Innovations in Personalizing Treatment for Eating Disorders Using Idiographic Methods and the Impact of Personalization on Psychological, Physical, and Sociodemographic Outcomes

项目摘要/摘要 进食障碍是一种严重的精神疾病：每52分钟就有一人死于进食障碍。 ED与许多负面后果高度相关，包括公共卫生和个人 疾病负担、医疗和心理并存以及健康的社会决定因素 (SDOH)。对EDS的治疗反应不佳；没有循证治疗 适用于患有神经性厌食症(AN)或其他指定进食或进食障碍(OSFED)的成年人 只有50%的成年人对目前的循证治疗有反应。没有精确度 治疗方法，也不存在任何考虑社会背景的治疗方法。个性化 考虑到社会背景，对ED的治疗迫切需要改善治疗 应对并最大限度地减少与这些疾病相关的痛苦。我们的总目标，延伸 在我们过去工作的基础上，创建基于具体(或一个人)的个性化治疗 模型(称为跨诊断网络通知个性化治疗EDS；T-NIPT- Ed)。我们将进行两个阶段的研究，以系统地描述单个机制的特征 治疗(第一阶段：N=900)，然后测试每个治疗模块的疗效(第二阶段： N=240，取自第一阶段)，与目前的黄金标准治疗(认知 增强的行为疗法：CBT-E)。我们的研究目标是(1)描述流行率 T-NIPT-ED精准治疗机制与医学和心理并存 (例如肥胖；抑郁)、个人疾病负担(例如残疾)、SDOH(例如食物 不安全)和特定于这些机制的公共卫生结果(例如，服务利用)， (2)确定个性化目标机制在与基于证据的机制相匹配时是否有所改善 T-NIPT-ED的治疗模块和(3)T-NIPT-ED的改变是否与 改善结局(与CBT-E相比)，包括ED结局、合并症、疾病负担和 公共卫生结果，以及这些结果是否受到SDOH的影响。这些目标将 最终导致对ED的第一次精确治疗，并可扩展到其他 精神疾病。拟议的研究使用了高度创新的方法；密集 利用移动技术收集的纵向数据与最先进的具体数据相结合 提供虚拟、个性化治疗的建模方法。这项建议综合了 评估广泛的(例如，SDOH；公共卫生负担)和具体的(例如，ED症状) 结果，以确保社会背景可以融入个性化。建议数 这项研究具有很高的临床影响。最终，这项提议将直接导致 传播一种以证据为基础的个性化急症治疗方法以及意愿 作为整个精神病学领域精准治疗发展的典范。

PROJECT SUMMARY/ABSTRACT Eating disorders (EDs) are serious mental illness: someone dies of an ED every 52 minutes. EDs are highly related to a host of negative outcomes, including public health and individual disease burden, medical and psychological comorbidities, and social determinants of health (SDOH). Treatment response for EDs are suboptimal; there are no evidence-based treatment for adults with anorexia nervosa (AN) or Other Specified Feeding or Eating Disorder (OSFED) and only 50% of adults respond to current evidence based treatments. There are no precision treatments, nor any treatments that consider social context, in existence. Personalized treatments for EDs, that consider social contexts, are urgently needed to improve treatment response and minimize the suffering associated with these illnesses. Our overall goal, extending upon our past work, is to create a treatment personalized based on idiographic (or one person) models (termed Transdiagnostic Network Informed Personalized Treatment for EDs; T-NIPT- ED). We will carry out a two-phase study to systematically characterize individual mechanisms of treatment (Phase I: N=900) and then test the efficacy of each treatment module (Phase II: N=240 drawn from Phase I) compared to the current gold-standard treatment (Cognitive Behavioral Therapy Enhanced: CBT-E). Our study goals are to (1) characterize the prevalence of T-NIPT-ED precision treatment mechanisms and medical and psychological comorbidities (e.g., obesity; depression), individual disease burden (e.g., disability), SDOH (e.g., food insecurity), and public health outcomes (e.g., service utilization) specific to these mechanisms, (2) identify if personalized target mechanisms improve when matched to evidence-based treatment modules of T-NIPT-ED and (3) test if change in T-NIPT-ED is associated with improved outcomes (vs CBT-E), including ED outcomes, comorbidities, disease burden, and public health outcomes and if these outcomes are moderated by SDOH. These goals will ultimately lead to the very first precision treatment for ED and can be extended to additional psychiatric illnesses. The proposed research uses highly innovative methods; intensive longitudinal data collected with mobile technology is combined with state-of-the art idiographic modeling methods to deliver a virtual, personalized treatment. This proposal integrates assessment of broad (e.g., SDOH; public health burden) and specific (e.g., ED symptoms) outcomes, to ensure that social context can be integrated into personalization. The proposed research has high clinical impact. Ultimately, this proposal will lead directly to the creation and dissemination of an evidence-based individually-personalized treatment for EDs, as well as will serve as an exemplar for precision treatment development across the entire field of psychiatry.