Relapse Prevention and Changing Habits in Anorexia Nervosa

NCT ID: NCT04810624

Last Updated: 2025-03-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

SUSPENDED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-06-21

Study Completion Date

2026-01-30

Brief Summary

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This study aims to optimize a treatment package for the relapse prevention treatment of AN. In the Preparation Phase, we examined accessibility and feasibility of the treatment package.

In the current Optimization Phase, we will identify which components of treatment contribute to positive outcomes after acute hospitalization. We will carefully evaluate maintenance of remission, measured by rate of weight loss and end-of-trial status.

Detailed Description

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While many approaches to reducing relapse after hospital care have been tried, there is little information about which treatment elements confer benefit. This trial, 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. 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 the acceptability and feasibility of 5 components that together target habits: 1) Behavioral, 2) Cognitive, 3)Motivation, 4) Food Monitoring, and 5) Skill Consolidation. In the Preparation Phase, 10 participants were enrolled, and accessibility and feasibility of the treatment package was examined. The current Optimization Phase includes a finalized treatment manual (including an online platform) and will test each component's contribution to weight maintenance after acute treatment.

Conditions

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Anorexia Nervosa

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Do, Accept, Motivation Through Values, Sessions, Long-Term Food Logs,

Behavior Do: Including in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food Monitoring - Long-Term: Use of food logs for duration of treatment.

Group Type EXPERIMENTAL

No interventions assigned to this group

Do, Accept, Motivation through Values, Sessions, Short-Term Food Logs

Behavior Do: Including in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Accept, Motivation through Values, Check-Ins, Short-Term Food Logs

Behavior Do: Including in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Accept, Motivation through Values, Check-Ins, No Food Logs

Behavior Do: Including in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Accept, Motivation through Narratives, Sessions, Short-Term Food Logs

Behavior Do: Including in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Accept, Motivation through Narratives, Sessions, No Food Logs

Behavior Do: Including in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Accept, Motivation through Narratives, Check-Ins, Long-Term Food Logs

Behavior Do: Including in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

Food Monitoring - Long-Term: Use of food logs for duration of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Change, Motivation Through Values, Sessions, Short-Term Food Logs

Behavior Do: Including in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Change, Motivation Through Values, Sessions, No Food Logs

Behavior Do: Including in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Change, Motivation through Values, Check-Ins, Long-Term Food Logs

Behavior Do: Including in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

Food Monitoring - Long-Term: Use of food logs for duration of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Change, Motivation Through Narratives, Sessions, Long-term Food Logs

Behavior Do: Including in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food Monitoring - Long-Term: Use of food logs for duration of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Accept, Motivation through Values, Sessions, Short-Term Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Accept, Motivation through Values, Sessions, No Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Accept, Motivation through Narratives, Check-Ins, Short-Term Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Accept, Motivation through Narratives, Check-Ins, No Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Change, Motivation Through Values, Sessions, Long-Term Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food Monitoring - Long-Term: Use of food logs for duration of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Change, Motivation Through Values, Sessions, No Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Change, Motivation through Values, Check-Ins, Short-Term Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Change, Motivation through Values, Check-Ins, No Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Change, Motivation through Narratives, Sessions, Short-Term Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Change, Motivation through Narratives, Sessions, No Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Change, Motivation through Narratives, Check-Ins, Long-Term Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

Food Monitoring - Long-Term: Use of food logs for duration of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Change, Motivation through Narratives, Check-Ins, Short-Term Food Logs

Behavior Do: Including in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

Food-Monitoring - Short-Term: Use of food logs for first 5 weeks of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Do, Change, Motivation through Narratives, Check-Ins, No Food Logs

Behavior Do: Including in-session eating experiments.

Thought Change: Monitoring and actively challenging distorted thoughts.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

No Food-Monitoring: No recommendation for food records or logs during treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Accept, Motivation through Values, Check-Ins, Long-Term Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Values: Identifying individual motivators for recovery and opportunities to expand upon non-eating disorder aspects of identity.

Check-Ins for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress conducted independently by participant, with only brief (\~20-min) check-ins during this period.

Food Monitoring - Long-Term: Use of food logs for duration of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Talk, Accept, Motivation through Narratives, Sessions, Long-Term Food Logs

Behavior Talk: Discussion of recent eating and plans for upcoming eating; absence of in-session eating experiments.

Thought Accept: Mindfully accepting of unhelpful thoughts as passing mental phenomena that need not guide behavior.

Motivation Through Narratives: Using stories of others with lived experience (e.g., writings, podcasts) to appreciate long-term dangers of AN and the opportunity for symptom resolution with sustained recovery, without discussion of individualized motivators.

Sessions for Skills Consolidation: Consolidation of skills introduced to patient and monitoring of continued progress using 45-min, face-to-face (via video) sessions.

Food Monitoring - Long-Term: Use of food logs for duration of treatment.

Group Type EXPERIMENTAL

Relapse Prevention and Changing Habits (REACH+)

Intervention Type BEHAVIORAL

Psychotherapy

Interventions

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Relapse Prevention and Changing Habits (REACH+)

Psychotherapy

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of Anorexia Nervosa at hospital admission
* Medically Stable
* Internet capability with videoconferencing
* Weight restored (BMI \> 19 kg/m2) at New York State Psychiatric Institute

Exclusion Criteria

* Current substance use or other comorbid disorder requiring specialized treatment
* Pregnancy
* Imminent risk of suicide
* Serious medical illness
* Daily psychotropic medication other than antidepressants (medications that are known effect weight are exclusionary, i.e. stimulants, olanzapine, mirtazapine)
* Participation in outside psychotherapy or structured treatment program (support groups will be allowed). Individuals who are discharged on medications would need to have a non-study psychiatrist.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Columbia University

OTHER

Sponsor Role collaborator

Brown University

OTHER

Sponsor Role collaborator

National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

New York State Psychiatric Institute

OTHER

Sponsor Role lead

Responsible Party

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Joanna Steinglass

Professor of Psychiatry

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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New York State Psychiatric Institute

New York, New York, United States

Site Status

Countries

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United States

References

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Steinglass JE, Attia E, Glasofer DR, Wang Y, Ruggiero J, Walsh BT, Thomas JG. Optimizing relapse prevention and changing habits (REACH+) in anorexia nervosa. Int J Eat Disord. 2022 Jun;55(6):851-857. doi: 10.1002/eat.23724. Epub 2022 Apr 30.

Reference Type BACKGROUND
PMID: 35488866 (View on PubMed)

Other Identifiers

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R34MH127180

Identifier Type: NIH

Identifier Source: secondary_id

View Link

8110

Identifier Type: -

Identifier Source: org_study_id

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