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.

Comparing integrative cognitive‐affective therapy and guided self‐help cognitive‐behavioral therapy to treat binge‐eating disorder using standard and naturalistic momentary outcome measures: A randomized controlled trial

“…Refinements of the ICAT‐BED treatment itself could potentially enhance its efficacy, including the incorporation of ecological momentary intervention targeting momentary binge‐eating precipitants (Smith & Juarascio, 2019). The use of a multiphase optimization strategy (MOST) design may be particularly well suited to examine specific components of ICAT‐BED, as well as other potential binge‐eating interventions, in a randomized controlled trial (Manasse, Clark, Juarascio, & Forman, 2019). More effectively targeting ICAT‐BED treatment predictors (dietary restraint, emotion regulation) and moderators (overvaluation of shape and weight, self‐discrepancy, and self‐control) that have recently been identified in this sample (Anderson et al, in press) will be especially crucial in improving treatment efficacy.…”

Effects of Decentering and Non-judgement on Body Dissatisfaction and Negative Affect Among Young Adult Women

“…By showing that core elements of mindfulness, which have received support in previous research, were just as effective as rest, our findings reinforce the importance of including an appropriate control condition and suggest focus may be better placed on sustained longer-term practice or multifaceted strategies. Future research could use a factorial design with a constant intervention component (i.e., a component that every person receives, which in this case would be non-judgemental, decentered, and present awareness) to test the effect of add-ons to the "minimal necessary" component of mindfulness (Manasse et al, 2019).…”

Does virtual reality enhance the effects of inhibitory control training for loss-of-control eating? A factorial experiment

“…As is typical in studies utilizing factorial designs, groups were collapsed across factor (e.g., VR or non-VR, ICT or Sham) for analyses with LOC, inhibitory control, and implicit liking as outcomes. A factorial design allows for examination of main and interaction effects with equivalent power due to the ability to pool participants across factors [36,37,54]. Graphs are presented by condition rather than by factor in order to more clearly examine trends.…”