Ng, M. Y., & Weisz, J. R. (2016). Annual research review: Building a science of personalized intervention for youth mental health.

Question 1

: Within the past decade, health care service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental health care, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decisionmaking through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. Findings: The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths’ environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. Conclusion: The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians’ use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, although challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families.

Answer 1

oke

Question 2

personalized intervention for mental health problems combines ……

Answer 2

• reliable assessments of clinically relevant individual characteristics
• with treatments tailored for individuals who share those characteristics to optimize treatment gain

Question 3

bij psychologie zijn er geen duidelijke biomarkers die een ziekte bepalen: waarop zouden wij hier personalized treatment kunnen maken?

Answer 3

integrating multiple predictors of treatment engagement or impact: bv. comorbidity, motivation for change, treatment history.

Alternatively, personalizing approaches may include selecting psychotherapy, psychoactive medication, or another efficacious treatment (e.g. deep brain stimulation); deciding whether to combine interventions and, if so,
how to sequence them; and choosing psychotherapy techniques to use, problems or psychological/behavioral mechanisms to target, and the temporal order of the selected techniques or targeted problems. Finally, interventions may be personalized via
continual assessment of patient response and side effects to guide clinical decisions. Hence, intervention may not only be matched or tailored at the outset based on patient characteristics, but also adaptive—that is, adjusted according to the patient’s treatment response over time.

Question 4

empirically supported therapies ESTs

Answer 4

‘clearly specified psychological treatments shown to be efficacious in controlled research with a delineated population’

Question 5

wat is het probleem met die ESTs

Answer 5

ze zijn gestandardizeerd, in plaats van persoonlijk. prescribed for all patients who have the target problem, following a standard linear, sessionby-session sequence. but lack instructionson how to personalize these plans.

Question 6

limitations of ESTs

Answer 6

• lage effect sizes
• clinicians dont use them often becasue they are too rigid and need to be modified anyway

Question 7

8 strategies in the evidence base for personalizing mental health outcomes

Answer 7

1. therapies adapted for specific subgroups (bv disruptive behaviour in mexican american families)
2. therapies targeting youths environments (multisystemic therapy)
3. modular therapies (clients needs and wants)
4. sequential, multiple assignment, randomized trials (SMARTs) (A trial design that randomizes individuals to a first-stage treatment or assessment condition, assesses response, then potentially randomizes individuals to next-stage treatment options based on their response)
5. measurement feedback systems (assessment and progress measures sensitive to clinical change)
6. meta-analyses comparing treatments for specific patient characteristics (

Question 8

modular therapy=

Answer 8

Modular therapy is a flexible, individualized approach to psychological treatment where specific, evidence-based therapy modules are selected and combined to address a client’s unique needs.