DESCRIPTION (provided by applicant): The current project is a re-submission for a K23 award for Dr. Adrienne Juarascio, an Assistant Research Professor at Drexel University. Dr. Juarascio is establishing herself as an early-career investigator in patient oriented research with a focus on innovative treatment development for eating disorders. In particular, Dr. Juarascio is interested in using experimental therapeutics approaches to improve existing treatments for subgroups who experience minimal improvement from existing treatments. This K23 award will provide Dr. Juarascio with the necessary support to accomplish the following goals: (1) Develop expertise in the mechanisms of existing gold-standard treatments for eating pathology and moderators of response to treatment, (2) attain the skills and knowledge necessary to design, conduct, and evaluate clinical trials in outpatient settings, (3) gain experience with assessment techniques for hypothesized maintenance factors in eating pathology, with a focus on bio-behavioral assessment procedures, (4) build proficiency with multi-level and longitudinal analytic approaches related to clinical trial research, and (5) increase skills related to manuscript preparation, grant writing and management, clinical supervision, and academic leadership. To achieve these goals, Dr. Juarascio has assembled a mentoring team comprised of two co-primary mentors (Dr. Michael Lowe and Dr. Evan Forman), two co-mentors (Dr. Carl Lejuez, and Dr. Matthew Hayes) and two consultants (Dr. Carlos Grilo and Dr. Robert Gallop) with whom she has created a training plan that will provide her with the skills needed to become a successful federally-funded independent investigator. As part of this training plan, Dr. Juarascio will develop and assess a novel treatment (Nutritional Counseling and Acceptance-based Treatment, N-CAAT) for patients with bulimia nervosa (BN) who are high in weight suppression, a factor associated with the development and maintenance of BN symptoms and with poor treatment outcome. The poor outcomes for this sub-group are likely due to the predictable weight gain that occurs once normal eating behavior resumes. Although weight gain can reduce the biobehavioral bind that promotes continued pathology, weight gain can also be distressing and promote continued engagement in maladaptive eating behaviors. Innovative treatments that address core maintenance factors are needed to improve outcome. The proposed project will consist of three phases, with Phase I focusing on the creation of a treatment manual, Phase II pilot testing the manual in a small sample and assessing target engagement, and Phase III testing the feasibility, acceptability, target engagement, and target validation of N-CAAT in a small pilot RCT. The primary study aims will be to evaluate the feasibility of recruitment, randomization, retention, assessment procedures, and implementation of the novel treatment to enhance the probability of success in subsequent RCTs. This research will form the basis of a randomized interventional trial that will be submitted in an R01 grant application before the end of the K23 award.

Project Narrative There is a critical need to improve treatments for patients with bulimia nervosa who show poor response to existing behavioral treatment approaches. Patients high in weight suppression are one sub-group that appears to do poorly in existing treatment programs and experience a greater time to remission, likely due to the propensity towards weight gain coupled with an intense fear of gaining weight. Behavioral treatments that specifically target maintenance factors for bulimic symptoms among patients high in weight suppression could improve outcomes and reduce time to remission.