Developing more efficient, effective, and disseminable treatments for eating disorders: an overview of the multiphase optimization strategy

Abstract

The present manuscript describes the multiphase optimization strategy (MOST) and its potential applications to treatments for eating disorders (EDs). The manuscript describes the three phases of MOST, discusses a hypothetical case example of how MOST could be applied to developing a disseminable ED treatment, and reviews the pros and cons of the MOST approach. Outcomes from treatments for EDs leave room for improvement. However, traditional methods of treatment development and evaluation (i.e., the treatment package approach) make it challenging to determine how best to improve ED treatments. For example, testing full treatment packages in open trials and RCTs without systematic testing of each component is inefficient (as it is unknown which components are effective), and often does not provide concrete future directions for optimization of the treatment. Much stands to be gained by optimizing treatments in the early stages before testing them in open trials or RCTs. MOST is an alternative, engineering-inspired research framework that is well-suited to address the issues of inefficiency associated with the treatment package approach. MOST entails identifying the most promising treatment components for inclusion in interventions, then eliminating or deemphasizing less efficacious/inert components. This strategy results in a treatment comprised of only effective components that can then be tested via RCT. Though the MOST approach has limitations, it has the potential to greatly benefit ED treatment research and is worthy of application in the field.

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References

  1. 1.

    Keel PK, Brown TA (2010) Update on course and outcome in eating disorders. Int J Eat Disord 43(3):195–204. https://doi.org/10.1002/eat.20810

    Article  PubMed  Google Scholar 

  2. 2.

    Wilson GT, Grilo CM, Vitousek KM (2007) Psychological treatment of eating disorders. Am Psychol 62(3):199–216. https://doi.org/10.1037/0003-066X.62.3.199

    Article  PubMed  Google Scholar 

  3. 3.

    Linardon J (2018) Rates of abstinence following psychological or behavioral treatments for binge-eating disorder: meta-analysis. Int J Eat Disord. https://doi.org/10.1002/eat.22897

    Article  PubMed  Google Scholar 

  4. 4.

    Linardon J, Wade TD (2018) How many individuals achieve symptom abstinence following psychological treatments for bulimia nervosa? A meta-analytic review. Int J Eat Disord 51(4):287–294. https://doi.org/10.1002/eat.22838

    Article  PubMed  Google Scholar 

  5. 5.

    Linardon J et al (2017) The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis. J Consult Clin Psychol 85(11):1080. https://doi.org/10.1037/ccp0000245

    Article  PubMed  Google Scholar 

  6. 6.

    Stuhldreher N et al (2012) Cost-of-illness studies and cost-effectiveness analyses in eating disorders: a systematic review. Int J Eat Disord 45(4):476–491. https://doi.org/10.1002/eat.20977

    Article  PubMed  Google Scholar 

  7. 7.

    Collins LM et al (2005) A strategy for optimizing and evaluating behavioral interventions. Ann Behav Med 30(1):65–73. https://doi.org/10.1207/s15324796abm3001_8

    Article  PubMed  Google Scholar 

  8. 8.

    Practice APTFoE-B (2006) Evidence-based practice in psychology. Am Psychol 61(4):271–285. https://doi.org/10.1037/0003-066X.61.4.271

    Article  Google Scholar 

  9. 9.

    Begg C et al (1996) Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 276(8):637–639. https://doi.org/10.1016/j.explore.2005.12.003

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Collins LM, Murphy SA, Strecher V (2007) The Multiphase Optimization Strategy (MOST) and the Sequential Multiple Assignment Randomized Trial (SMART): new methods for more potent eHealth interventions. Am J Prev Med 32(5):S112–S118. https://doi.org/10.1016/j.amepre.2007.01.022. Suppl 1 : .

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    NIH (2017) Innovative research methods: prevention and management of symptoms in chronic Illness (R21). https://grants.nih.gov/grants/guide/pa-files/PA-13-167.html. Accessed 31 Jan 2017

  12. 12.

    Pellegrini CA et al (2014) Optimization of remotely delivered intensive lifestyle treatment for obesity using the Multiphase Optimization Strategy: opt-IN study protocol. Contemp Clin Trials 201438(2):251–259. https://doi.org/10.1016/j.cct.2014.05.007

    Article  Google Scholar 

  13. 13.

    Czajkowski SM et al (2015) From ideas to efficacy: the ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol 34(10):971–982. https://doi.org/10.1037/hea0000161

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Tomarken AJ, Waller NG (2005) Structural equation modeling: strengths, limitations, and misconceptions. Annu Rev Clin Psychol 1:31–65. https://doi.org/10.1146/annurev.clinpsy.1.102803.144239

    Article  PubMed  Google Scholar 

  15. 15.

    Kraemer HC et al (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59(10):877–883. https://doi.org/10.1001/archpsyc.59.10.877

    Article  PubMed  Google Scholar 

  16. 16.

    Linardon J, X de la P Garcia, Brennan L (2017) Predictors, moderators, and mediators of treatment outcome following manualised cognitive-behavioural therapy for eating disorders: a systematic review. Eur Eating Disord Rev 25(1):3–12. https://doi.org/10.1002/erv.2492

    Article  Google Scholar 

  17. 17.

    Vall E, Wade TD (2015) Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. Int J Eat Disord 48(7):946–971. https://doi.org/10.1002/eat.22411

    Article  PubMed  Google Scholar 

  18. 18.

    Brown A, Mountford V, Waller G (2013) Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa. Behav Res Ther 51(4–5):216–220. https://doi.org/10.1016/j.brat.2013.01.008

    Article  PubMed  Google Scholar 

  19. 19.

    Graves TA et al (2017) A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders. Int J Eat Disord 50(4):323–340. https://doi.org/10.1002/eat.22672

    Article  PubMed  Google Scholar 

  20. 20.

    Haslam M, Meyer C, Waller G (2011) Do eating attitudes predict early change in eating behaviors among women with bulimic disorders who are treated with cognitive behavioral therapy? Int J Eat Disord 44(8):741–744. https://doi.org/10.1002/eat.20910

    Article  PubMed  Google Scholar 

  21. 21.

    Lockwood R, Serpell L, Waller G (2012) Moderators of weight gain in the early stages of outpatient cognitive behavioral therapy for adults with anorexia nervosa. Int J Eat Disord 45(1):51–56. https://doi.org/10.1002/eat.20885

    Article  PubMed  Google Scholar 

  22. 22.

    Marcoulides OK, Waller G (2012) Nonspecific predictors of weight gain in the early stages of outpatient cognitive behavioral therapy for adults with anorexia nervosa: replication and extension. Int J Eat Disord 45(6):746–750. https://doi.org/10.1002/eat.22014

    Article  PubMed  Google Scholar 

  23. 23.

    Waller G (2016) Treatment protocols for eating disorders: clinicians’ attitudes, concerns, adherence and difficulties delivering evidence-based psychological interventions. Curr Psychiatry Rep. https://doi.org/10.1007/s11920-016-0679-0

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Waller G, Corstorphine E, Mountford V (2007) The role of emotional abuse in the eating disorders: implications for treatment. Eating Disord J Treat Prev 15(4):317–331. https://doi.org/10.1080/10640260701454337

    Article  Google Scholar 

  25. 25.

    Waller G, Evans J, Stringer H (2012) The therapeutic alliance in the early part of cognitive-behavioral therapy for the eating disorders. Int J Eat Disord 45(1):63–69. https://doi.org/10.1002/eat.20914

    Article  PubMed  Google Scholar 

  26. 26.

    Fichter MM, Quadflieg N, Rehm J (2003) Predicting the outcome of eating disorders using structural equation modeling. Int J Eat Disord 34(3):292–313. https://doi.org/10.1002/eat.10193

    Article  PubMed  Google Scholar 

  27. 27.

    Tasca GA, Lampard AM (2012) Reciprocal influence of alliance to the group and outcome in day treatment for eating disorders. J Counsel Psychol 59(4):507. https://doi.org/10.1037/a0029947

    Article  Google Scholar 

  28. 28.

    Spangler DL, Baldwin SA, Agras WS (2004) An examination of the mechanisms of action in cognitive behavioral therapy for bulimia nervosa. Behav Ther 35(3):537–560. https://doi.org/10.1016/S0005-7894(04)80031-5

    Article  Google Scholar 

  29. 29.

    Wonderlich SA et al (2014) A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychol Med 44(3):543–553. https://doi.org/10.1017/S0033291713001098

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Collins LM et al (2011) The multiphase optimization strategy for engineering effective tobacco use interventions. Ann Behav Med 41(2):208–226. https://doi.org/10.1007/s12160-010-9253-x

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Dziak JJ, Nahum-Shani I (2016) Three-level modeling for factorial experiments with experimentally induced clustering. Penn State Methodology Center. Optimizing behavioral interventions. https://methodology.psu.edu/ra/most. Accessed 2 Feb 2017

  32. 32.

    Penn State Methodology Center (2016) Optimizing behavioral interventions. https://methodology.psu.edu/ra/most. Accessed 2 Feb 2017

  33. 33.

    Baker TB et al (2011) New methods for tobacco dependence treatment research. Ann Behav Med 41(2):192–207. https://doi.org/10.1007/s12160-010-9252-y. DOI

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Insel T et al (2010) Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry 167(7):748–751. https://doi.org/10.1176/appi.ajp.2010.09091379

    Article  PubMed  Google Scholar 

  35. 35.

    Chorpita BF, Daleiden EL, Weisz JR (2005) Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. Ment Health Serv Res 7(1):5–20. https://doi.org/10.1007/s11020-005-1962-6

    Article  PubMed  Google Scholar 

  36. 36.

    Chorpita BF, Daleiden EL (2009) Mapping evidence-based treatments for children and adolescents: application of the distillation and matching model to 615 treatments from 322 randomized trials. J Consul Clin Psychol 77(3):566. https://doi.org/10.1037/a0014565

    Article  Google Scholar 

  37. 37.

    Schlam TR et al (2016) Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment. Addiction 111(1):142–155. https://doi.org/10.1111/add.13153

    Article  PubMed  Google Scholar 

  38. 38.

    Pellegrini CA et al (2015) Corrigendum to “Optimization of remotely delivered intensive lifestyle treatment for obesity using the Multiphase Optimization Strategy: Opt-IN study protocol”. Contemp Clin Trials 45(Pt B):468–469. https://doi.org/10.1016/j.cct.2015.09.001

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Baker TB et al (2017) Implementing clinical research using factorial designs: a primer. Behav Ther. https://doi.org/10.1016/j.beth.2016.12.005

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Collins L, Kugler K, Gwadz M (2016) Optimization of multicomponent behavioral and biobehavioral interventions for the prevention and treatment of HIV/AIDS. AIDS Behav 20:197–214. https://doi.org/10.1007/s10461-015-1145-4

    Article  PubMed Central  Google Scholar 

  41. 41.

    DuBois RH et al (2017) A network analysis investigation of the cognitive-behavioral theory of eating disorders. Behav Res Ther 97:213–221. https://doi.org/10.1016/j.brat.2017.08.004

    Article  PubMed  Google Scholar 

  42. 42.

    Engel SG et al (2013) The role of affect in the maintenance of anorexia nervosa: evidence from a naturalistic assessment of momentary behaviors and emotion. J Abnorm Psychol 122(3):709–719. https://doi.org/10.1037/a0034010

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Mallorquí-Bagué N et al (2018) Emotion regulation as a transdiagnostic feature among eating disorders: cross-sectional and longitudinal approach: emotion regulation and eating disorders. Eur Eating Disord Rev 26(1):53–61. https://doi.org/10.1002/erv.2570

    Article  Google Scholar 

  44. 44.

    Collins LM, Dziak JJ, Li R (2009) Design of experiments with multiple independent variables: A resource management perspective on complete and reduced factorial designs. Psychol Methods 14(3):202–224. https://doi.org/10.1037/a0015826

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Kugler K et al (2012) Effect coding versus dummy coding in analysis of data from factorial experiments. Technical Report

  46. 46.

    Collins LM et al (2014) Evaluating individual intervention components: making decisions based on the results of a factorial screening experiment. Transl Behav Med 4(3):238–251. https://doi.org/10.1007/s13142-013-0239-7

    Article  PubMed  Google Scholar 

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Correspondence to Stephanie M. Manasse.

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Manasse, S.M., Clark, K.E., Juarascio, A.S. et al. Developing more efficient, effective, and disseminable treatments for eating disorders: an overview of the multiphase optimization strategy. Eat Weight Disord 24, 983–995 (2019). https://doi.org/10.1007/s40519-018-0632-9

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Keywords

  • Eating disorders
  • Experimental design
  • Factorial design
  • Treatment development
  • Treatment evaluation
  • Treatment efficacy