P137 Directed Model

P163 Directed Model

P169 Directed Model

P173 Directed Model

Applications: Personalized Therapy

Gordon Paul (1967)

“What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances?”

RCT as the Gold Standard •  Experimental designs intended to reveal

relatively macroscopic differences between large groups (i.e. treatment conditions)

•  Post hoc moderator analyses often suffer from poor replication and statistical bias due a lack of random assignment

Precision Medicine •  Hamburg & Collins (2010)–  Food and Drug Administration– National Institutes of Health

•  ‘Strategy 3.2’ of NIMH Strategic Plan–  “Expand and deepen the focus to

personalize intervention research

Personalized Psychotherapy •  Therapygenetics•  Sequential, Multiple Assignment,

Randomized Trials (SMART)•  Personalized Advantage Index (PAI)•  Dynamic Assessment & Modular Therapy

To what degree have you: 1.  Felt down or depressed2.  Felt hopeless3.  Experienced loss of

interest or pleasure4.  Felt worthless or guilty5.  Felt worried6.  Felt restless7.  Felt irritable

8.  Had difficulty concentrating

9.  Experienced muscle tension

10.  Felt fatigued11.  Avoided activities12.  Procrastinated13.  Sought reassurance

Procedure •  Structured Clinical Interview– GAD and/or MDD

•  Web-based smartphone assessment– 4x/day for ~ 30 days

•  Factor analysis of individual data (P-Technique)

•  Dynamic Factor Modeling•  Targeted, modular treatment delivery (UP)

Participants •  38 Survey Completers– 18 GAD (47%)– 15 comorbid GAD + MDD (40%)– 5 MDD (13%)– 17 w/ comorbid Social Anxiety Disorder (43%)

•  25 treatment completers– 3 currently in treatment– 5 treatment dropouts– 5 pre-treatment dropouts

Treatment Completers – 11 GAD (44%)– 10 comorbid GAD + MDD (40%)– 4 MDD (16%)

•  Hamilton Depression ∆  =  7  points  – Average length = 10 sessions– Cohen’s d = 2.18 (.22/session)–  Johnsen & Friborg (2015) = 1.69 (.12/session)

•  Hamilton Anxiety ∆  =  9  points  – Cohen’s d = 1.56 (.16/session)

Restless  

Worried  

Worthless  

Hopeless  

Down/Dep.  

Reassurance  

Fa4gue  

Tension  

Concentra4on  

Av.  Ac4vi4es  

Procras4na4on  

Irritable  

F1  23%  

F2  19%  

F3  14%  

.57  

.56  

.70  

.77  

.65  

.46  

.36  

.48  

.98  

.75  

.33  

.55  

.95  

.31   Down  =  .37  

R.S.  =  -­‐.37  

P048  

F1  (t-­‐1)  

F2  (t-­‐1)  

F3  (t-­‐1)  

P048  

F1  (t)  

F2  (t)  

F3  (t)  

.66  

-­‐.13  

.70  

-­‐.17  

.62  

.29  

.34  

.55   .30  

.31  

.25  

P048 Network Model

P048 Network Model

P048 Network Model

P048 Network Model

Thank You •  Jonathan Barkin•  James Boswell•  Hannah Bosley•  Cyrus Chi•  Allie Diamond•  Katya Fernandez•  Sheryl FitzGerald

•  Christine Nguyen•  Alyssa Parker•  Jennifer Paul•  Alyssa Parker•  Christine Nguyen•  Jon Reeves•  Glenn Lawyer