A Pilot Investigation of Network-Informed Personalized Treatment for Eating Disorders versus Enhanced Cognitive Behavioral Therapy and Dynamic Mechanisms of Change

项目总结/摘要 饮食失调（ED）是严重的精神疾病，死亡率在所有疾病中排名第二。 精神疾病，并带来很高的社会，个人和经济成本。治疗反应 ED的治疗效果并不理想，只有50%的成年人对循证治疗有反应， 无神经性厌食症（AN）或其他特定喂养或进食的循证治疗 疾病（OSFED）存在。ED如此难以治疗的部分原因是 症状表现的异质性，使其难以确定治疗的目标， 因为两个人，即使有相同的诊断，也有很大的不同。个性化治疗， 紧急需要能够改善治疗反应并最大限度地减少痛苦的ED 与这些疾病有关。我们的科学前提是，从我们过去的工作中发展出来的， 基于特定模型的个性化治疗（称为网络信息个性化 治疗; NA-PT）将优于目前的金标准治疗（增强认知功能 行为疗法：CBT-E）。我们的研究目标是（1）开发和测试可接受性， NA-PT与CBT-E随机化的可行性和初步疗效，以及（2）测试 网络识别的精确目标是变化的机制。这些目标最终将 导致了艾德的第一个个性化治疗，并可扩展到其他 精神疾病。拟议的研究采用高度创新的方法;密集的 利用移动的技术收集的纵向数据与最先进的具体 建模方法来提供虚拟的个性化治疗。具体目标是：（1）收集 关于NA-PT（n=40）随机化的可行性和可接受性的初步数据， EDs与CBT-E（n=40），（2）为了测试NA-PT与CBT-E在以下方面的初步临床疗效： 临床结果（例如，艾德症状、体重指数、生活质量）和（3）检查是否 对于由NA识别的精确目标，以及动态网络结构的变化， 与临床结果的变化相关。这项研究具有临床意义。 最终，这一提议将直接导致证据的产生和传播- 基于ED的个性化治疗，以及将作为个性化治疗的典范。 整个精神病学领域的治疗发展。

PROJECT SUMMARY/ABSTRACT Eating disorders (EDs) are serious mental illness, with the second highest mortality rate of any psychiatric disorder and carry high societal, personal, and economic costs. Treatment response for EDs are suboptimal, with only 50% of adults responding to evidence based treatments and no evidence-based treatment for anorexia nervosa (AN) or Other Specified Feeding or Eating Disorder (OSFED) in existence. Part of the reason EDs are so difficult to treat is the high heterogeneity in symptom presentation, making it difficult to identify what to target in treatment, as two individuals, even with the same diagnosis, substantially vary. Personalized treatments for EDs are urgently needed that can improve treatment response and minimize the suffering associated with these illnesses. Our scientific premise, developed from our past work, is that treatment personalized based on idiographic models (termed Network Informed Personalized Treatment; NA-PT) will outperform the current gold-standard treatment (Enhanced Cognitive Behavioral Therapy: CBT-E). Our study goals are to (1) develop and test the acceptability, feasibility, and preliminary efficacy of a randomization of NA-PT versus CBT-E and (2) to test if network-identified precision targets are the mechanism of change. These goals will ultimately lead to the very first personalized 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. Specific aims are (1) To collect preliminary data on the feasibility and acceptability of the randomization of NA-PT (n=40) for EDs versus CBT-E (n=40), (2) To test the initial clinical efficacy of NA-PT versus CBT-E on clinical outcomes (e.g., ED symptoms, body mass index, quality of life) and (3) To examine if changes in NA-identified, precision targets, as well as in dynamic network structure, are associated with change in clinical outcomes. The proposed research has clinical impact. Ultimately, this proposal will lead directly to the creation and dissemination of an evidence- based personalized treatment for EDs, as well as will serve as an exemplar for personalized treatment development across the entire field of psychiatry.