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

Eating disorders (EDs) are complex mental health conditions significantly impacting individuals' well-being. Many with mild-to-moderate EDs lack access to treatment due to stigma, high demand for services, and cost. Apps offer a promising avenue for support but often suffer from low engagement and user satisfaction. Existing apps frequently lack personalization and functionality beyond manual CBT or self-help books. To address this, the study aimed to understand therapists' approaches to treating mild-to-moderate EDs and how an app could integrate into their treatment pathways.

Systematic reviews demonstrate the short-term effectiveness of digital interventions for EDs, but engagement challenges remain. Qualitative studies highlight the need for more appealing and engaging apps. Clinicians express concerns regarding personalization, patient safety, and data privacy. Many existing apps merely digitize manual CBT, lacking the sophistication to fully support the therapeutic process. This study seeks to address this gap by focusing on the in-depth experiences and views of therapists, going beyond simply digitizing existing CBT approaches.

Twelve web-based semistructured interviews (45-60 minutes) were conducted with ED therapists in the UK, recruited from First Steps ED and Thrive Mental Wellbeing. The interview guide covered five themes: therapists’ treatment approach, implementation of therapy, engagement and motivation strategies, perspectives on ED apps, and suggestions for app content and design. A structured thematic analysis, validated by two researchers, was employed. The COREQ checklist guided the reporting. Ethical approval was obtained from the University College London Research Ethics Committee, and informed consent was secured from all participants. Data were analyzed using NVivo, following a structured thematic approach.

The study involved 12 therapists (mean age 28.7 years; 58% female). While CBT formed the basis of treatment, therapists adopted a flexible, person-centered approach, incorporating ACT, compassion-focused therapy, and psychodynamic techniques. The therapeutic relationship was identified as pivotal. Therapists viewed apps as potentially valuable across all treatment stages (pre-treatment, during treatment, post-treatment), for psychoeducation, self-monitoring, and relapse prevention. However, concerns emerged regarding safety, data privacy, triggering content, and the potential difficulty of replicating the therapeutic relationship within an app. Specific suggestions for app content included psychoeducation, coping strategies (breathing exercises, grounding techniques), self-monitoring tools (food and mood diaries), thought records, goal setting, motivational tools, body image work, and peer support. However, the use of exposure therapy within an app was deemed less suitable by several therapists.

This study highlights the need for ED apps that move beyond simple CBT digitization. An integrative, adaptive approach mirroring therapists’ practices is crucial, incorporating other therapeutic methods. The challenge of replicating the therapeutic relationship in an app necessitates careful consideration of design elements that foster trust, empathy, and engagement. Addressing safety and privacy concerns is paramount. The potential for AI tools to support self-reflection and emotion recognition should be explored, but ethical considerations and user involvement are essential. Personalized features, clear guidance, and user-friendly design are vital for improving engagement. A blended approach where the app complements therapy and therapists can monitor progress is suggested.

This therapist-centered study provides valuable insights for developing user-centric ED apps. The key is to create clinically safe, evidence-based apps that complement therapy by extending care and supporting self-management. Further co-design work with users and therapists is needed to refine these findings and rigorously test the effectiveness of app features. Addressing concerns around data privacy and safety is crucial for successful implementation.

The study's sample size (12 therapists) limits generalizability. Convenience sampling might introduce bias. Further research with larger and more diverse samples is needed to confirm these findings and explore the effectiveness of different app designs in different populations.