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MICBT voor niet-ondergewicht volwassenen met eetstoornissen (MICBT-ED)
CBT-E vs CBT-F+Metacognitieve interpersoonlijke therapie voor niet-ondergewicht volwassenen met eetstoornissen: onderzoeksprotocol voor een gerandomiseerde, gecontroleerde pilotstudie
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
De studie is een pilot-gerandomiseerde gecontroleerde studie die tot doel heeft de haalbaarheid en effectiviteit te evalueren van wekelijkse MIT bij verslaving aan CBT-F bij een groep volwassenen met de diagnose ED. Concreet zullen de onderzoekers in een steekproef van niet-ondergewicht volwassenen met erectiestoornissen onderzoeken of een combinatie van MIT en CBT-F, eenmaal vergeleken met CBT-E, a) haalbaar is, b) goed wordt verdragen en c) potentieel effectief is bij het eten stoornissen symptomen en andere uitkomsten.
De onderzoekers verwachten dat de experimentele groep CBT-F+MIT een hoge therapietrouw en retentie zou kunnen hebben op grond van eerdere onderzoeken naar MIT voor persoonlijkheidsstoornissen. Ze verwachten ook goede resultaten in de primaire uitkomst. Gezien de kleine steekproef is dit slechts een pilotstudie, dus eventuele conclusies over andere uitkomsten zullen als voorlopig worden beschouwd. De resultaten zullen nieuw bewijs leveren dat ertoe kan leiden dat CBT-F+MIT wordt beschouwd als een behandelingsoptie voor ED-onderzoeken die in grotere onderzoeken de moeite waard zijn.
Studietype
Inschrijving (Werkelijk)
Fase
- Niet toepasbaar
Contacten en locaties
Studie Locaties
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VR
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Verona, VR, Italië, 37100
- Centro di Trattamento Integrato. Disturbi Alimentari e Obesità (CTI) di Gloria Fioravanti
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Beschrijving
Inclusiecriteria:
- ED gediagnosticeerd in de afgelopen 6 maanden
- Op zoek naar behandeling voor eetstoornis
- In staat om schriftelijke, geïnformeerde toestemming te geven
- BMI > 18,5
Uitsluitingscriteria:
- Acute psychotische episode, psychotische symptomen, bipolaire I-stoornis; antisociale persoonlijkheids stoornis
- Suïcidale gedachten
- Middelenmisbruik
- Eerdere psychologische interventie voor andere eetstoornissen
- Momenteel bezig met een andere lopende behandeling
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Enkel
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Actieve vergelijker: CBT-E
Deelnemers in de CBT-E-conditie krijgen in totaal 20 CBT-E-sessies gedurende 20 weken.
De CBT-E-behandeling bestaat uit vier fasen.
CBT heeft met name tot doel patiënten te informeren over het belang van zelfbeheersing, de gevaren van beperkend gedrag zoals zelfopgewekt braken.
Bovendien biedt CGT strategieën aan patiënten om hun gewoonlijk disfunctionele gedrag te volgen en zo hun bewustzijn te vergroten (d.w.z.
eetdagboekmethode) terwijl het de beschikbaarheid van voedsel vermindert en activiteiten aanmoedigt die onverenigbaar zijn met te veel eten.
Patiënten zullen worden getraind in het oplossen van problemen om deze gevoelens te veranderen, evenals in het vergroten van hun zelfbewustzijn om irrationele gedachten over hun lichaamsgewicht en lichaamsvorm te herkennen.
Bovendien zullen ze geleidelijk worden blootgesteld aan voedsel dat ze hadden vermeden.
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In de eerste fase zal de behandeling gericht zijn op het bereiken van een gedeeld begrip van de eetstoornis van de patiënt en de bijbehorende instandhoudingsfactoren.
In deze fase wordt de patiënt geholpen om zijn eetgewoonten te reguleren en te stabiliseren en zo zijn gewichtsproblemen aan te pakken.
In de tweede fase wordt de gemaakte voortgang in detail beoordeeld.
In de derde fase zullen de sessies gericht zijn op de centrale processen die de psychopathologie van de eetstoornis van de patiënt in stand houden.
Dit omvat met name het aanpakken van zorgen over gewicht en lichaamsvorm, cognitieve en calorische dieetbeperkingen, gebeurtenissen en emoties die van invloed zijn op voeding.
In fase drie en vier komen klinische perfectie, een laag globaal gevoel van eigenwaarde, intolerantie voor emoties en interpersoonlijke problemen ook aan de orde.
Tegen het einde van de derde fase en tijdens de vierde fase zullen ook procedures worden geïmplementeerd om het risico op terugval op korte en lange termijn te minimaliseren.
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Experimenteel: CBT-F+MIT
Deelnemers aan de CBT-F+MIT-conditie krijgen in totaal 20 sessies gedurende 20 weken. Concreet zullen 2 sessies alleen gebaseerd zijn op CGT-F zoals gewoonlijk. Tijdens deze sessies krijgen de deelnemers een psycho-educatieve training over eetgedrag en een inleiding in de protocolinstrumenten, namelijk het monitoringformulier, de gewichtstabel, de transdiagnostische formulering en de eetprobleemchecklist (EPCL). Deze elementen zullen aan het begin van de resterende 18 sessies worden gebruikt om de regels van het eetgedrag te controleren en om verhalende episodes uit te lokken. Deze materialen zullen de basis vormen voor het MIT-gedeelte van de sessie, waarin therapeuten zullen proberen om samen met de patiënt een gedeeld begrip te vormen van de psychologische redenen die ten grondslag liggen aan hun ED-symptomen en hun onaangepaste interpersoonlijke functioneren. MIT-sessies zullen worden geïntegreerd in het CBT-F-protocol dat psycho-educatie, heropvoeding op het gebied van voeding en management voor ED zal bieden. |
Het doel is om gezondere strategieën te ontwikkelen voor het omgaan met negatieve gedachten en gevoelens voorafgaand aan ED en voor het betrekken van patiënten bij sociale interacties die voldoen aan hun relationele basiswensen.
Ze zullen dus begrijpen dat perfectionisme en de behoefte aan controle die ze door ED ervaren, copingstrategieën zijn die zijn ontwikkeld binnen interpersoonlijke patronen van interactie met significante anderen, waarbij een laag zelfbeeld en emotionele ontregeling een centrale rol spelen.
MIT heeft tot doel het vermogen van individuen te verbeteren om hun eigen affect en cognities te begrijpen en zich ervan bewust te worden dat ze worden gedreven door onaangepaste, starre en vooringenomen schema's over zichzelf en anderen, om een beter begrip te vormen van de geest van de anderen en deze kennis te gebruiken om reageren op meer adaptieve manieren op sociale moeilijkheden of evolutionair geselecteerde wensen.
MIT stelt individuen ook in staat om na te denken over hoe deze schema's kunnen fungeren als triggers voor ED-gedrag en om effectievere copingstrategieën te ontwikkelen in het licht van interpersoonlijke stressoren.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Eating Disorder Examination Questionnaire (EDE-Q6; Fairburn & Beglin, 1994)
Tijdsspanne: 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)
Tijdsspanne: 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).
Tijdsspanne: 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)
Tijdsspanne: 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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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Gestructureerd klinisch interview voor DSM-5-stoornissen (SCID-5; Michael B. First, Janet BW Williams)
Tijdsspanne: Bij basislijn
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Voor het beoordelen en definiëren van het DSM-5-model voor persoonlijkheidsstoornissen.
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Bij basislijn
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State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983)
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 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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Medewerkers en onderzoekers
Onderzoekers
- Hoofdonderzoeker: Gloria Fioravanti, Centro di Trattamento Integrato. Disturbi Alimentari e Obesità (CTI) di Gloria Fioravanti
- Studie directeur: Raffaele Popolo, Centro di Terapia Metacognitiva Interpersonale, Roma
Publicaties en nuttige links
Algemene publicaties
- Fairburn CG, Cooper Z, Doll HA, O'Connor ME, Palmer RL, Dalle Grave R. Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK-Italy study. Behav Res Ther. 2013 Jan;51(1):R2-8. doi: 10.1016/j.brat.2012.09.010. Epub 2012 Oct 22.
- 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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- Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krleza-Jeric K, Hrobjartsson A, Mann H, Dickersin K, Berlin JA, Dore CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013 Feb 5;158(3):200-7. doi: 10.7326/0003-4819-158-3-201302050-00583.
- Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord. 1994 Dec;16(4):363-70.
- Gormally J, Black S, Daston S, Rardin D. The assessment of binge eating severity among obese persons. Addict Behav. 1982;7(1):47-55. doi: 10.1016/0306-4603(82)90024-7.
- Murphy R, Straebler S, Cooper Z, Fairburn CG. Cognitive behavioral therapy for eating disorders. Psychiatr Clin North Am. 2010 Sep;33(3):611-27. doi: 10.1016/j.psc.2010.04.004.
- Fairburn CG, Bailey-Straebler S, Basden S, Doll HA, Jones R, Murphy R, O'Connor ME, Cooper Z. A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behav Res Ther. 2015 Jul;70:64-71. doi: 10.1016/j.brat.2015.04.010. Epub 2015 Apr 22.
- Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26(1), 41-54.
- Dalle Grave R, Calugi S, Conti M, Doll H, Fairburn CG. Inpatient cognitive behaviour therapy for anorexia nervosa: a randomized controlled trial. Psychother Psychosom. 2013;82(6):390-8. doi: 10.1159/000350058. Epub 2013 Sep 20.
- Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment. Behav Res Ther. 2003 May;41(5):509-28. doi: 10.1016/s0005-7967(02)00088-8.
- Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
- Fairburn CG, Patel V. The global dissemination of psychological treatments: a road map for research and practice. Am J Psychiatry. 2014 May;171(5):495-8. doi: 10.1176/appi.ajp.2013.13111546. No abstract available.
- Poulsen S, Lunn S, Daniel SI, Folke S, Mathiesen BB, Katznelson H, Fairburn CG. A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. Am J Psychiatry. 2014 Jan;171(1):109-16. doi: 10.1176/appi.ajp.2013.12121511.
- Dalle Grave R, Calugi S, Doll HA, Fairburn CG. Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa: an alternative to family therapy? Behav Res Ther. 2013 Jan;51(1):R9-R12. doi: 10.1016/j.brat.2012.09.008. Epub 2012 Oct 4.
- Dalle Grave R, Calugi S, El Ghoch M, Conti M, Fairburn CG. Inpatient cognitive behavior therapy for adolescents with anorexia nervosa: immediate and longer-term effects. Front Psychiatry. 2014 Feb 12;5:14. doi: 10.3389/fpsyt.2014.00014. eCollection 2014.
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- Lilenfeld LR, Kaye WH, Greeno CG, Merikangas KR, Plotnicov K, Pollice C, Rao R, Strober M, Bulik CM, Nagy L. A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry. 1998 Jul;55(7):603-10. doi: 10.1001/archpsyc.55.7.603.
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- Psychische aandoening
- Tekenen en symptomen, spijsvertering
- Gedragssymptomen
- Neurocognitieve stoornissen
- Cognitieve stoornissen
- Pathologische aandoeningen, tekenen en symptomen
- Gedrag
- Tekenen en symptomen
- Gedrag van het kind
- Sociaal gedrag
- Zelfbeheersing
- Probleemgedrag
- Cognitieve disfunctie
- Persoonlijkheidsstoornissen
- Voedings- en eetstoornissen
- Emotionele regulatie
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