Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 18, 2024
Date Accepted: Feb 4, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Enhancing Emotion Regulation in Family-Based Treatment for Adolescent Anorexia Nervosa through the BALANCE Mobile App: A Feasibility and Acceptability Study
ABSTRACT
Background:
Anorexia nervosa (AN) is a severe psychiatric disorder with high morbidity and mortality, particularly among adolescents. Family-based treatment (FBT) is the leading evidence-based intervention for adolescent AN, involving parents in re-nourishment and behavior interruption. Despite its effectiveness, challenges in emotion regulation (ER) during high-stress situations like mealtimes contribute to suboptimal treatment outcomes, with only 35-50% of adolescents achieving full recovery. Enhancing ER skills during FBT may improve treatment response and recovery rates. The BALANCE mobile app was developed to address this need, offering real-time, DBT-based distress tolerance skills designed to support adolescents and families during mealtimes.
Objective:
This study evaluates the feasibility and acceptability of the BALANCE mobile app, designed to improve distress tolerance during mealtimes for adolescents with anorexia nervosa (AN) undergoing family-based treatment (FBT).
Methods:
BALANCE was developed collaboratively with Stanford University’s Center for Biodesign, utilizing student input and the Stanford Spezi ecosystem. Feasibility and acceptability were assessed through self-reported questionnaires from 24 adolescents (12-18 years old), including those with and without AN.
Results:
The app demonstrated high usability and acceptability, with 80% of participants reporting enjoyment and 100% finding it user-friendly. Adolescents reported that BALANCE helped them manage stressful mealtimes more effectively.
Conclusions:
BALANCE shows promise as a tool for enhancing distress tolerance in adolescents with AN during FBT. Future research should explore its integration into clinical practice and its impact on treatment outcomes.
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