Non-invasive Cranial Electrical Stimulation for Mealtime Anxiety in Adults With Eating Disorders

Rogers Behavioral Health30 enrolled

Overview

The study is to evaluate the feasibility of using a non-invasive brain stimulation device in a sample of inpatients with eating disorders (ED). The study will help researchers evaluate whether their device protocol is practical for eating disorder inpatients as a way to manage eating disorder and anxiety symptoms. A secondary aim of the study is to evaluate preliminary effectiveness of the protocol for reducing pre-meal anxiety during the treatment, and explore effects on eating disorder symptoms over the course of the inpatient admission.

Evaluate the feasibility and acceptability of a protocol for using Alpha-Stim AID® (explicitly references the patented waveform and delivery method in the Alpha-Stim AID® device manufactured and marketed by Electromedical Products International, Mineral Wells, TX) to manage acute pre-meal anxiety in eating disorder inpatients indicated by recruitment and retention, dropout reasoning, nature and frequency of patient-reported side effects, level of missing patient-reported data, staff perception and patient perception. Secondary outcomes include pre-meal anxiety rated on a 0-10 visual analogue scale, eating disorder symptom severity during the three-session protocol and across the inpatient admission using the Eating Disorder-15 assessment, and clinical impairment from disordered eating using the Clinical Impairment Assessment-Eating only version, across the same timepoints.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Eating Disorders

Eligibility

Sex: ALLMin age: 18 YearsMax age: 30 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age 18-30 years old at the time of enrollment 2. Enrolled in Rogers Behavioral Health Eating Disorder Recovery Program Inpatient Unit at the Oconomowoc, WI clinic location 3. Have a primary diagnosis of any DSM-5 eating disorder (anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, other specified feeding or eating disorder) 4. Ability to communicate effectively using written and spoken English 5. Participant is eligible for mealtime anxiety support based on: * ≤ 75% meal plan compliance * Visible anxiety/distress during program meals * Engagement in compensatory behaviors or self-harm before, during, or after meals, or medical staff judge patient to be at risk of same Exclusion Criteria: 1. Metal in the body of any kind (e.g., braces, pacemakers, metal plates or screws, intracranial electrodes, implanted devices/defibrillators, prostheses) 2. Currently taking medication that reduces seizure threshold (e.g., clomipramine) 3. Cranial pathologies (e.g., holes, plates) 4. History of seizure or black-out concussion 5. Pregnancy 6. Risk of suicide/self-harm by self-strangulation with cranial electrotherapy stimulation (CES) device judged by study medical staff 7. Participant calibrates to a stimulation level below 200 microampere (μA)

Outcomes

Primary Outcomes

Percentage of patients who were recruited, enrolled and completed the study

The percentage of eligible patients approached for recruitment, percentage of recruited patients enrolled, and percentage of enrolled patients completing the study, each as recorded by study staff.

Time frame: From recruitment to end of study intervention at day 3.

Patient-reported dropout reason

The patient's self-reported rationale for leaving the study prematurely (e.g., unexpected discharge from inpatient eating disorder treatment, unable to tolerate stimulation, emergent suicidality, unwilling to participate in the protocol, etc.).

Time frame: Anytime from enrollment to the end of study intervention at day 3.

Patient-reported side effects

Patient-reported side effects questionnaire assessing side effects experienced from the intervention day prior.

Time frame: Before the first session on days 2 and 3 of the study intervention.

Patient perception of acceptability as assessed by the Credibility and Expectancy Questionnaire

The Credibility and Expectancy Questionnaire is a 6-item self-report survey used to assess patients' belief and expectation that they will benefit from a treatment. We will use two questions from the scale to assess how much the participant believes the treatment makes sense, and how strongly they feel it will help them. It is rated on a 10-point scale with anchors 1-9 (not at all (1), somewhat (5), very (9)). The two questions from the CEQ will be as follows: 1. How logical does cranial electrical stimulation for pre-meal anxiety seem? 2. How successful do you think cranial electrical stimulation will be in reducing your pre-meal anxiety?

Time frame: Baseline, Days 2 and 3 of study intervention.

Percent completion of study data collection

Tracking and reporting completeness of all patient-reported outcome data and study data abstracted from electronic medical records.

Time frame: At end of patient's participation and end of admission on inpatient unit.

Secondary Outcomes

Pre-meal anxiety on a visual analogue scale on a scale from 0-10.

A patient-reported measure of pre-meal anxiety rated on a 0-10 visual analogue scale. A score of 0 is no anxiety while a score of 10 is maximum anxiety.

Time frame: Prior to each meal on intervention days 1, 2 and 3.

Eating Disorder Symptoms using the Eating Disorder-15 (ED-15) measure

Patient self-reports of eating disorder symptoms using the Eating Disorder-15 (ED-15) measure. The ED-15 includes two attitudinal subscales, scored as follows: 1) Weight \& Shape Concerns = mean of items 2, 4, 5, 6, 9, and 10 (add the six scores and divide by 6), 2) Eating Concerns = mean of items 1, 3, 7 and 8 (add the four scores and - divide by 4). The Overall attitudinal score is the mean of the scores on all ten items (total the ten items and divide by 10). All items are positively scored from 0-6.

Time frame: From enrollment until end of study intervention on day 3.

The Fear of Food Measure (FOFM)

The Fear of Food Measure (FOFM) is a measure of the degree to which patients report fearing eating and food itself. Scores on the FOFM can assess if patients are improving while undergoing eating disorder treatment. The FOFM is a 23 item scale positively scored 0-5 with three attitudinal scales measuring Anxiety About Eating, Food Anxiety Behaviors (i.e., avoidance), and Feared Concerns (i.e., feared outcomes of eating). Scores on all subscales will be examined, but Food Anxiety Behaviors scores are the most directly comparable across eating disorder diagnoses (e.g., Avoidant Restrictive Food Intake Disorder (ARFID) vs. anorexia and bulimia nervosa, Other Specified Feeding or Eating Disorders (OSFED)).

Time frame: At days 1, 2 and 3 of intervention.

Eating disorder clinical impairment rated on the Clinical Impairment Assessment - Eating only (CIA)

The Clinical Impairment Assessment - Eating only (CIA) is a 16-item measure of physical, cognitive, and emotional impairment from disordered eating. Items are scored on a 0-4 scale. The Eating-only version of the measure assesses impairment specifically related to restrictive or binge eating behavior, rather than impairment from other eating disorder behaviors that are not universally applicable to all eating disorders (i.e., purging, compensatory exercise). The measure is scored by summing all items for a possible score of 0-64.