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During Covid, Eating Disorder Patients Turn to Apps

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Equip’s approach is to assign each family a dedicated virtual care team that includes a therapist, dietician, MD psychiatrist, peer mentor, and a mentor who works with the entire family. The company has partnered with insurance companies to provide families with up to a year of covered treatment. (This in itself could be considered a major benefit—according to the National Eating Disorder Association, insurance claims are often denied as people navigate the psychological and physical aspects of treatment on their own.) On average, families participate in five sessions per week—one with each provider—and discuss eating disorder behaviors and symptoms, like weight loss, food restriction, binge episodes, or excessive exercise.

“The past two decades of research have shown that family involvement in eating disorder treatment contributes to more successful outcomes,” says Equip’s CEO and cofounder, Kristina Saffran, referencing a type of evidence-based treatment known as family-based therapy (FBT), or the Maudsley Approach. In contrast to CBT or other individual therapies, FBT relies on the participation of a patient’s relatives and focuses on externalizing the illness—for example, driving home the point that the disorder and the patient are not one and the same. “Eating disorders have strong genetic and neurobiological underpinnings, and where traditional treatments focus on talk therapy to encourage choosing to eat and cease behaviors, FBT recognizes that malnourished brains cannot—versus will not—make these choices, and that compassionate, insistent, and trained families are best equipped to renourish their loved one,” Saffran says.

Tricia, an Ohio mother (who also asked to be identified just by a first name), participated in the beta test to support her 18-year-old daughter who is recovering from anorexia. She says the program provided structure and accountability for the entire family. “We know we still have a road ahead of us to reach full recovery for our daughter,” Tricia says. “Our hope has been renewed, and for that we are very grateful.”

Fitzsimmons-Craft is working on her own digital treatment, too. Originally called Student Bodies-Eating Disorder, the CBT-based program asks users to log meals, communicate with online coaches, and track behaviors like food restriction or “body checking,” a common practice in which a person excessively critiques themself before a mirror, and may also use their hands, tape measures, scales, or clothing to assess their body’s size and shape. In August, Fitzsimmons-Craft published a study in JAMA Network Open indicating that among 690 college-aged women who tried it, those who used the app and web-based program saw a greater reduction in symptoms like restricting, bingeing, and weight obsession over a two-year period than those who went through traditional care at an on-campus counseling center. “These kinds of tools are now here to stay,” she says, pointing out that they’re available 24/7. “While they’ll never fully replace in-person treatment, everyone now sees the benefits and role they can have.”

The Recovery Record staff is currently investigating how to deliver even more immediate care via the Apple Watch. If a user is experiencing an overwhelming urge to binge, for example, they would be able to tap on the app, indicate the severity of the impulse, and immediately receive a reminder to use a practical strategy like “urge surfing,” a mindfulness technique that involves riding the wave of an impulse until it passes. Other coping strategies include distracting the person from a troubling thought, or motivating them—both of which can be accomplished by sending their watch the right GIF.

Tregarthen says this adaptation of the app could be critical for users in need of instant help. “With two taps, you can identify an urge and instantaneously access a surprisingly helpful coping strategy,” she says. “Research is showing that this 20-second micro-intervention can help stave off the compulsion to act on the urge. For someone who is fighting to overcome an eating disorder, this counts for a whole lot. The little victories really add up.”

For Heather, the accountability and easy access of the Recovery Record app in its current form has helped her navigate a particularly challenging time. “There are a lot of resources, and it makes you feel more connected and able to monitor things in a manageable way,” she says. “Most people have a phone on them constantly, so they might as well use it to do something positive for their lives.”

Update 9-29-2020 12:09 PM: This article was updated to correct the status of the online program Selfina.

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