Therapist‐Guided Smartphone‐Based Aftercare for Inpatients With Severe Anorexia Nervosa ( SMART ‐ AN ): A Randomized Clinical Trial

Objective

To evaluate the efficacy of a 16‐week therapist‐guided, smartphone‐based aftercare intervention as an add‐on to treatment as usual (TAU) following inpatient treatment for anorexia nervosa (AN).

Method

In this single‐center randomized clinical trial, 186 female inpatients with DSM‐5 AN (≥ 13 years; body mass index (BMI) ≥ 15.0 kg/m ² at discharge; smartphone access) were randomized to TAU plus smartphone‐based aftercare (intervention group, IG; n  = 93) or TAU only (control group, CG; n  = 93). The intervention used the Recovery Record app with individualized goals and therapist feedback of decreasing frequency over 16 weeks. Outcomes were assessed at discharge (T0), end of intervention (T1), and 6‐month follow‐up (T2) by blinded assessors, and were analyzed using linear mixed effect models (intention‐to‐treat). The primary outcome was the Eating Disorder Examination (EDE) global score; secondary outcomes included BMI, depressive symptoms, self‐reported eating disorder psychopathology, self‐efficacy, and stage of change.

Results

At T1, there was no significant between‐group difference in EDE global score (mean difference, 0.12; 95% CI, −0.21 to 0.46), and results were similar at T2 (0.27; 95% CI, −0.13 to 0.67). Secondary outcomes did not differ clearly between groups. Intervention adherence was high (69.9% completed 16 weeks). Rehospitalizations occurred in 4.7% of participants by T1 and 26.4% by T2, without significant between‐group differences.

Discussion

In a context of intensive TAU with rapid access to outpatient psychotherapy, adding therapist‐guided smartphone‐based aftercare did not yield additional short‐term symptom benefit after inpatient treatment for AN. Future work should refine digital aftercare and embed it more closely into blended treatment models.

Trial Registration: ClinicalTrials.gov identifier: NCT04228939