Take a minute to look at the people around you wherever you are right now. Chances are high that almost every single person is on their phone, or has their phone readily accessible. At least three-quarters of adults in the US own a smartphone at this point. And if the latest research is any indication, smartphone users are in physical contact with their device literally thousands of times per day. The widespread use of smartphones has changed the way people conduct every aspect of their lives, from paying bills to keeping in touch with friends across the world. So why not have technology change the way people receive mental health treatment as well?
The role of technology in behavior change related to eating disorders is complicated. But our field, like many others, remains hopeful that the power of smartphone technology can be harnessed to heal.
Research done so far on smartphone apps has offered support for their use in therapeutic settings. Apps that provide supplemental support to traditional therapy improve access to care for patients because they can receive assistance from a variety of locations, not just while face-to-face with a clinician. There is also some reason to believe that patients who use these apps feel less burdened by their treatment and are therefore more likely to stick to their treatment plan, including self-monitoring, an essential component to cognitive behavioral therapy (CBT) for eating disorders.
The ease and accessibility of these apps led researchers at the Mount Sinai Eating and Weight Disorders Program to evaluate the usefulness of a smartphone app, Noom Monitor, as a supplement to Cognitive Behavioral Therapy-Guided Self Help (CBT-GSH) in reducing binge eating symptoms. The Noom Monitor aims to “simplify and digitize self-monitoring records” and was designed specifically to help facilitate CBT-GSH. The research team predicted that those patients who used Noom Monitor and received CBT-GSH would have a greater reduction in their eating disorder symptoms, and would be more likely to stay in the study and stick to their self-monitoring, compared to a group that only received CBT-GSH.
66 adults (17% male, 83% female) with diagnoses of either bulimia nervosa (44%) or binge eating disorder (56%) were recruited and randomized to either traditional CBT-GSH or CBT-GSH + Noom.
All of the participants received CBT-GSH, an intervention that included reading a self-help manual based on CBT strategies that they were to then utilize, as well as having brief, in-person visits with a clinician, once weekly for the first four weeks and then bi-weekly for the next eight weeks.
The standard CBT-GSH group filled out self-monitoring sheets throughout the duration of the study (36 weeks), while the CBT-GSH + Noom group did all the self-monitoring activities on their smartphone and their therapist had access to their data.
The research team was primarily interested in how the groups fared in terms of frequency of binge eating episodes. Adherence – sticking to the CBT homework – was measured by the number of days of completed self-monitoring and number of days where three meals were recorded by patients.
At the end of the 12 weeks of CBT-GSH treatment, the researchers found that the CBT-GSH + Noom group reported significantly fewer binge eating episodes than the CBT-GSH only group. However, the difference between groups was absent 6 months after the conclusion of the treatment.
Contrary to the researchers’ prediction, there was a similar rate of dropout in both groups, suggesting that either the ease and accessibility of smartphone apps may not matter so much for treatment compliance or that CBT-GSH is an acceptable stand-alone treatment. As Dr. Robyn Sysko, Assistant Professor and study co-author, explains, “The failure to show a difference between treatments at six months is a function of how good CBT-GSH is as a treatment—it’s quite potent and the effects are long-lasting. We hope this study provides some evidence that smartphone apps don’t interfere with the benefits of CBT-GSH, and it may be necessary to think creatively about how best to utilize technology in making treatment more accessible.”
The CBT-GSH + Noom group did report better adherence to meals and snacks, with an average of three meals a day and two snacks. Because regular eating is an important aspect of CBT and eating disorder recovery, the finding that patients who engaged in real time self-monitoring also ate more regularly provides positive support for the use of smartphone apps in treatment.
What does it all mean?
Though this study offers mixed support for supplemental treatment provided through smartphone apps, it does add to what we already know in a few important ways. Dr. Tom Hildebrandt, Associate Professor of Psychiatry and study co-author, elaborates, “We think this study provides evidence that smartphone interventions can be used effectively to reduce eating pathology.” Smartphone apps that monitor eating might be useful in helping some patients stick to the regular eating pattern recommended in eating disorders treatment. According to Dr. Hildebrandt, this kind of research provides “the opportunity to see if we can leverage technology to reach people wherever they are and help them on a much larger scale than what has been possible to date.”
However, there is still limited evidence for the role of smartphone technology in the long-term reduction of eating disorder symptoms. In response to this, the research team is currently conducting a large scale long-term study using Noom Monitor with binge eaters. This study will examine the effectiveness of Noom Monitor across different settings and through a telemedicine platform (i.e. not just CBT-GSH) and eating disorders.