# Neuroscience-informed treatment to remotely target reward mechanisms in post-acute anorexia nervosa

> **NIH NIH R34** · VIRGINIA COMMONWEALTH UNIVERSITY · 2024 · $214,380

## Abstract

PROJECT SUMMARY/ABSTRACT
 Anorexia nervosa (AN) is a serious illness with extremely high morbidity and mortality rates. Clearly
efficacious treatments are lacking for adults with AN, especially during the post-acute stage following higher-
level care (e.g., residential, partial-hospital program [PHP]). Most patients achieve symptom stability in
intensive treatment, but up to 50% relapse and more experience residual or co-morbid (e.g., affective)
symptoms after discharge. Appropriate outpatient treatment is often unavailable or inaccessible in this stage.
 Despite a rapid growth in the knowledge on the biobehavioral mechanisms promoting AN, this information
has rarely been incorporated into treatment. One set of mechanistic targets increasingly acknowledged as
relevant to AN are those of the reward system. The reward (a.k.a., positive affect or valence) system has been
implicated in maintenance of myriad psychiatric disorders, including common AN co-morbidities (e.g., mood
and anxiety disorders). A wealth of evidence, including our pilot data, suggests that individuals with AN show
deficit reward sensitivity to experiences generally considered rewarding (e.g., social interactions, eating),
similar to those with affective disorders. However, distinct from other psychiatric illnesses, individuals with AN
also show elevated reward sensitivity to weight-loss experiences and cues (e.g., exercise, low-calorie foods).
Starvation in acute AN appears to exacerbate these processes. However, these same problems affect weight-
restored AN, suggesting they represent core illness mechanisms. Although reward anomalies have long been
noted in the literature, currently no treatments for AN designate positive affect as a primary intervention target.
To remedy this gap, we will test whether a remotely-deployed psychosocial treatment targeting positive
affect, Positive Affect Treatment (PAT), can alter reward mechanisms and enhance treatment outcomes in
post-acute AN. PAT is a cognitive-behavioral therapy originally designed to treat mood and anxiety disorders
and adapted by our team to target reward anomalies in AN (PAT-AN). Our pilot data suggest that PAT-AN,
delivered in person or via teletherapy, effectively targets positive affect and reward sensitivity to improve BMI
and eating disorder, anxiety, depressive symptoms. We will extend this investigation to the post-acute period of
AN, during which we expect to even more effectively engage the reward system, due to the removal of the
biological constraints of starvation. Adults with broadly-defined AN (N = 70) leaving residential or PHP will be
randomized to 24 weeks of PAT-AN or active control (psychoeducation and behavior therapy) as adjunctive to
treatment as usual. Treatment will be delivered via the highly accessible and scalable format of teletherapy.
Throughout treatment and follow-up, subjects will complete a novel multimodal battery (e.g., mobile-delivered
and neurocognitive measures) assessing measuring r...

## Key facts

- **NIH application ID:** 10876393
- **Project number:** 5R34MH129464-03
- **Recipient organization:** VIRGINIA COMMONWEALTH UNIVERSITY
- **Principal Investigator:** Ann Frances Haynos
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $214,380
- **Award type:** 5
- **Project period:** 2022-08-10 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10876393

## Citation

> US National Institutes of Health, RePORTER application 10876393, Neuroscience-informed treatment to remotely target reward mechanisms in post-acute anorexia nervosa (5R34MH129464-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10876393. Licensed CC0.

---

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