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

项目摘要/摘要 饮食失调是一种严重的精神疾病，死亡率在所有疾病中排名第二。 精神障碍，并带来高昂的社会、个人和经济代价。治疗反应 对于ED来说，只有50%的成年人对循证治疗和 对于神经性厌食症(AN)或其他特定的喂养或进食，没有循证治疗 无序(OSFED)存在。急症如此难以治疗的部分原因是高 症状表现的异质性，使得很难确定治疗的目标， 作为两个个体，即使有相同的诊断，也会有很大的不同。个性化治疗 急切需要的是能够改善治疗反应并将痛苦降至最低的急救药物 与这些疾病有关。我们从过去的工作中发展出来的科学前提是 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)将优于目前的黄金标准治疗(增强认知 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随机对照的可行性和初步疗效以及(2)测试IF 网络识别的精确目标是变革的机制。这些目标最终将 导致第一个针对ED的个性化治疗，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。具体目标是(1)收集 NA-PT(n=40)随机对照的可行性和可接受性的初步数据 EDS与CBT-E(n=40)，(2)比较NA-PT与CBT-E的初步临床疗效。 临床结果(例如，ED症状、体重指数、生活质量)和(3)检查 NA识别的精确目标以及动态网络结构的变化是 与临床结果的变化有关。这项拟议的研究具有临床影响。 最终，这项提议将直接导致创建和传播证据- 基于急诊室的个性化治疗，以及将作为个性化的典范 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.