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

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PROJECT SUMMARY/ABSTRACT Despite eating disorders (EDs) carrying one of the highest mortality rates among all psychiatric disorders, there is no evidence-based treatment for anorexia nervosa and only 50% of individuals respond to the gold standard treatment for bulimia nervosa and binge eating disorder (cognitive- behavioral therapy enhanced: CBT-E). These low response rates are likely partially due to the large variations in symptom presentations. One major factor contributing to the high rates of heterogeneity across EDs is the wide variety of cognitive-affective factors, which maintain active illness states. CBT-E is based on the idea that overvaluation of weight and shape is the primary cognitive-affective mechanism responsible for maintaining EDs ‘on average’ (i.e., for most individuals) and is delivered in a standardized format. However, there is a well-documented relationship between “non-traditional” cognitive-affective mechanisms, such as perfectionism, worry, and shame, and EDS. Therefore, a method is needed that can provide a more personalized approach to ED treatment by addressing the high heterogeneity and specifically targeting non-traditional cognitive-affective mechanisms. The specific aims of the proposed project are to: (1) develop a coding system to identify the traditional and non-traditional cognitive-affective targets that are addressed in both a personalized and standardized (CBT-E) treatment, (2) use personalized networks to examine if coded treatment targets correspond with data-identified and manualized (i.e., CBT-E) treatment targets, (3) identify coded profiles of participants with non-traditional cognitive-affective profiles versus ED-traditional cognitive- affective profiles, and (4) test if participants with non-traditional cognitive-affective profiles versus ED-traditional cognitive-affective profiles from idiographic networks differ in treatment outcomes via condition. This project will be an important initial step towards identifying the relations between eating disorders, cognitive-affective factors, and outcomes in eating disorders to use in personalized treatments. Importantly, the career development and mentorship plan outlined in this diversity supplement application will promote Ms. Ortiz’s success as a minority researcher and contribute to the initiative of building a scientific workforce.