App Adapted for Anorexia Nervosa Could Strengthen Recovery, Prevent Relapse

Patients who have anorexia nervosa and are discharged from acute care could benefit from an app specially designed to offset barriers to effective outpatient treatment, according to eating disorder professionals interviewed in a new study published in Frontiers in Digital Health. Their findings suggest that a recovery-focused app might help prevent relapse.

Prior research reports relapse rates of 31% to 52%, with the highest rates during the first 2 months following discharge, the authors wrote.

Patients with anorexia nervosa are typically discharged from treatment centers once they hit their goal weight range, especially in hospital programs, the authors explained. However, although weight restoration and medical stabilization are important goals, research shows that full recovery also involves resolution of behavioral and psychological symptoms.

“Achievement of full recovery in the acute setting is challenging and often not possible,” the authors said. “High-quality outpatient care is imperative to prevent relapse.”

They proposed to develop an app to provide community-based support for persons in recovery from anorexia nervosa, which has the second highest mortality rate of any mental disorder.

Goals of the study were to understand the transition process more fully from acute to outpatient care, examine how eating disorder providers currently use technology in treatment frameworks, and gather feedback from eating disorder professionals on how best to incorporate an app into post–acute care of anorexia nervosa.  

The researchers contacted 12 treatment centers from across the United States. Ultimately, 11 eating disorder providers from 7 treatment centers partnered with the research team.  

To address the aims of their study, the authors used semistructured interview questions to assess each treatment center’s approach to discharging patients. Five wide-ranging themes emerged:

• Attitudes toward and approaches to outpatient care
• Barriers to outpatient care
• Past experiences utilizing technology as a treatment tool
• Comfort, interest, and skepticism in app-based interventions
• Suggestions for a self-help, app-based treatment for post acute care

The most common obstacles to accessing effective outpatient treatment were a shortage of specialized therapists and long wait lists.

Participant input offered much anecdotal evidence on the strengths and weaknesses associated with current postacute treatment. Barriers to high-quality outpatient care included the following:

• A shortage of eating disorder professionals, associated with long waiting lists; in some cases, it can be months before a patient is able to see a therapist
• Location, especially for rural patients unable to access an outpatient specialist who specializes in eating disorders
• Prevalence of financial barriers, with available eating disorder professionals often not taking insurance
• Transportation
• Clinician burnout
• Fluency with the English language.

In addition, participants offered keen insight into strategies that would strengthen support for patients leaving intensive treatment:

• In terms of developing an app-based treatment, the most common recommendation was to make the app “engaging and interactive,” by including games, voice-guided body and food exposures, videos, podcasts, and interactive tools
• Participants stressed the importance of testing an app themselves before introducing it to clients
• Some strongly encouraged an adjunctive social networking component, but cautioned that any social media group must be strictly monitored
• Patients with anorexia nervosa who did not engage in outpatient therapy often returned to higher levels of care, which aligns with previous research on the poor outcomes and high relapse rates associated with the condition

Although the present study offered important findings, there were several limitations. Of the participants interviewed, all were White and not Hispanic or Latino. Additionally, of the 11 providers, 8 were female. Finally, thematic analysis was conducted by only 1 rater.

Still, the study researchers and participants alike expressed positive attitudes toward the integration of an app into the post–acute care flow, suggesting its potential benefit as a treatment tool.

“The key to developing quality app-based interventions is engaging individuals who will be most implicated by the intervention: app users and treatment center representatives,” the authors concluded.

Reference

Haas A, Laboe AA, McGinnis C, et. al. Adapting a mobile app to support patients with anorexia nervosa following post-acute care: perspectives from eating disorder treatment center stakeholders. Front Digit Health.Published online May 19, 2023. doi: 10.3389/fdgth.2023.1099718