Personalizing eating disorder treatment using idiographic models: An open series trial.

Abstract

Objective: Treatments for adults with eating disorders (EDs) only work in about 50% of individuals, and for some diagnoses (e.g., anorexia nervosa; atypical anorexia nervosa), there are no existing evidence-based treatments. Part of the reason that treatments may only work in a subset of individuals is because of the high heterogeneity present in the EDs, even within diagnoses. Manualized treatments delivered in a standard format may not always address the most relevant symptoms for a specific individual. Method: The current open series trial recruited participants with transdiagnostic ED diagnoses (N = 79) to investigate the feasibility, acceptability, and initial clinical efficacy of a 10-session network-informed personalized treatment for eating disorders. This treatment uses idiographic (i.e., one-person) network models of ecological momentary assessment symptom data to match participants to evidence-based modules of treatment. Results: We found that network-informed personalized treatment was highly feasible with low dropout rates, was rated as highly acceptable, and had strong initial clinical efficacy. ED severity decreased from pre- to posttreatment and at 1-year follow-up with a large effect size. ED cognitions, behaviors, clinical impairment, worry, and depression also decreased from pre- to posttreatment. Conclusions: These data suggest that network-informed personalized treatment has high acceptability and feasibility and can decrease ED and related pathology, possibly serving as a feasible alternative to existing treatments. Future randomized controlled trials comparing network-informed personalized treatment for ED to existing gold standard treatments are needed. Additionally, more research is needed on this type of personalized treatment both in the EDs, as well as in additional forms of psychopathology, such as depression.

A pilot randomized controlled trial of transdiagnostic network‐informed personalized treatment for eating disorders versus enhanced cognitive behavioral therapy

“…This completion rate of 83% is on par with trials of CBT‐E which generally have attrition rates ranging from 20% to 54% (Atwood & Friedman, 2020). This study also indicated strong initial clinical efficacy on both ED symptoms and co‐occurring symptoms with medium to large effect sizes (Levinson et al, 2023). There were no significant differences between diagnoses (i.e., AN, BN, BED, OSFED; p = .538) or between those with an underweight body mass index (BMI) at baseline compared to those with a BMI of 18.5–30 ( p = .824; Levinson et al, 2021).…”

“…Models from our preliminary data with the same amount of time points converged with high stability in over 99% of cases. For analyzes of clinical outcomes and change in network loadings, we calculated power by estimating at least medium effect sizes based on preliminary findings of a large effect size ( d = 1.00) in our pilot research (Levinson et al, 2023). We used the package SIMR in R which uses Monte Carlo simulations to estimate power for mixed effects models based on preliminary data (Green & MacLeod, 2019).…”

“…This initial pilot study was an open series trial examining the feasibility and acceptability of T‐NIPT‐ED. Pilot data revealed that personalized, data‐driven ED treatment was rated as highly acceptable with very low drop‐out (Levinson et al, 2023). This completion rate of 83% is on par with trials of CBT‐E which generally have attrition rates ranging from 20% to 54% (Atwood & Friedman, 2020).…”

“…Though research applying idiographic NA has suggested these models may inform treatment, scholarship testing this method against existing approaches remains limited. Referring to the National Institute of Health (NIH) stage model for testing behavioral interventions (Rounsaville et al, 2001a(Rounsaville et al, , 2001b, the pilot study (Levinson et al, 2023) represents testing at stage 1. This initial pilot study was an open series trial examining the feasibility and acceptability of T-NIPT-ED.…”

Are central eating disorder network symptoms sensitive to item selection and sample? Implications for conceptualization of eating disorder psychopathology from a network perspective.

“…EMA Battery. A comprehensive 56-item EMA battery measured ED behaviors (e.g., restriction, binge eating), ED cognitions (e.g., feeling fat), and nontraditional ED symptoms, such as affect (e.g., anxiety, sadness), symptoms of commonly co-occurring concerns (e.g., intrusive thoughts), and transdiagnostic mechanisms (e.g., self-criticism) (Levinson et al, 2022(Levinson et al, , 2023. Participants rated items on a 0-100 visual analog scale.…”