Evaluating and Implementing a Smartphone Application Treatment Program for Bulimia Nervosa and Binge Eating Disorder
Evaluating and Implementing a Smartphone Application Treatment Program for Bulimia Nervosa and Binge Eating Disorder
Bulimia nervosa and binge eating disorder pose a public health concern due to their high
 co-occurrence with other psychiatric disorders and poor physical health outcomes. It is
 therefore concerning that less than half of these patients seek treatment for their
 condition. People may be reluctant to seek treatment due to not wanting to disclose symptoms
 to family members. Even for those who do wish to seek help, treatment is often inaccessible
 due to the geographic centralization of eating disorder specialists and a low ratio of
 specialists to patients. Therefore, the aim of this study is to test a potential solution to
 these problems and make eating disorder care more private and accessible.

 One possible way to improve the accessibility of treatment is through smartphone applications
 (or "apps"). We are testing an app called Recovery Record, which is primarily a tool used to
 self-monitor eating habits, where patients record their meals and related thoughts, feelings,
 emotions, and behaviours (e.g., binge eating/purging). The app also offers additional
 features such as discrete reminders to log meals, positive reinforcement, social support,
 coping strategy suggestions, and linking users with clinicians for real-time feedback and
 suggestions. The application is scientifically supported and has been tested with positive
 results.

 Recently, app developers have created a computer-automated 8-week treatment program that uses
 the patient's data to provide a tailored and individualized treatment program. This program
 aims to mimic the process of therapy by checking in with users, reminding them of their
 reasons for wanting to recover, and working towards goals. We will be testing this automated
 app treatment program, comparing it both with and without input from a trained coach
 providing individualized feedback to users.
The prevalence of bulimia nervosa (BN) is approximately 1.0-1.5% among women. With
 consistently higher prevalence rates, binge eating disorder (BED) affects up to 3.5% of women
 and 1.5% of men. These eating disorders represent a public health concern due to the high
 comorbidity of BN and BED with other psychiatric disorders and the association with poor
 physical health outcomes.

 Given this public health impact, it is concerning that less than half of BN and BED patients
 seek treatment for their eating disorder. This is especially concerning since a greater
 duration of untreated illness is associated with a poorer prognosis. Individuals' reluctance
 to seek treatment is likely due to factors such as an avoidance of disclosing symptoms to
 family members or clinicians. For example, one study reported that 27% of adolescents with BN
 declined participation because they did not want their families involved. Even for those who
 do wish to engage, treatment is often inaccessible due to the geographic centralization of
 eating disorder specialists and a low ratio of specialists to patients.

 Given the ubiquity of smartphone devices among adults and adolescents, one possible way to
 improve treatment accessibility and privacy is to offer it through a smartphone app. In
 recent development, an evidence-based smartphone app called Recovery Record (RR) has been
 conceived for use by people suffering from eating disorders as an adjunct to clinical
 treatment. This tool allows patients to self-monitor eating behaviours, connect with their
 clinician directly through the app, and provides other therapeutic features (e.g. cues coping
 skill use). Preliminary findings suggest that the app is feasible, with 67% of users
 continuing to log meals at 30 days. As well, RR is currently the most downloaded, most rated,
 and highest rated app of its kind, which suggests it is highly acceptable among users.

 In support of these findings, one study demonstrated that 26% of app users in a clinically
 severe range at baseline demonstrated clinically significant reductions in eating disorder
 symptoms at least 28 days later, which is consistent with other forms of self-help for BN.
 Moreover, 89% of users reported that using Recovery Record helped their condition from
 getting worse and a majority reported improvements to the frequency of disordered behaviours,
 reported urges, and mood.

 App developers have outfitted the app with an adaptive 8-week program that automatically uses
 patient data to tailor treatment for individual users (i.e. an automated pure self-help
 course of treatment). Although pure self-help is efficacious for BN and BED, self-help
 augmented by coaching (from a health care profession) has been associated with even better
 outcomes (with a moderate effect size). Given the support for this smartphone app and this
 potential avenue for providing private and accessible care to Nova Scotians, the aim of this
 study is to assess the efficacy of this adaptive smartphone app program, both coached and
 uncoached, for BN and BED patients.
Inclusion Criteria:

 -  DSM-V diagnosis of bulimia nervosa or binge eating disorder

 -  Ages 16-65 years

 -  Has an Apple or Android smartphone with a data plan or daily access to Wi-Fi

 -  Is able to download smartphone applications from the Apple App Store or Google Play
 Store to their smartphone

 -  Lives in Canada

 -  Provides consent to participate

 Exclusion Criteria:

 -  Actively engaged in psychological treatment, specifically for bulimia nervosa or binge
 eating disorder

 -  Lacks English fluency

 -  High risk for suicide, as determined by the Columbia Suicide Severity Rating Scale
 (Self-Report Screening Version)