Eating disorders, – including anorexia nervosa, bulimia nervosa and binge eating, among others — are among the most difficult addictions to treat. According to the National Eating Disorders Association (NEDA), about 20 million women and 10 million men will develop eating disorders at some point in their lives.
At the University of Kansas, a research team is using a new grant from NEDA to develop a smartphone app for clinical use with patients receiving treatment for an eating disorder.
“Sadly, for 40 to 60 percent of patients with an eating disorder, the very best available treatments simply don’t work,” said Kelsie Forbush, M. Erik Wright Assistant Professor of Clinical Psychology at KU, who is leading the development of the app. “Researchers and clinicians have put a lot of time and energy into developing new treatments for eating disorders, but the majority of these new treatments have not improved outcomes.”
Forbush said the app is motivated by a new direction in the field of mental illness called “patient-focused treatment outcomes” research. It can improve outcomes by providing timely information on patient progress. Getting more accurate, timely assessment can enable therapists to treat their clients with quicker results and better end-of-treatment outcomes, Forbush says. If necessary, therapists can make adjustments to treatment.
The new app will enable clinicians to track and assess a patient’s response to treatment by using computer-adaptive technology (CAT). The app will guide clients through a series of questions drawn from two self-reporting measures: the Eating Pathology Symptoms Inventory (EPSI) and the Inventory of Depression and Anxiety Symptoms (IDAS).
Forbush says the app has been designed so that clinicians can access immediate feedback on their patients’ outcomes, without having to analyze the results themselves. He says the app may be better able to deliver objective analysis of clients’ answers, helping therapists assess if treatment is working.
Most therapists tend to underestimate negative treatment outcomes for their clients, Forbush notes. One study found that 25 percent of therapists believed their clinical skills were in the top 90 percent — and none considered their skills to be below those of their peers.
“Clinicians don’t have a crystal ball,” Forbush said. “If they’re not assessing outcomes, they can’t be 100 percent accurate in predicting how clients are doing. The dashboard will signal clinicians each week — ‘here’s how your client is doing’ — with the user-friendly warnings and helpful tips and strategies to consider implementing if clients are not doing well.
The app’s developers hope it can make an important, public health contribution by reducing the number of people who die due to complications from an eating disorder.
The researchers plan to use the grant to test the app in several eating-disorder treatment settings in the Greater Kansas City area, including at Children’s Mercy Eating Disorder Clinic, Insight Counseling and EDCare Kansas City.
A number of smartphone apps are already available to help patients with eating disorders, according to Crystal Karges, director of content and social media at Eating Disorder Hope/Addiction Hope.
Several of the most widely used apps include:
Recovery Record: This app enables users who are in outpatient treatment to communicate closely with their treatment team. They can use it to track daily meals, and record their emotions throughout the day.
Optimism: This app also helps users document their feelings, helping them to spot and understand possible triggers for relapse.
Rise Up and Recover: This app providers personal inspiration daily, using positive images and aspirations. Meals can also be tracked, and files shared with the treatment team.
Eating Disorder Assessment: This app provides a series of health and behavior-related questions to help the user decide if he or she needs treatment.