The personalized advantage index: Translating research on prediction into individualized treatment recommendations. A demonstration

Background: Advances in personalized medicine require the identification of variables that predict differential response to treatments as well as the development and refinement of methods to transform predictive information into actionable recommendations. Objective: To illustrate and test a new method for integrating predictive information to aid in treatment selection, using data from a randomized treatment comparison. Method: Data from a trial of antidepressant medications (N = 104) versus cognitive behavioral therapy (N = 50) for Major Depressive Disorder were used to produce predictions of post-treatment scores on the Hamilton Rating Scale for Depression (HRSD) in each of the two treatments for each of the 154 patients. The patient's own data were not used in the models that yielded these predictions. Five pre-randomization variables that predicted differential response (marital status, employment status, life events, comorbid personality disorder, and prior medication trials) were included in regression models, permitting the calculation of each patient's Personalized Advantage Index (PAI), in HRSD units. Results: For 60% of the sample a clinically meaningful advantage (PAI≥3) was predicted for one of the treatments, relative to the other. When these patients were divided into those randomly assigned to their "Optimal" treatment versus those assigned to their "Non-optimal" treatment, outcomes in the former group were superior (d = 0.58, 95% CI .17-1.01). Conclusions: This approach to treatment selection, implemented in the context of two equally effective treatments, yielded effects that, if obtained prospectively, would rival those routinely observed in comparisons of active versus control treatments. © 2014 DeRubeis et al

Momentary perceptions and effects of interpersonal interactions: The role of eating pathology

Eating disorder symptoms have been associated with increased dependency, self-silencing, lower social competence and increased self-concept reactivity in response to interpersonal stress. We conducted an analysis of the processes that lead to interpersonal reactivity in individuals with elevated eating pathology. For one week, participants responded to a PDA-based survey after every interpersonal interaction lasting 5 minutes or longer. The survey assessed perceptions of the interaction, mood, self-esteem, and body satisfaction. We hypothesized that individuals with elevated levels of eating pathology would report more negative interactions, and respond to these interactions with greater decreases in self-esteem, mood, and body satisfaction. We found that bulimic pathology was related to lower average levels of warm and positive perceptions. We also found that bulimia significantly moderated the relationship between dominant perceptions and self-esteem, dominant perceptions and positive mood, and positive/negative perceptions and positive mood. Non-bulimic eating pathology did not produce any significant results.</p

Pretreatment anxiety predicts patterns of change in cognitive behavioral therapy and medications for depression.

OBJECTIVE: Some studies report that initial anxiety is associated with equivocal or negative effects in depression treatment. In contrast, at least four studies of cognitive behavioral therapy (CBT) report that anxiety predicts greater or more rapid change in depression. Further exploration is needed to clarify the relationship between initial anxiety and depression change. Questions include the relationship between anxiety and patterns of change and time to relapse, as well the specificity effects to CBT. METHOD: The study assessed the relation of Beck Anxiety Inventory anxiety scores to early rapid change and overall change in Beck Depression Inventory-II depression scores during acute depression treatment. Participants were 178 individuals enrolled in a randomized controlled trial of CBT versus medications (ADM) for moderate to severe depression. They were 58% female and 83% Caucasian, with an average age of 40 (SD = 11.5). Thirty four percent (34%) were married or cohabitating. Hierarchical linear models including quadratic growth parameters were used to model change. The relation of anxiety to the probability of post-treatment relapse was also examined. RESULTS: Findings indicate that higher levels of anxiety predict early rapid change, but not overall change, in both CBT and ADM. However, patients with higher levels of intake anxiety evidenced increased risk for relapse after CBT. CONCLUSIONS: Early rapid change predicted by anxiety occurs across different treatment conditions, but this early rapid response is not indicative of positive overall outcome in all cases. These findings might indicate that anxiety predicts a response to non-specific “common factors” of treatment

Prognosis moderates the engagement-outcome relationship in unguided cCBT for depression:a proof of concept for the prognosis moderation hypothesis

OBJECTIVE: Understanding how treatments work is a goal of psychotherapy research, however the strength of relationships between therapy processes and outcomes is inconsistent. DeRubeis, Cohen, et al. (2014) proposed that process-outcome relationships are moderated by patient characteristics. These "patient response patterns" (PRPs) indicate individuals' responsiveness to the active ingredients of treatment. Given the same quality of therapy, one individual may receive more benefit than another depending on their PRP. The "prognosis moderation hypothesis" states that PRPs can be defined by pretreatment prognostic indicators. Medium prognosis groups ("pliant-like") will have stronger process-outcome relationships than good ("easy-like") or poor ("challenging-like") groups.METHOD: N = 190 individuals received unguided computerized CBT. They were 58% women, aged 44.7 years. Engagement with the cCBT program was the process variable. PRPs were defined by predicted scores from a prognostic regression model. Outcomes were BDI scores at 3, 6, and 12 months. "Easy-like," "pliant-like" and "challenging-like" groups were created and the engagement-outcome relationship was assessed as a function of group.RESULTS: Engagement-outcome correlations by PRP were: easy-like, r = -.27 (p &lt; .05); pliant-like, r = -.36 (p &lt; .01); and challenging-like, r = .05 (p = .70). The pliant-like group was found to be the only moderator of the engagement-outcome relationship. Results were similar at 6 months but faded at 12.CONCLUSIONS: The engagement-outcome relationship varied as a function of prognosis, providing support for the prognosis moderation hypothesis. The "pliant-like" group appeared most sensitive to treatment procedures. Future research is needed to refine the methods for identifying PRPs. (PsycINFO Database Record</p

Appearance Investment and Everyday Interpersonal Functioning: An Experience Sampling Study

Several studies have shown that body satisfaction affects interpersonal functioning. However, few have studied the specific interpersonal correlates of another important body image dimension, appearance investment—that is, the importance a woman places on appearance. We used an experience sampling design with PDA (personal digital assistant) devices to assess how 92 college women's appearance investment is related to perceptions of everyday social interactions and to investigate the association of these perceptions with mood and self-esteem. For 1 week, participants completed electronic diaries of their mood, self-esteem, and perceptions of one-on-one interactions. High appearance investment was associated with a stronger relationship between perceived communion of the interaction and negative mood and self-esteem. Notably, highly appearance-invested women did not report differences in average momentary levels of perceived communion or agency in interactions, negative mood, or self-esteem when compared to women with lower appearance investment. In contrast, women with low body satisfaction reported lower average perceptions of communion and self-esteem as well as higher average negative mood compared to women with higher body satisfaction, but no relationships among perceptions and self-esteem and mood were found. Thus, self-esteem and negative mood in women high in appearance investment might be contingent on perceptions of communion in interactions, even though they appear to have average levels of mood and self-esteem in general. This mood and self-esteem contingency could predispose appearance-invested women to psychological distress or eating pathology. </jats:p