A Study of Cognitive-Behavioral Therapy for Rumination Disorder

Study Overview
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Brief Summary
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The primary aim of this study is to pilot cognitive behavioral therapy (CBT-RD) for 10 individuals ages 10 and older who have rumination disorder

Detailed Description
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Rumination disorder (RD; also known as rumination syndrome) is a disordered eating behavior characterized by the repeated regurgitation of food during or soon after eating. The frequency of repeated regurgitation of food typically occurs at least a few times per week, frequently daily with subsequent re-chewing, re-swallowing, or spitting out of the regurgitated material. The widely used technique for treatment of RD has typically been diaphragmatic breathing, which works by serving as a competing response to abdominal wall contractions, which is hypothesized to trigger regurgitation. However, the efficacy of diaphragmatic breathing remains unknown and has mainly been delivered through a one-session instruction with an occasional follow-up. In the absence of evidence-based treatments for RD, the investigators, alongside a collaboration with Dr. Jennifer Thomas at the Eating Disorders Clinical and Research Program (EDCRP) at Massachusetts General Hospital, have created a manualized treatment, Cognitive-Behavioral Therapy for Rumination Disorder (CBT-RD) informed by published case reports and currently in use at EDCRP at Massachusetts General Hospital and the Psychological Services Center at Drexel University. CBT-RD targets the habitual contraction of the abdominal wall and preceding events through the use of habit reversal, using primarily diaphragmatic breathing as a competing response. This study involves a phone screen to determine eligibility, followed by 5-8 sessions of CBT-RD (approximately 50 minutes each). A battery of questionnaires will be administered at pre-treatment, post-treatment, and 3-month follow-up intervals.

Official Title
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A Pilot Study of Cognitive-Behavioral Therapy for Rumination Disorder

Conditions
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Rumination Disorder

Intervention / Treatment
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* Behavioral: CBT-RD


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 10 or above Experience repeated regurgitation of food during or soon after eating, consistent with rumination disorder If applicable, have stable psychiatric medication for the past three months Exclusion Criteria: Currently engage (in past three months) in any regular compensatory behaviors (e.g., self-induced vomiting, laxative/diuretic use) Current diagnosis of anorexia nervosa Acute suicide risk Are currently receiving psychological treatment for rumination disorder Co-morbid clinically significant psychological disorder that would require attention beyond the study treatment (e.g., psychotic disorder, substance dependence) Current pregnancy

Ages Eligible for Study
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Minimum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: There is only one arm in this study - all participants will be in the same arm, as all participants will receive CBT-RD. There is no control group.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention (CBT-RD)<br>There is only one arm in this study - all participants will be in the same arm, as all participants will receive CBT-RD. There is no control group. | Behavioral: CBT-RD<br>* 5-8 sessions of cognitive behavioral therapy for rumination disorder (CBT-RD), held once per week in an outpatient setting.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pica, Avoidant/Restrictive Food Intake Disorder, Rumination Disorder Interview (PARDI) | A semi-structured interview to assess pica, Avoidant/Restrictive Food Intake Disorder (ARFID), and/or rumination disorder diagnosis, severity, and symptoms. We will use the PARDI to assess frequency and severity of rumination behavior specifically. | Change from baseline to 3-month follow-up |