Recovery Record: The sustainability of a smartphone application in facilitating recovery from an eating disorder. A patient’s perspective.
I began using Recovery Record, as a form of “pre-therapy”, whilst on the waiting list for CBT for my eating disorder (anorexia: binge-purge subtype).
Recovery record is a free smartphone application, which is widely accessible and easy to use. Many of its features contain components of evidence-based interventions for eating disorders: most notably CBT/CBT-E.
The app provides a paper-free way for me to “self-monitor”: that is - to record a food diary alongside thought records, significant emotions, behaviours and concurrent events. My log entries can be viewed by my consultant and therapist, via a clinician version of the app.
Having my smartphone to hand for much of the day makes recording convenient and means that log entries can be written “in the moment”, thus improving their accuracy and reliability.
In the context of sustainable clinical practice, this smartphone application has a number of potential benefits, which I have aligned with the principles of sustainable health care:
Patient empowerment:
“Self-monitoring” and “planned regular eating” form the mainstay of CBT for eating disorders. When my consultant suggested using Recovery Record as a “bridge” to therapy, I was fairly ambivalent about addressing my eating disorder and I had little motivation to change.
For me, self-monitoring via the app was the first step in facing up to my eating disorder. Right from the start, the ball was in my court: using the app would only be effective if I recorded reliably and accurately. For the first time, I had to be open and honest about my eating behaviour - both with myself and with my consultant.
Patients with eating disorders are encouraged to eat three meals and three snacks each day, in order to establish a regular pattern of eating. The Recovery Record app provides prompts to log each meal and snack at appropriate times of day. If I try to skip a meal, these reminders make me consider why I have not eaten and provide a gentle nudge in the right direction. What I eat is up to me, although I have a meal-plan to use as a guide.
In this way, the app has helped me to take ownership for my recovery: each mealtime I face a choice and by making the “right” choices, day by day, I move forwards on the road to recovery. Feeling empowered to do this myself (for example being able to decide what to eat, rather than being fed on a hospital ward) has given me far more autonomy and has allowed me to implement changes which will be more sustainable in the long term.
Ultimately, using the Recovery Record app has emphasised to me that although I have the support of a specialist team, I am the one who has to do the hard work. After all, there is no magic pill!
Lean service delivery:
The clinician version of Recovery Record allows both my consultant and therapist to view my data. In the early stages, my consultant reviewed my logs several times each week. This helped to keep me engaged and “on track”. She quickly spotted a pattern of eating-disordered behaviour which was “keeping me stuck” (restriction early in the day, tricking my body into “starvation” and inevitably leading to bingeing later on).
Using the app’s “messaging” feature, my consultant was able to provide focused support, send messages of encouragement and intervene in a timely manner, in order to keep me from slipping backwards. This motivated me. I felt that if my consultant was making such an effort to support me, I should try equally hard to engage: self-monitoring accurately and reliably; and trying to implement change.
Reducing carbon:
Whilst this required motivation and commitment from my consultant, these short, frequent episodes of virtual patient contact reduced the need for face-to-face appointments (thus reducing clinic time, costs and travel emissions, as well as freeing up appointments for other patients).
Prevention:
I had been using Recovery Record for three months before I started CBT. During this time, without any intervention, my eating disorder symptoms would have perpetuated, leading to further weight-loss and potentially necessitating more costly and intensive intervention (e.g. hospital admission).
Conversely, by the time I started CBT, I was feeling much more motivated to tackle my eating disorder. Having taken ownership for my recovery, I had completely broken free from the “binge-purge cycle”, I was reliably self-monitoring and I was making some headway in establishing a pattern of regular eating.
Using the Recovery Record app during this time - with specialist clinician support - undoubtedly prevented disease progression and was effective in initiating and facilitating recovery.
Efficient use of clinician input:
By the time I started CBT, I felt like I had a head-start and we could really “hit the ground running”. The progress I had made in the three months of using Recovery Record alone, had probably saved us 6-10 weeks worth of appointments.
It took some persuasion for my therapist to agree to using Recovery Record, but it soon became clear that using the app would be hugely beneficial in facilitating my therapy sessions.
My therapist reviews my logs from the past week on the day of my appointment, making a note of common themes, recurring thoughts and difficult behaviours that need addressing. Writing open, honest log entries enables her to gain a clear picture of “where I am coming from”. This means that she can prepare in advance for each session: using my data to tailor and target discussion, and to provide timely intervention.
Consequently, we can make the best, most efficient use of the time available, rather than “going over everything again”.
In the long-run, this effective use of therapy time could potentially reduce the number of CBT appointments needed. Using my therapy time to explore the “deeper issues” in more detail (rather than focusing on the more superficial events of the week) will enable me to gain a clearer understanding of the causes and triggers for my eating disorder, which will hopefully lead to full recovery and prevent relapse in the future.
My consultant reviews my logs about once a week, which continues to provide encouragement and motivation, as it reminds me that she is keeping track of my progress and is engaged in my recovery. She is able to use my data to evaluate the effectiveness of treatment, make informed clinical decisions and provide timely and targeted interventions.
Having used Recovery Record together, I feel my consultant knows me well and that we have good rapport when we meet face-to-face. At follow-up appointments we can save time, yet cover issues in more depth, as she has a good idea of what has been happening. I can also look back over my logs to remind myself of the events of recent weeks. (This has also been helpful in facilitating treatment for my affective disorder). Using the app has almost certainly reduced the frequency and number of consultant follow-up appointments that I have needed.
In summary:
Use of the Recovery Record smartphone application prior to starting CBT for my eating disorder enabled me to establish a pattern of self-monitoring and regular eating, whilst preventing disease progression. Subsequently, time spent in therapy sessions and consultant follow-up appointments has been used efficiently and to best effect, reducing the number “face-to-face” meetings overall.
Most importantly, this intervention has empowered me to take ownership for my recovery. I am hopeful that this will lead to full, sustainable, recovery from my eating disorder and prevent relapse in the future.
Finally, it can be hard to recognise change when it is only happening in small steps, but having everything logged - right from the start of recovery - shows me just how far I have come. Applying a sustainability framework has highlighted the benefits of this type of service innovation.
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