# Optimizing Relapse Prevention and Changing Habits (REACH+) in Anorexia Nervosa

> **NIH NIH R34** · NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC · 2021 · $287,293

## Abstract

Anorexia nervosa (AN) is a serious mental illness with significant morbidity and mortality rates, and relapse
rates ranging from 40-80% after acute treatment. A central behavioral disturbance in AN is the restriction of
food intake, which is promoted by entrenched thoughts, feelings, and routines. While many approaches to
reducing relapse after hospital care have been tried, there is little information about which treatment elements
confer benefit. Relapse Prevention and Changing Habits (REACH+) targets the habitual control of maladaptive
behavior to support patients with AN in the 6 months after acute treatment, a time of high vulnerability to
relapse. REACH+ builds on preliminary data that indicate that behavioral interventions that target habits in AN
can lead to changes in entrenched behaviors in the acute treatment setting. This approach has not yet been
developed for the relapse prevention setting. We will test whether treatment components can interrupt the
habitual control of maladaptive behavior and, by targeting this illness mechanism, decrease relapse and
improve outcomes. We will use a Multiphase Optimization STrategy (MOST) framework an ideal means for
improving treatment efficacy by simultaneously and efficiently evaluating multiple possible intervention
components, to determine which contribute to positive treatment outcomes and should therefore be included in
a robust treatment package for relapse prevention. Each component of REACH+ addresses a question that is
critical to answer in order to identify and optimize a relapse prevention treatment package that balances
efficacy and burden. We will test competing versions of 5 components that together target habits: 1)
Behavioral, 2) Cognitive, 3) Motivation, 4) Food Monitoring, and 5) Skill Consolidation. First, we will conduct
the final stages of the Preparation Phase (including Focus Groups) to maximize feasibility and acceptability of
the intervention components. Second, an Optimization Phase experiment with a finalized treatment manual
(including an online platform) will test each component's contribution to weight maintenance after acute
treatment. We will provide 6 months of REACH+ for 60 individuals with AN, weight-restored via our Eating
Disorders Program. Sessions, conducted via telehealth, will be augmented with psychoeducation, homework
assignments, and monitoring through an online platform. Participants will be randomly assigned to different
versions of each treatment component. Optimization criteria focus on the contribution of the component to
weight maintenance (main effect), and will additionally consider effect sizes, treatment adherence, and end-of-
treatment status. This will ensure that the finalized treatment package includes the most effective and feasible
components for definitive testing in a future randomized controlled trial. This systematic approach to treatment
development is critical for achieving the best outcomes most quickly and efficiently.

## Key facts

- **NIH application ID:** 10288420
- **Project number:** 1R34MH127180-01
- **Recipient organization:** NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
- **Principal Investigator:** EVELYN ATTIA
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $287,293
- **Award type:** 1
- **Project period:** 2021-07-08 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10288420

## Citation

> US National Institutes of Health, RePORTER application 10288420, Optimizing Relapse Prevention and Changing Habits (REACH+) in Anorexia Nervosa (1R34MH127180-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10288420. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*