Exploring Therapists’ Approaches to Treating Eating Disorders to Inform User-Centric App Design: Web-Based Interview Study

Background: Digital interventions show potential for self-management and treatment of mild to moderate eating disorders (EDs), yet apps are infrequently recommended by therapists and often have poor engagement and user satisfaction. Barriers include concerns about patient safety, data privacy, and perceived effectiveness. Many existing apps offer limited functionality or largely replicate manual CBT, which may not adequately support therapy or engagement. Objective: To explore therapists’ perspectives on supporting people with mild to moderate EDs in the community, their treatment approaches, and how an ED app could fit alongside treatment. Methods: Semistructured web-based interviews were conducted with ED therapists in the United Kingdom recruited from First Steps ED and Thrive Mental Wellbeing. Five themes were explored: treatment approach; implementation in practice; engagement and motivation strategies; perspectives on a potential ED app; and app content/design suggestions. A structured thematic analysis was conducted and validated by two researchers. Results: Twelve therapists (mean age 28.7 years, SD 7.3; 58% female) participated. Therapists commonly went beyond traditional CBT, using flexible, person-centered approaches and additional techniques (eg, ACT, compassion-focused therapy). Engagement and motivational strategies used in therapy could be mirrored in apps. The therapeutic relationship was seen as central to outcomes and difficult to replicate digitally. Therapists saw potential for evidence-based apps across the treatment pathway but emphasized addressing safeguarding, data privacy, and risks of triggering content. Conclusions: Findings inform the design of clinically safe, evidence-based ED apps to complement therapy by extending continuity of care, self-management, and psychoeducation. Therapists favored integrative, adaptive CBT combined with other approaches, and emphasized engagement and motivation strategies that could be reflected in apps. While concerns remain—particularly around replicating the therapeutic relationship—therapists were cautiously optimistic about app integration across pretreatment to posttreatment stages, recognizing growing potential with advances in technology and AI.

Pamela Carien Thomas, Pippa Bark, Sarah Rowe