Merwin Rhonda M, Moskovich Ashley A, Babyak Michael, Feinglos Mark, Honeycutt Lisa K, Mooney Jan, Freeman Sara P, Batchelder Heather, Sangvai Devdutta
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3842, Durham, NC, 27712, USA.
Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Duke University Medical Center, Durham, NC, USA.
J Eat Disord. 2021 Jan 6;9(1):6. doi: 10.1186/s40337-020-00357-6.
Eating disorders (EDs) among individuals with type 1 diabetes (T1D) increase the risk of early and severe diabetes-related medical complications and premature death. Conventional eating disorder (ED) treatments have been largely ineffective for T1D patients, indicating the need to tailor treatments to this patient population and the unique conditions under which ED symptoms emerge (in the context of a chronic illness with unrelenting demands to control blood glucose, diet and exercise). The current study was a pilot open trial of iACT, a novel intervention for EDs in T1D grounded in Acceptance and Commitment Therapy (ACT). iACT was based on the premise that ED symptoms emerge as individuals attempt to cope with T1D and related emotional distress. iACT taught acceptance and mindfulness as an alternative to maladaptive avoidance and control, and leveraged personal values to increase willingness to engage in T1D management, even when it was upsetting (e.g., after overeating). A tailored mobile application ("app") was used in between sessions to facilitate the application of ACT skills in the moment that individuals are making decisions about their diabetes management.
Adults with T1D who met criteria for an ED completed 12 sessions of iACT (with three optional tapering sessions). In addition to examining whether treatment was acceptable and feasible (the primary aim of the study), the study also examined whether iACT was associated with increased psychological flexibility (i.e., the ability to have distressing thoughts/feelings about diabetes while pursuing personally meaningful values), and improvements in ED symptoms, diabetes management and diabetes distress.
Treatment was acceptable to T1D patients with EDs and feasible to implement. Participants reported increased psychological flexibility with diabetes-related thoughts/feelings, and less obstruction and greater progress in pursuing personal values. There were large effects for change in ED symptoms, diabetes self-management and diabetes distress from baseline to end-of-treatment (Cohen's d = .90-1.79). Hemoglobin A also improved, but the p-value did not reach statistical significance, p = .08.
Findings provide preliminary evidence for iACT to improve outcomes for T1D patients with EDs and support further evaluation of this approach in a controlled trial.
NCT02980627 . Registered 8 July 2016.
1型糖尿病（T1D）患者中的饮食失调（EDs）会增加早期和严重糖尿病相关医疗并发症以及过早死亡的风险。传统的饮食失调（ED）治疗方法对T1D患者大多无效，这表明需要针对该患者群体以及ED症状出现的独特情况（在需要持续控制血糖、饮食和运动的慢性病背景下）量身定制治疗方法。当前的研究是一项关于iACT的开放性试验，iACT是一种基于接受与承诺疗法（ACT）的针对T1D患者饮食失调的新型干预措施。iACT基于这样一个前提，即当个体试图应对T1D及相关情绪困扰时，ED症状就会出现。iACT教授接受和正念，作为适应不良的回避和控制的替代方法，并利用个人价值观来提高参与T1D管理的意愿，即使在令人心烦意乱的情况下（例如，暴饮暴食后）也是如此。在各次治疗之间使用了一个量身定制的移动应用程序（“应用程序”），以促进在个体就其糖尿病管理做出决策的当下应用ACT技能。
符合ED标准的成年T1D患者完成了12次iACT治疗（还有三次可选的逐渐减量治疗）。除了检查治疗是否可接受和可行（该研究的主要目的）之外，该研究还检查了iACT是否与心理灵活性增加（即，在追求个人有意义的价值观时对糖尿病产生痛苦的想法/感受的能力）以及ED症状、糖尿病管理和糖尿病困扰的改善相关。
治疗对于患有ED的T1D患者是可接受的，并且实施起来是可行的。参与者报告说，与糖尿病相关的想法/感受的心理灵活性有所增加，在追求个人价值观方面的阻碍减少且进展更大。从基线到治疗结束，ED症状、糖尿病自我管理和糖尿病困扰的变化有很大影响（科恩d值 = 0.90 - 1.79）。糖化血红蛋白也有所改善，但p值未达到统计学显著性，p = 0.08。
研究结果为iACT改善患有ED的T1D患者的治疗效果提供了初步证据，并支持在对照试验中对这种方法进行进一步评估。
NCT02980627。于2016年7月8日注册。
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