Reducing Relapse by Enhancing Reward Responsivity in Anorexia Nervosa: The VIBRANT (Virtual Interventions for Bolstering Recovery following Anorexia Nervosa Treatment) Trial †.

Introduction: The post-acute phase of anorexia nervosa (AN) following discharge from higher-level care is a high-risk period in which relapse rates are high and many individuals lack access to effective treatment. Even after acute nutritional stabilization, AN is characterized by decreased biobehavioral sensitivity towards general rewards and elevated sensitivity towards weight-loss cues. These reward patterns may continue to maintain eating disorder and comorbid affective symptoms. To address these gaps in the treatment literature for post-acute AN, we propose a randomized controlled trial comparing Positive Affect Treatment for AN (PAT-AN), a neuroscience-informed therapy adapted to target these reward imbalances in AN, to more standard psychoeducational and behavioral treatment (PBT) for eating disorders following acute care.

Method: Adult participants (N = 80) with broad AN, including atypical AN, discharged from intensive treatment (e.g., residential, partial hospitalization) for AN within the past 6 months will be randomly assigned to 24 weeks of remotely-delivered PAT-AN or PBT. We will compare the feasibility, acceptability, and efficacy of each treatment to augment post-acute outpatient care for AN. A multimodal neurocognitive and self-report battery will assess eating pathology, comorbid symptom, and putative reward mechanism changes over the course of treatment (i.e., baseline, mid-treatment, post-treatment, three-month follow-up) and on a week-to-week basis.

Discussion: This trial will, for the first time, directly target observed reward disturbances in the post-acute period of AN. Thus, this investigation has the potential to simultaneously evaluate a novel, efficacious treatment for AN and to further evaluate the role of reward dysfunction in AN maintenance.