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Shifting Perspectives: Enhancing outcomes in adolescent anorexia nervosa with cognitive remediation therapy

Award Number: R33MH119262
ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 05/01/2019
PERIOD OF PERFORMANCE END DATE: 06/30/2025

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Shifting Perspectives: Enhancing outcomes in adolescent anorexia nervosa with cognitive remediation therapy - ABSTRACT/PROJECT SUMMARY This application seeks support for a phased project. In the initial (R61) 2-year phase we will establish that Cognitive Remediation Therapy (CRT) can increase set-shifting in parents of and/or adolescents with Anorexia Nervosa (AN). Our second aim is to determine the appropriate dose needed to achieve positive change in set- shifting. Attaining our milestone would trigger support for three additional years (R33) to confirm target engagement and appropriate dose. We will also evaluate whether or not adding CRT to Family Based Treatment (FBT) will improve outcome compared to FBT alone. Set-shifting (a type of executive functioning often referred to as cognitive flexibility) inefficiencies are hypothesized to be an endophenotype of AN and are, therefore, heritable. Cognitive flexibility can be impacted negatively by situational factors such as malnutrition, stress, and anxiety. It is likely that both adolescents (who are malnourished) and parents (who are under stress) experience significant state-based reduction in their cognitive flexibility during AN and its treatment. While cognitive flexibility can be increased through CRT, there is a significant gap in our knowledge about how to apply CRT to the treatment of adolescent AN, specifically concerning the most appropriate target for CRT: parents or adolescents? The majority of research on CRT with adolescents with AN are pilot and feasibility studies and target set-shifting in adolescents, not parents. We hypothesize that targeting parents may be more impactful for adolescent outcome. First, we must determine if we can increase set-shifting via CRT. In the initial R61 phase we propose to recruit and randomly assign 54 families who have a child with AN to FBT, FBT with parent-focused CRT, or FBT with adolescent-focused CRT. Target engagement will be assessed via neuro- psychological assessment and self-report of cognitive and behavioral flexibility. If we meet our proposed milestones in the R61 phase, we will proceed to the R33 phase. It is possible that one (N = 72 families) or both (N = 93 families) CRT conditions will be examined in the R33 phase. We will confirm our findings from the R61 phase (target engagement and dose of CRT). We will also examine adolescent outcome in FBT alone versus FBT+(parent or adolescent) CRT. Outcome includes rate of weight gain, cognitive symptoms of AN, and variety in macronutrient intake by the adolescent. We will gather preliminary data on putative moderators and/or mediators across both phases in order to inform results. This phased R61/R33 application is innovative in that it is the first to adapt CRT to parents only. Evidence supporting FBT+CRT to increase set-shifting in parents/adolescents will inform future efforts to leverage our understanding of (heritable) neurobiology of AN in adolescents to improve outcome. Further, if CRT for parents significantly improves set-shifting, we can focus our efforts on how best to augment current treatments, support parents, and increase positive outcomes for the adolescent and reduce relapse. Even negative results would inform our understanding of set-shifting inefficiencies as an endophenotype in AN, its measurement, and usefulness as a target in treatment.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2023	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	3401 CIVIC CENTER BLVD	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Mental Health Research Grants	000	5	12/5/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $720,102 )
2023	2023	CHILDREN'S HOSPITAL OF PHILADELPHIA, THE	3401 CIVIC CENTER BLVD	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Mental Health Research Grants	000	5	7/12/2023	NON-COMPETING CONTINUATION	$720,102
														Subtotal = $720,102

Issue Date FY: 2022 ( Subtotal = $904,124 )
2022	2022	CHILDREN'S HOSPITAL OF PHILADELPHIA, THE	3401 CIVIC CENTER BLVD	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Mental Health Research Grants	000	4	8/12/2022	NON-COMPETING CONTINUATION	$832,396
2022	2021	CHILDREN'S HOSPITAL OF PHILADELPHIA, THE	3401 CIVIC CENTER BLVD	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Mental Health Research Grants	001	3	8/26/2022	EXTENSION WITH OR WITHOUT FUNDS	$71,728
														Subtotal = $904,124

Issue Date FY: 2021 ( Subtotal = $855,669 )
2021	2021	CHILDREN'S HOSPITAL OF PHILADELPHIA, THE	3401 CIVIC CENTER BLVD	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Mental Health Research Grants	000	3	9/1/2021	EXTENSION WITH OR WITHOUT FUNDS	$855,669
														Subtotal = $855,669

Grand Total All Awards = $2,479,895

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Shifting Perspectives: Enhancing outcomes in adolescent anorexia nervosa with cognitive remediation therapy

Award Number: R33MH119262

ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 05/01/2019

PERIOD OF PERFORMANCE END DATE: 06/30/2025

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