A Relapse Prevention Program for Reducing Relapse and Fear of Food in People With Anorexia Nervosa
Condition: Eating Disorders
MeSH terms: Anorexia; Feeding and Eating Disorders; Anorexia Nervosa
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      This study will compare the effectiveness of two types of psychotherapy, a relapse prevention
      program and cognitive behavioral therapy, in reducing relapse and fear of eating situations
      in people with anorexia nervosa.
    

Detailed description: 
      Anorexia nervosa (AN) is a serious and often chronic eating disorder characterized by
      restrictive eating habits and failure to maintain a healthy minimal body weight. Symptoms of
      AN may include distorted body image, fear of weight gain, obsessive exercise, and binge and
      purge eating behaviors. In severe cases of AN, a person may practice extreme dieting to
      levels of near starvation. These unhealthy behaviors may cause further medical complications,
      including organ damage, irregular heart rhythm, premature osteoporosis, and heart failure. AN
      has one of the highest mortality rates of all psychiatric disorders, claiming the lives of up
      to 6% of those affected. When treated with a form of psychotherapy and nutritional guidance,
      people can restore weight to healthy levels and recover from AN, but the chance of relapse
      remains high. A program aimed specifically at reducing relapse, Exposure Therapy and Ritual
      Prevention with Motivational Enhancement for Relapse Prevention in Anorexia Nervosa
      (AN-EX/RP), may be more effective than common psychotherapy treatments, such as cognitive
      behavioral therapy (CBT), in enhancing long-term recovery from AN. This study will compare
      the effectiveness of AN-EX/RP with CBT in reducing relapse and fear of eating situations in
      people with AN.

      Participants in this study will include patients who have achieved normal weight while
      inpatients at the New York State Psychiatric Unit. Eligible participants will undergo initial
      assessments that will include questionnaires, interviews, and two laboratory-based meals.
      Participants will then be assigned randomly to receive 6 months of outpatient psychotherapy
      treatment with either AN-EX/RP or CBT. Participants assigned to receive AN-EX/RP will attend
      90-minute sessions twice weekly for the first few months, then weekly thereafter. Sessions
      will focus on fear of eating situations and will help participants to confront, rather than
      avoid, these fears in order to learn through practice that the fears are unrealistic.
      Participants assigned to receive CBT will attend treatment sessions twice weekly for the
      first month and then weekly thereafter. CBT sessions will focus on thoughts, feelings, and
      behaviors that perpetuate the eating disorder, with the aim to develop healthier patterns.
      After completing the 6 months of treatment, all participants will repeat the initial
      assessments.
    

Intervention name(s): Food Exposure Therapy and Ritual Prevention with Motivational Enhancement for Relapse Prevention in Anorexia Nervosa (AN-EX/RP); Cognitive behavioral therapy (CBT)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): AN-EX/RP will consist of in-session exposures to feared eating situations without using avoidance behaviors as well as formal motivational interviewing techniques.; CBT for anorexia nervosa sessions will focus on behaviorally normalizing eating patterns throughout the day and on cognitively addressing dysfunctional thinking that promotes disordered eating.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Exposure Therapy; Relapse Prevention; Anorexia Nervosa