Improving aftercare with technology for anorexia nervosa after intensive inpatient treatment: A pilot randomized controlled trial with a therapist – guided smartphone app

Review by Craig Johnson, PhD, CEDS, FAED

Neumayr, C., Voderholzer, U., Tregarthen, J., & Schlegl, S. (2019). Improving aftercare with technology for anorexia nervosa after intensive inpatient treatment: A pilot randomized controlled trial with a therapist – guided smartphone app. International Journal of Eating Disorders, 52(10), 1191-1201.

https://doi.org/10.1002/eat.23152

Forty female patients were recruited to the study following discharge from inpatient treatment.  All 40 patients had routine discharge plans.  20 of the patients were randomized to an 8 week smartphone based aftercare intervention with therapist feedback as an adjunct to their routine discharge plan (intervention group) and the other 20 continued with their routine discharge plans (control group).  The intervention group was given access to a smart phone app designed specifically for patients with eating disorders (Recovery Record).  The app focuses on self -monitoring, meal planning, tracking eating disorder behaviors, and includes a variety of psychological interventions taken from CBT, DBT, ACT and MET.  The therapist intervention was accomplished via the app and occurred 2x per week for the first 4 weeks and 1x week for the second 4 weeks.  The therapists were eating disorder specialists and their feedback, delivered through the app, was focused on eating behaviors, mood regulation and overall motivation. Results showed a high level of adherence and a very high acceptance of the app and the aftercare intervention by patients. End of intervention results (8 weeks), indicated a small to moderate effect size advantage in overall improvement favoring the app assisted intervention group vs. the control group. At six month follow-up the advantages of the Intervention group had eroded and there were no significant differences between the groups.

Why is this important?

Relapse rates are high for patients with AN that receive inpatient/residential treatment.  Current research indicates that between 20 to 40% will relapse shortly after discharge.  One notable factor that seems to contribute to relapse is when patients return to geographic areas that do not have access to specialized eating disorder providers.  Technology based interventions, particularly an eating disorder specific app such as Recovery Record, that allows for real time monitoring of moods, thoughts, and behaviors known to predict relapse, coupled with ongoing feedback from a remote eating disorder specialist could greatly reduce relapse rates.  In the current pilot study, despite small sample sizes, the app/ed specialist therapist intervention group showed better overall improvement until the intervention was stopped.  Also noteworthy, most patients reported that the feedback from the ED expert was the most helpful feature in the app and 2/3 of the patients reported that they were not sure that they would keep using the app without the weekly therapeutic feedback and guidance.  Clearly this finding sets the stage for a study comparing therapist assisted app vs app alone.  Although the current study suffers from all of the limitations of small preliminary study, it shines a light on the very exciting field of technology- based interventions that potentially,  allow us to extend the reach of specialized care to areas that lack such resources.