JMIR Publications

ABSTRACT

Background:

The potential for digital interventions in the self-management and treatment of mild to moderate eating disorders has already been established. However, apps are infrequently recommended by eating disorder therapists to their clients. Those that are, often have poor engagement and user satisfaction leading to unsatisfactory outcomes. Barriers to clinical recommendation include patient safety, data privacy and belief that the intervention may not be helpful. Many existing interventions have limited functionality or do not differ much from manual CBT or self-help books, which may not adequately support the therapeutic process or sustain user engagement. This study aims to better understand how therapists working in the community support their clients, where they see an eating disorder app fitting into treatment and what would be helpful for their clients to include within an app. This should inform the development of future interventions which are engaging, effective and can complement therapists’ work.

Objective:

This study explored the perspectives of therapists who support people with mild to moderate eating disorders in the community, to understand their treatment approach, process and specific techniques they used in treatment. It also examined their perspectives on where a digital eating disorder app might fit in the treatment pathway as an adjunct to treatment and how it could engage users.

Methods:

Twelve semi-structured interviews were completed with therapists in the UK. Six of these were with eating disorder professionals who support solely clients with eating disorders and six were with mental health professionals who see a range of clients, including some with eating disorders/disordered eating but for whom eating disorders was not their primary focus. A content-analysis following an inductive thematic approach was completed which focused on approach to treatment, treatment process, how they engaged and motivated their clients and suggestions for the app design and content.

Results:

12 eating disorder / mental health therapists from a range of backgrounds (Mean age= 28.7 years; 7 female/5 male) participated in the online interviews. Five main themes were reported: (1) Integrative Treatment Approach (2) Therapeutic Process (3) Engaging and Motivating Clients (4) Perspectives on a Potential Digital App (5) Therapist Suggestions for App Content and Design (6) Commonly Used Therapeutic Tools and Techniques. Therapists provided an integrative CBT approach which was implemented in a flexible, person-centred manner, with engagement and motivational strategies to support the client through the therapeutic process. Therapists were generally positive about the potential for apps across all stages of the treatment pathway though highlighted potential concerns including data privacy, triggering content and ability to personalise treatment to the user.

Conclusions:

This research provides real-world insight into how eating disorder therapists in the community support their clients with mild to moderate eating disorders. If gives a cautious yet optimistic perspective on the potential integration of digital apps into eating disorder treatment across all stages of the treatment pathway. It provides detailed recommendation in terms of functionality and design of digital apps which can support therapists in their work by extending continuity of care and supporting in the self-management and psychoeducation of their clients.