Optimizing a Smartphone Application for Individuals With Eating Disorders
Optimizing a Smartphone Application for Individuals With Eating Disorders
This study will augment an existing mobile application for individuals with eating disorders
 by developing adaptive, tailored content targeting remediation of cognitive distortions. The
 adaptive application will be deployed and assessed for efficacy relative to the standard
 product in a randomized controlled trial.
Eating Disorders (ED) are common and serious psychological disorders. Anorexia Nervosa (AN)
 has a prevalence estimated at between 0.48% and 0.70% among young females. Bulimia Nervosa
 (BN) is a serious mental health problem, with a prevalence of between 1-2% of young women
 while clinically significant bulimic behaviors occur in an additional 2-3%. There are
 significant barriers to access of evidence-based treatments and current models of individual
 psychotherapy will likely never meet the enormous need for psychological services for ED.
 Unfortunately, even with treatment, rates of recovery are modest with the best performing
 treatments achieving remission in only about 50% of cases while relapse rates are high,
 especially if the ED becomes chronic. It is widely acknowledged that a major shift in
 intervention practice is needed and that smartphone apps will almost certainly play a role
 due to their reach and breadth of functionality.

 As the first commercially available smartphone app for EDs, Recovery Record (RR) has
 established wide reach and user acceptability. The app provides users with meal and ED
 symptom self-monitoring and coping skill strategies in an evidence-based CBT format.
 Preliminary pilot data suggest that for a proportion of RR users, using RR is associated with
 clinically significant symptom reduction. However, a limitation of the current app is that it
 is a "one-size-fits-all" product that does not account for the heterogeneity of ED symptoms.
 Genetic, personality and neurocognitive data support distinct clusters of ED presentations
 that also differ according to response to treatment, course and outcome. Pilot data confirm
 that clinical response to RR is not homogenous across groups and that extent of cognitive
 distortions is the most potent factor to predict outcome. There is considerable opportunity
 to increase RR's effectiveness across a range of ED symptoms and behaviors by creating
 adaptive and tailored content focused on remediation of cognitive distortions.

 During Phase 1 of this study screening algorithm will be validated against an unseen,
 prospective test dataset of approximately 2,000 users. All candidate predictor variables will
 be entered into a Signal Detection Analysis to confirm the sensitivity and specificity of the
 screen. Informed by the resultant algorithms, adaptive content will be developed that targets
 ED-specific cognitive distortions. To evaluate acceptability, adapted content will be piloted
 with approximately 200 individuals for a period of one month. Participant feedback and
 utilization data will inform content acceptability and feasibility. By the end of the first
 phase tailored content that is acceptable to individuals with specific symptom presentations
 will be developed.

 Phase 2 will focus on an evaluation of whether an adaptive app offering tailored content
 addressing eating related cognitive distortions in a stepped way can outperform the current
 standard app. The adaptive content will be integrated into a new, dynamic version of the app
 (RR-A) that will then be evaluated against the current app (RR-S). Approximately 5,000
 registered users of RR will be randomized to receive either RR augmented with targeted
 content (RR-A), or RR in its current standard format (RR-S) over a two-month period. Outcome
 data will be measured at baseline, one month, end of treatment, and at six-month follow-up.
 At the end of the study period it is predicted that the resultant evidence-based product will
 have demonstrated ability to bring about clinically significant reduction in symptoms in more
 users than the current app, and thus will have potential to make a substantial public health
 impact.
Inclusion Criteria:

 -  Meets criteria for clinically significant symptoms of eating disorder using
 self-report measures

 -  Has an Android or iPhone and is willing to use phone for the study

 -  Is able to speak and read English

 -  Lives within the United States of America

 -  Is at least 16 years of age

 Exclusion Criteria:

 -  Has visual, hearing, voice, or motor impairment that would prevent completion of study
 and treatment procedures

 -  Has any psychiatric condition for which participation in a clinical trial of
 psychotherapy may be either inappropriate or dangerous (e.g., psychotic disorders,
 bipolar disorders, severe post traumatic stress disorder, etc.).

 -  Exhibits severe suicidality, including ideation, plan, and intent.

 -  Currently receiving weekly psychotherapy or planning to receive weekly psychotherapy
 for eating disorder during the 12 weeks of the study.