Engagement Patterns and User Feedback from a Dialectical Behavior Therapy App for Eating Disorders

Abstract Smartphone applications (apps) for eating disorders (EDs) are efficacious, though early disengagement is a common problem that limits their effectiveness. Addressing engagement problems requires understanding user app interactions and gathering detailed feedback following a period of use. We developed the first DBT skills training app ( Resilience ) and established evidence for its efficacy. In this report, we present data on participant engagement patterns of Resilience and analyze detailed feedback from participants, including perceived satisfaction ratings and avenues for improvement. Secondary analyses from an RCT of participants with recurrent binge eating ( M age = 39.2, SD = 12.2, n = 576) were conducted. Data on engagement patterns, perceived satisfaction, and participants’ experiences were obtained. Descriptive statistics and frequencies were calculated to provide an overview of app engagement patterns, satisfaction ratings, perceived helpfulness, and constructive feedback themes. Negative binomial and logistic regression models were conducted to predict engagement and satisfaction from participant characteristics, and a linear regression was conducted to explore whether engagement levels were associated with symptom change. More than eight in 10 participants logged into the app, demonstrating good uptake. Engagement was variable, with only 44% completing more than three of the five modules. Sixty percent of participants were satisfied with the app, and emotion regulation skills were perceived as the most helpful aspect. Predictors of better engagement included older age, and lower binge eating frequency and distress tolerance levels. Exploratory analyses did not find a significant association between engagement and symptom change. Findings highlight the challenges of sustained engagement with ED apps and delivering content and features that satisfy each user’s needs. Continued efforts towards identifying innovative ways to ensure that ED apps are used for longer periods may be required. Findings align with broader research indicating engagement problems with mental health apps despite acceptable satisfaction ratings.