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 recommendation include patient safety, data privacy and a perception that they may not be effective. 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.

Objective:

This study explored the perspectives of therapists who support people with mild to moderate eating disorders in the community, exploring their existing treatment approach, and how an eating disorder app might fit in the treatment pathway alongside treatment.

Methods:

Semi-structured online interviews were completed with eating disorder therapists in the UK. Participants were recruited from FirstSteps ED, a specialist community-based eating disorder service and Thrive Mental Wellbeing, a workplace mental health provider. Five main themes were covered: (1) Therapists’ Treatment Approach, (2) How Therapy was Implemented in Practice, (3) Strategies for Engaging and Motivating Clients, (4) Perspectives on a Potential Eating Disorder App and (5) Suggestions for App Content and Design. A structured thematic analysis was validated by two researchers.

Results:

Twelve eating disorder and mental health therapists (Mean age = 28.7 years; 7 female, 5 male) participated. Therapists dealing with complex eating disorder issues went beyond traditional CBT using additional therapeutic techniques and a flexible, person-centred approach to treatment. This included engagement and motivational strategies to support the client, elements of which could be mirrored in an app. Therapists identified the therapeutic relationship as key to success which may be hard to replicate in an app. They saw the potential for evidenced-based apps across all stages of the treatment pathway. The need to address safeguarding, data privacy and potential for triggering content within the app were vital.

Conclusions:

This study advanced our understanding of how to design and develop clinically safe, evidence-based eating disorder apps which can complement therapy, by extending continuity of care and in the self-management and psychoeducation of clients. It emphasized an integrative, adaptive CBT which incorporated other therapeutic approaches based on individuals’ needs, which could be replicated in an app, as could the strategies to support engagement and motivation. It gave a cautious yet optimistic perspective on the potential integration of apps into eating disorder treatment across all stages of treatment pathway, from pre-treatment to post-treatment maintenance. It highlighted various concerns which could be addressed, and potential limitations such as the therapeutic relationship, while recognising the growing potential of apps with rapid technology and AI advancements.