With a new $50,000 award from the National Eating Disorders Association (NEDA), a research team at the University of Kansas is developing a smartphone app for clinical use with patients receiving treatment for an eating disorder -- the deadliest of all mental disorders.
According to the NEDA, approximately 20 million women and 10 million men in America will develop an eating disorder at some point in their lives. These include anorexia nervosa, bulimia nervosa, binge eating disorder and a category named "other specified feeding or eating disorder," which includes a variety of unique combinations of symptoms.
"Sadly, for 40 to 60 percent of patients with an eating disorder, the very best available treatments simply don't work," said Kelsie Forbush, M. Erik Wright Assistant Professor of Clinical Psychology at KU, who is leading the development of the app. "Researchers and clinicians have put a lot of time and energy into developing new treatments for eating disorders, but the majority of these new treatments have not improved outcomes."
Forbush said the app is motivated by a new direction in the field of mental illness called "patient-focused treatment outcomes" research.
"Instead of developing new types of treatments, patient-focused treatment outcomes research is designed to improve outcomes by monitoring patient progress and providing feedback directly to therapists to enhance ongoing treatment," she said. "Research in other areas of mental illness shows that monitoring patient outcomes on a week-to-week basis can increase positive outcomes by as much as 20 percent and reduce the number of patients who would have a poor outcome by 10 percent, so it's a potentially powerful way to help patients get better."
But, according to the KU researcher, most clinicians don't have the time, and many don't have adequate training, to perform weekly client-focused outcome assessments.
"Clinicians are incredibly busy and some therapists simply don't have the time to track, analyze and interpret outcomes at every session for every patient," said Forbush. "Some clinicians are also unsure of how to interpret patients' scores. A clinician might think, 'I see my patient has a certain score -- what does that mean, and what should I do differently?' Patient-focused treatment outcomes research enables therapists to treat their clients faster, with fewer sessions, and leads to better end-of-treatment outcomes. It works because therapists are getting feedback at each session and can more easily adjust their treatment accordingly."
The new app will allow clinicians to track and assess a patient's response to treatment quickly by using computer-adaptive technology (CAT). The app will guide clients through a series of questions drawn from two self-reporting measures: the Eating Pathology Symptoms Inventory (EPSI) and the Inventory of Depression and Anxiety Symptoms (IDAS).
CAT uses a client's previous answers to determine which questions to ask next, shortening the overall number of questions without losing accuracy of the results.
"The client will use a smartphone or tablet," Forbush said. "A client will answer questions and their data will be visible to clinicians on a user-friendly, web-based platform. Clinicians will also get easy-to-interpret 'signal warnings' to let them know if their patient is on track, if they need to adjust or intensify their treatment, or if their patient is in danger of a poor outcome. Our app is designed so that clinicians won't have to worry about interpretation, they'll get feedback on their patients' outcome without having to analyze the results themselves."
The KU researcher said that the app's analysis of clients' answers could give clinicians more realistic feedback on the effectiveness of treatment.
"Most therapists underestimate negative treatment outcomes for their ongoing clients," said Forbush. "A past study found 25 percent of therapists believed their clinical skills were in the top 90 percent -- and none viewed their skills to be below their peers. My hope is that providing therapists with 'real-time' patient feedback to compensate for common biases in the ability to predict future treatment 'failures' will help to empower therapists to identify their patients who are at risk for poor outcomes early in treatment and adjust therapy."
Forbush's co-investigators include Christopher Cushing, assistant professor of clinical child psychology at KU; Sara Gould, assistant professor of pediatrics at Children's Mercy - Kansas City; Lauren Ptomey, research assistant professor at the Center for Physical Activity and Weight Management at KU Medical Center; and Louis Tay, assistant professor of Industrial-Organizational Psychology at Purdue University, who is helping to design the app's interface and algorithms. Lei Wang, a graduate student in computer engineering at KU, helped create the beta-version of the app.
"Clinicians don't have a crystal ball," Forbush said. "If they're not assessing outcomes, they can't be 100 percent accurate in predicting how clients are doing. The dashboard will signal clinicians each week -- here's how your client is doing -- with the user-friendly warnings and helpful tips and strategies to consider implementing if clients are not doing well. Our work is important. If we can improve client outcomes, this will have a major impact on public health by reducing the number of clients who die as a result of complications from an eating disorder."
Support from NEDA will enable Forbush's team to test the app in various eating-disorder treatment settings in the Greater Kansas City area, including at Children's Mercy Eating Disorder Clinic, Insight Counseling and EDCare Kansas City.
Forbush said she is energized to embark on this work, particularly because it will help address an important problem for therapists who treat people with eating disorders.
"When we received news that our grant was funded, therapists started emailing me about how excited they are to work together on this study," she said. "It's incredibly rewarding to have the opportunity to partner with clinicians so we can work together to make a difference for people with the deadliest form of mental illness."