for adolescents with AN. The current study is to refine and test an approach developed form family-based treatment, family-based treatment for weight restoration in young adults (18-25 years) with AN
Keywords: Address; Adolescence; Adolescent; Adult; Affect; Age; age group; aged; Anorexia Nervosa; base; Body mass index; Bulimia; Caring; Case Series; Childhood; Clinical Trials; Collaborations; college; Data; Dependence; design; Development; dosage; Dropout; Eating; Eating Disorders; Elements; Emotional; Family; Family member; Fostering; Friends; Friendships; Future; Goals; grandparent; Grant; Individual; Interview; Investments; Manuals; Marriage; meetings; Mental disorders; Monitor; Mortality Vital Statistics; Outcome; Outcome Measure; Overweight; Parents; Partner in relationship; patient population; Patients; Phase; phase 2 study; Population; primary outcome; programs; Provider; psychosocial; Psychotherapy; public health relevance; Questionnaires; Research; response; restoration; Sample Size; Series; Services; Siblings; Social Functioning; Spouses; Staging; success; symposium; Symptoms; Testing; therapy development; Time; Treatment Cost; Weight; Weight Gain; Woman; young adult
Relevance: Anorexia Nervosa (AN) has the highest mortality rate compared to any other psychiatric disorder, yet there is no established treatment for adult AN. The most promising treatment is family-based treatment for adolescents with AN. The current study is to refine and test an approach developed form family-based treatment, family-based treatment for weight restoration in young adults (18-25 years) with AN
Project start date: 2010-07-01
Project end date: 2013-03-31
Budget start date: 1-APR-2012
Budget end date: 31-MAR-2013
5R34MH083914-03 (2012): $207963
Sponsored Links Excellgen http://Excellgen.com
FAMILY BASED TREATMENT FOR YOUNG ADULTS WITH ANOREXIA NERVOSA
Yu Eunice, Associate Professor
University Of Chicagocity: Chicago country: United States (us)
Grant 5R34MH083914-02 from National Institute Of Mental Health
Abstract: Anorexia Nervosa (AN) is a serious psychiatric illness with the highest mortality rate of any other psychiatric disorder. There is no established efficacious treatment for adult AN. Promising outcomes are seen in family- based treatment (FBT) for adolescents. FBT has undergone significant development in the past 10 years; delivered in conjoint and separated format, manualized for adolescent AN, dosage requirements investigated, adapted and manualized for adolescent bulimia nervosa and evaluated for older adolescents. Given the success of FBT with adolescents and high treatment retention rates for this age group, the absence of FBT for young adults with AN is surprising given the comparable dependence upon family between late adolescence and young adulthood. Our preliminary findings suggest that enlisting the family in treatment for this older age group may be efficacious. This is a proposal for a Stage I treatment development program to develop and test FBT to promote weight restoration in young adults (18-25 yrs) with AN (FBT-Y). Important adaptations of 6- month, 18 session FBT-Y are these. First, broadening the notion of family of origin (parents) to also include family of ´choice´ (e.g., spouse/cohabiting partner, aunts/uncles, grandparent/s), i.e., adult family members who have an emotional investment in the patient, which may include emotional (e.g. marriage) and/or financial leverage (e.g., paying college tuition, rent, etc., for the patient). Second, FBT-Y fosters collaboration between the young adult and the family of choice; and third, FBT-Y addresses in an up-to-date way young adult developmental concerns. This study involves 2 Phases. Phase 1 is to develop and refine the FBT-Y manual, utilizing an iterative case series approach, using initial and ongoing meetings of the expert treatment development team, video-taping and analysis of sessions, weekly case conferences, and on-going assessments of patient, family and therapist. These assessments will be used to make necessary changes to the treatment manual. Up to two case series of 5 patients each will be utilized to develop the manual. Phase 2 of the study will assess the feasibility, acceptability and preliminary efficacy of FBT-Y using an open trial (n=20). Feasibility and acceptability will be assessed using questionnaires and qualitative interviews and examining recruitment and dropout rates. Effect-size and effect-size variability estimates of FBT-Y on our primary outcome measure, i.e., body mass index will be assessed. In addition, exploratory outcome examining secondary AN symptoms and psychosocial functioning will be examined. These calculations will inform a future full-scale clinical trial. Anorexia Nervosa (AN) has the highest mortality rate compared to any other psychiatric disorder, yet there is no established treatment for adult AN. The most promising treatment is family-based treatment for adolescents with AN. The current study is to refine and test an approach developed form family-based treatment, family-based treatment for weight restoration in young adults (18-25 years) with AN
Keywords: Address; Adolescence; Adolescent; Adult; Affect; Age; age group; aged; Anorexia Nervosa; base; Body mass index; Bulimia; Caring; Case Series; Childhood; Clinical Trials; Collaborations; college; Data; Dependence; design; Development; dosage; Dropout; Eating; Eating Disorders; Elements; Emotional; Family; Family member; Fostering; Friends; Friendships; Future; Goals; grandparent; Grant; Individual; Interview; Investments; Manuals; Marriage; meetings; Mental disorders; Monitor; Mortality Vital Statistics; Outcome; Outcome Measure; Overweight; Parents; Partner in relationship; patient population; Patients; Phase; phase 2 study; Population; primary outcome; programs; Provider; psychosocial; Psychotherapy; public health relevance; Questionnaires; Research; response; restoration; Sample Size; Series; Services; Siblings; Social Functioning; Spouses; Staging; success; symposium; Symptoms; Testing; therapy development; Time; Treatment Cost; Weight; Weight Gain; Woman; young adult
Relevance: Anorexia Nervosa (AN) has the highest mortality rate compared to any other psychiatric disorder, yet there is no established treatment for adult AN. The most promising treatment is family-based treatment for adolescents with AN. The current study is to refine and test an approach developed form family-based treatment, family-based treatment for weight restoration in young adults (18-25 years) with AN
Project start date: 2010-07-01
Project end date: 2013-03-31
Budget start date: 1-APR-2011
Budget end date: 31-MAR-2012
PFA/PA: PAR-09-173
5R34MH083914-02 (2011): $190908
Grants awarded to Yu Eunice
DIALECTICAL BEHAVIOR THERAPY FOR EARLY NON-RESPONDERS TO CBT WITH BINGE EATING DI
Yu Eunice
University Of Chicagocity: Chicago country: United States (us)
Grant 5K23MH081030-04 from National Institute Of Mental Health
Abstract: Binge Eating Disorder (BED) is a significant public health problem, with serious medical and psychosocial consequences. The most established treatment for BED is Cognitive Behavioral Therapy (CBT). Early response appears to predict good outcome in CBT for BED, while poor outcome may be predicted by more extreme emotion dysregulation. Standard Dialectical Behavior Therapy (DBT) is a group and individual therapy developed for individuals for whom other treatments have failed and who have extreme emotion dysregulation. A less intense (group only) version of DBT is efficacious for BED. A case series utilizing DBT with individuals with extreme emotion dysregulation (i.e., borderline personality disorder) and BED, suggests that DBT may be useful for ´difficult-to-treat´ eating disorders. The Primary Aim of this K-23 is to examine the efficacy of standard DBT compared to CBT+ (individual plus group CBT) in women with BED who have early non-response to individual CBT. The primary objective of this K-23 is to enhance my skill in the conduct of complex clinical trials and to examine whether standard DBT is promising for early non-responders to CBT. Women meeting criteria for BED who are early non-responders to CBT, i.e., do not decrease their binge eating by 65% within the first 4 weeks of individual CBT, will be randomized to six-months of standard DBT or CBT+. The primary hypothesis is that standard DBT is more efficacious than CBT+ for early non-responders to CBT in achieving binge-eating abstinence and reduction. Compared to CBT+, DBT will show greater reduction 1) secondary eating disorder behaviors, 2) therapy-interfering behaviors; and greater improvement in 3) general psychopathology (e.g., drug and alcohol abuse), and 4) psychosocial functioning. These hypotheses will be tested at post-treatment and at 3-month intervals for one year. The study will also assess the feasibility and acceptability of using psychophysiology (e.g., respiratory sinus arrhythmia), laboratory (mood induction and an interpersonal problem-solving task), and experience sampling (using a palm pilot to monitor every-day mood and behavior) tasks within the context of a randomized controlled trial. These measures will be used in an exploratory way to examine the moderators and mediators of treatment, derived from the DBT model of emotion dysregulation. Findings from the study will be used to determine a future R01 grant application
Keywords: Abstinence; Adult; Aftercare; Alcohol abuse; Applications Grants; Behavior; Binge Eating; Binge eating disorder; Biological; Borderline Personality Disorder; Bulimia; Case Series; Chicago; Client; Clinic; Clinical Psychology; Clinical Trials; Cognitive Therapy; Complex; Consultations; Dialectical behavior therapy; Drug abuse; Early treatment; Eating Disorders; emotion regulation; Emotional; Emotions; Enrollment; experience; Future; Individual; Laboratories; Measures; Mediator of activation protein; Medical; meetings; Modeling; Monitor; Moods; Outcome; Outcome Measure; Outpatients; Participant; Personal Digital Assistant; Postdoctoral Fellow; primary outcome; Problem Solving; programs; Psychopathology; Psychophysiology; psychosocial; public health medicine (field); Randomized; Randomized Controlled Trials; Research Personnel; respiratory; response; Sampling; Screening procedure; Sinus Arrhythmia; skills; Staging; Testing; theories; therapy development; treatment effect; Triage; Universities; Woman
Project start date: 2008-04-24
Project end date: 2013-03-31
Budget start date: 1-APR-2011
Budget end date: 31-MAR-2012
PFA/PA: PA-05-143
5K23MH081030-04 (2011): $143343
5K23MH081030-03 (2010): $140740