- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT05503745
MICBT til ikke-undervægtige voksne med spiseforstyrrelser (MICBT-ED)
CBT-E vs CBT-F + Metakognitiv interpersonel terapi for ikke-undervægtige voksne med spiseforstyrrelser: Undersøgelsesprotokol for et pilot randomiseret kontrolleret forsøg
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
Studiet er et randomiseret, kontrolleret pilotforsøg, der har til formål at evaluere gennemførligheden og effektiviteten af ugentlige MIT i afhængighed af CBT-F i en gruppe voksne diagnosticeret med ED. Specifikt vil efterforskerne undersøge i en prøve af ikke-undervægtige voksne, der præsenterer ED, om en behandling, der kombinerer MIT og CBT-F, en gang sammenlignet med CBT-E er a) mulig, b) veltolereret og c) potentielt effektiv til at spise. lidelsessymptomer og andre udfald.
Efterforskerne forventer, at forsøgsgruppen CBT-F+MIT vil være i stand til at have høj behandlingsadhærens og fastholdelse på baggrund af tidligere undersøgelser af MIT for personlighedsforstyrrelser. De vil også forvente gode resultater i det primære resultat. I betragtning af den lille stikprøve er dette blot et pilotstudie, så eventuelle konklusioner om andre resultater vil blive betragtet som foreløbige. Resultater vil give nye beviser, der kan føre til at overveje CBT-F+MIT som en behandlingsmulighed for ED, der fortjener undersøgelser i større forsøg.
Undersøgelsestype
Tilmelding (Faktiske)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
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VR
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Verona, VR, Italien, 37100
- Centro di Trattamento Integrato. Disturbi Alimentari e Obesità (CTI) di Gloria Fioravanti
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Beskrivelse
Inklusionskriterier:
- ED diagnosticeret inden for de seneste 6 måneder
- Søger behandling for spiseforstyrrelse
- Kan give skriftligt, informeret samtykke
- BMI > 18,5
Ekskluderingskriterier:
- Akut psykotisk episode, psykotiske symptomer, Bipolar I lidelse; antisocial personlighedsforstyrrelse
- Selvmordstanker
- Stofmisbrug
- Tidligere psykologisk intervention for andre spiseforstyrrelser
- I øjeblikket involveret i anden igangværende behandling
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Aktiv komparator: CBT-E
Deltagere i CBT-E-tilstanden vil modtage i alt 20 CBT-E-sessioner over 20 uger.
CBT-E behandling vil bestå af fire faser.
Især har CBT til formål at informere patienter om vigtigheden af selvkontrol, farerne ved nogle restriktive adfærd, såsom selvfremkaldt opkastning.
Desuden giver CBT strategier til patienter for at overvåge deres normalt dysfunktionelle adfærd og dermed øge deres bevidsthed (dvs.
maddagbogsmetoden), mens den reducerer tilgængeligheden af mad og tilskynder til aktiviteter, der er uforenelige med overspisning.
Patienterne vil blive trænet i problemløsning for at ændre disse følelser, samt i at øge deres selvbevidsthed for at genkende irrationelle tanker om deres kropsvægt og form.
Derudover vil de gradvist blive udsat for fødevarer, som de havde undgået.
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I den første fase vil behandlingen være fokuseret på at opnå en fælles forståelse af patientens spiseforstyrrelse og de relaterede vedligeholdelsesfaktorer.
I denne fase vil patienten blive hjulpet til at regulere og stabilisere sine spisevaner og dermed løse sine vægtproblemer.
I anden fase gennemgås de fremskridt, der er gjort, i detaljer.
I den tredje fase vil sessionerne fokusere på de centrale processer, der vedligeholder psykopatologien af patientens spiseforstyrrelse.
Dette indebærer især at imødegå bekymringer om vægt og kropsform, kognitive og kalorieindhold kostbegrænsninger, begivenheder og følelser, der påvirker ernæring.
I fase tre og fire klinisk perfektion behandles også lavt globalt selvværd, intolerance over for følelser og interpersonelle vanskeligheder.
Mod slutningen af tredje fase og i løbet af fjerde fase vil der også blive implementeret procedurer for at minimere risikoen for kort- og langsigtede tilbagefald.
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Eksperimentel: CBT-F+MIT
Deltagere i CBT-F+MIT-tilstanden vil modtage i alt 20 sessioner over 20 uger. Specifikt vil 2 sessioner kun være baseret på CBT-F som normalt. I løbet af disse sessioner vil deltagerne modtage psykoedukativ træning i spiseadfærd og en introduktion til protokolværktøjerne, nemlig overvågningsskemaet, vægtdiagrammet, transdiagnostisk formulering og spiseproblem-tjeklisten (EPCL). Disse elementer vil blive brugt i begyndelsen af de resterende 18 sessioner for at overvåge reglerne for spiseadfærd samt fremkalde narrative episoder. Disse materialer vil danne grundlag for MIT-delen af sessionen, hvor terapeuter sammen med patienten vil søge at danne en fælles forståelse af de psykologiske årsager, der ligger til grund for deres ED-symptomer og deres utilpassede interpersonelle funktion. MIT-sessioner vil blive integreret i CBT-F-protokollen, som vil give psyko-pædagogisk, ernæringsmæssig genopdragelse og ledelse for ED. |
Målet er at udvikle sundere strategier til at håndtere negative tanker og følelser forud for ED og til at engagere patienter i sociale interaktioner, der opfylder deres relationelle grundlæggende ønsker.
De vil således forstå, at perfektionisme og behovet for kontrol, de oplever gennem ED, er mestringsstrategier udviklet inden for interpersonelle mønstre for interaktion med betydningsfulde andre, hvor lavt selvværd og følelsesmæssig dysregulering spiller en central rolle.
MIT har til formål at forbedre individers evne til at skabe mening over deres egen affekt og kognition og blive bevidst om at være drevet af utilpassede, stive og forudindtaget skemaer om sig selv og andre, for at danne en rigere forståelse af de andres sind og bruge denne viden til at reagere på mere adaptive måder på sociale vanskeligheder eller evolutionært udvalgte ønsker.
MIT gør det også muligt for individer at reflektere over, hvordan disse skemaer kan fungere som triggere for ED-adfærd og at udvikle mere effektive mestringsstrategier i forhold til interpersonelle stressfaktorer.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Eating Disorder Examination Questionnaire (EDE-Q6; Fairburn & Beglin, 1994)
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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A self report measure assessing eating disorders over the past 4 weeks, providing a measure of the range of severity of eating disorder features.
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Eating Attitude Test (EAT-26; Garner & Garfinkel, 1979)
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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A self-report measure for identifying the presence of "eating disorder risk" based on attitudes, feelings and behaviors related to eating.
It assesses general eating behaviour and risky behaviours.
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Clinical Impairment Assessment Questionnaire (CIA 3.0; Bohn and Fairburn, 2008).
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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a self-report measure f assessing the severity of psychosocial impairment due to eating disorder features over the past 28 days.
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Binge Eating Scale (BES; Gormally et al., 1992)
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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a self-report questionnaire of the behavioral, cognitive and emotional features of objective binge eating (OBE).
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Struktureret klinisk interview for DSM-5 lidelser (SCID-5; Michael B. First, Janet B.W. Williams)
Tidsramme: Ved baseline
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Til vurdering og definition af DSM-5-model for personlighedsforstyrrelser.
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Ved baseline
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State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983)
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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A self-report measure of trait and state anxiety.
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Beck Depression Inventory (BDI; Beck, et al., 1961)
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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A self-report measures of depression.
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Symptom Check List (SCL-90)
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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A measure of psychopathology symptoms and their intensity at a specific point in time.
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004)
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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A self-report scale measuring individual differences in the ability to identify, accept and manage emotional experiences.
This measure help in understanding emotional dysregulation that might underlie the disorders.
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Toronto Alexithymia Scale (TAS - 20; Taylor & Bagby, 1992)
Tidsramme: Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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It assess difficulties in understanding, processing, or describing emotions
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Baseline; mid-treatment (assessed up to 20 weeks); end of treatment (assessed up to 60 weeks); 3, 6, 12, 18, and 24 months after end of treatment (assessed up to 156 weeks from baseline)
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Working Alliance Inventory-Short Revised (WAI; SR Hatcher & Gillaspy, 2006)
Tidsramme: Every 4 weeks during treatment (up to approximately 6 months, until end of treatment).
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It measure the therapeutic alliance by assessing three main aspects of the therapeutic alliance: agreement on the tasks of therapy, agreement on the goals of therapy and development of an affective bond.
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Every 4 weeks during treatment (up to approximately 6 months, until end of treatment).
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Samarbejdspartnere og efterforskere
Efterforskere
- Ledende efterforsker: Gloria Fioravanti, Centro di Trattamento Integrato. Disturbi Alimentari e Obesità (CTI) di Gloria Fioravanti
- Studieleder: Raffaele Popolo, Centro di Terapia Metacognitiva Interpersonale, Roma
Publikationer og nyttige links
Generelle publikationer
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- Fairburn CG, Cooper Z, Doll HA, O'Connor ME, Bohn K, Hawker DM, Wales JA, Palmer RL. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. Am J Psychiatry. 2009 Mar;166(3):311-9. doi: 10.1176/appi.ajp.2008.08040608. Epub 2008 Dec 15.
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- Psykiske lidelser
- Tegn og symptomer, fordøjelsessystemet
- Adfærdsmæssige symptomer
- Neurokognitive lidelser
- Kognitionsforstyrrelser
- Patologiske tilstande, tegn og symptomer
- Opførsel
- Tegn og symptomer
- Børns adfærd
- Social adfærd
- Selvkontrol
- Problemadfærd
- Kognitiv dysfunktion
- Personlighedsforstyrrelser
- Ernærings- og spiseforstyrrelser
- Følelsesmæssig regulering
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