New England Psychologist
October 2015

A Massachusetts private psychiatric hospital is using a mobile app for co-managing eating disorder recovery in real time.

Walden Behavioral Care of Waltham, which provides inpatient, residential, partial hospitalization, and intensive outpatient care for patients with eating disorders, is using the mobile health platform Recovery Record, which can be used on an iPhone, iPad or Android and enables patients and their providers to continuously monitor progress.

The app allows users to self-manage their recovery with behavioral monitoring. The system incorporates Cognitive Behavioral Therapy; personalized meal plans; clinical goals; and motivation enhancement, such as aspirational songs and supportive statements and emoticons. The app has built-in smart algorithms that detect opportunities for intervention and suggest relevant coping tactics.

Walden President and CEO Stuart Koman, Ph.D., said after a successful pilot program that began about a year ago, the app is now deployed throughout the system.

Patients control which staff members can access the information they are providing. The app has a food diary and a mood monitor, so patients can report how they are feeling at any given time.

“Certainly all younger and most of the older patients all have smartphones that they carry with them, so one of the benefits is that they are entering what they are eating into the food diary in real time, as opposed to trying to remember it later,” Koman said.

This real-time documentation can provide more accurate information than if a patient recalls later with the clinician what was eaten. “Self-reporting after the fact is less reliable,” he said.

Rebecca Bernat, LICSW, program director, Residential Programs, said the app has been a great communication tool. Patients in the residential program are given time to log in after meals, and the app cues them to use coping skills, reflect on urges and how they manage them, and offers suggestions. “I think it has proven to be very beneficial, particularly when we have patients who have been a little reluctant to share,” Bernat said.

Staff can review information immediately in real time or at a future appointment. “Because you can see the timeframe of things and what they’ve been doing daily, you can see progress and decline,” Bernat said.

Bernat said patients are more apt to use the app rather than write in a food diary, because it is so accessible and easy to use.

“In both the short- and long-term, it really just increases communication and allows us to be more knowledgeable about what’s really going on with the patient – what they are struggling with and what they are doing well with,” Bernat said. “We’ve done surveys with patients, and they’ve indicated that they feel they are more connected to us – and we feel the same way.”

Bernat said the app allows clinicians to send a supportive message to a patient right when they need it. “We can send a message saying, ‘Well done,’ in real time,” she said. Conversely, Bernat uses the app to support patients when they are struggling.

“Being able to say something in the moment to that person instead of having them getting stuck in their head is really invaluable,” Bernat said.

Koman said the app helps reach patients in a new way. “You have some people who come to therapy who become deeply engaged and recover and then you have a group kind of playing at the edge, who are in therapy but maybe not as motivated as you would hope,” Koman said. “Sometimes, just a different vehicle and a different way of going about it can create that engagement.”