2 - (SYM 1) Targeting Reward Processing with Temperament Based Therapy with Support (TBT-S) to Enhance Outcomes in Adults with Anorexia Nervosa

Abstract Body

Background: Temperament Based Therapy with Support (TBT-S) is an emerging neurobiologically-informed skills-based family intervention for adults with anorexia nervosa (AN). TBT-S targets reward and motivational deficits associated with AN via neurobiological psychoeducation and skills training to reduce eating disorder symptoms. Rather than attempting to change reward sensitivity, TBT-S uses a strength-based approach and teaches management strategies to leverage the innate personality traits related to AN in constructive ways to reduce maladaptive behaviors. TBT-S empowers support person involvement in a patient-directed manner and uses in vivo practice of skills to facilitate learning and behavior change.

Methods: Preliminary feasibility, acceptability and efficacy have been examined in three open trials of TBT-S delivered in a 5-day multifamily intensive format, including 1) for adults with protracted AN, 2) for emerging adults (ages 18-27), and 3) for adults receiving outpatient treatment in Oslo, Norway. Patients attended with at least one support person, and completed symptom assessments at pre-treatment, post-treatment and variable follow-up lengths.

Results: Attrition was low across the three trials (0-5.3%). Significant decreases in eating disorder psychopathology (global EDE-Q) were observed in adults with protracted AN post-treatment (n=51, mean age=24.5, mean illness duration=9.1 years; p=.014, d=.27) and 6-month follow-up (n=39; p=.001, d=.78), in young adults (mean age=19.6, mean illness duration=3.3 years) with AN (n=24) and bulimia nervosa (n=8) over 12 months (p=.002, r=.45) and in Norwegian adults with AN (n=35), BN (n=3) and USFED (n=3) immediately after treatment (n= 41; mean age=25.3; p=.001, d=0.77). Decreases in psychosocial impairment (CIA) at follow-up were also observed in young adults (17.67; p=.002, r=.42) and the Norwegian sample (p=.001, d=0.57). In all three trials, clinicians reported good feasibility and patients rated TBT-S as highly acceptable with high ratings on items assessing target engagement, including increased motivation for recovery, confidence in ability to change, and commitment to using TBT-S skills.

Conclusions: TBT-S is a promising new treatment for eating disorders with high acceptability. Open trials suggest a reduction in eating disorder symptoms and increase in motivation. Randomized controlled trials are needed to further assess treatment efficacy, test motivation as a mechanism of action, and evaluate treatment delivery in different formats.