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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
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