Acceptability and Feasibility of a Digital Mindfulness-Based Intervention for Anorexia Nervosa and Bulimia Nervosa

There is a great need for the development of scalable augmentations to treatments for anorexia nervosa (AN) and bulimia nervosa (BN), as most individuals with AN/BN are currently not able to access treatment. Mindfulness-based interventions (MBIs) may be promising for AN/BN and lend themselves well to digital delivery, increasing access. We aimed to develop and test the initial acceptability and feasibility of Mindful Courage, a digital MBI for AN/BN and atypical AN/BN.

We evaluated an 8-week version of Mindful Courage including 32 modules (8 core multi-media lessons, 24 brief audio-guided mindfulness practices) in N = 32 participants, who also received weekly phone coaching conducted by psychology students. Ten participants (31.2%) were enrolled in outpatient ED treatment while receiving the intervention. Participants completed assessments at baseline, post-intervention (8 weeks), and 2-month post-intervention follow-up.

Acceptability was demonstrated by relatively high ratings for perceived usability (81.34/100), understandability (4.6/5.0), engageability (4.1/5.0), visual appeal (4.1/5.0), helpfulness (4.2/5.0), skills acquisition (4.3/5.0), and confidence applying skills (4.2/5.0). Feasibility was demonstrated by high module completion (an average of 28/32 modules). There were significant reductions in target outcomes: ED symptoms (d = 1.21), body dissatisfaction (d = 0.73), depression (d = 0.76), anxiety (d = 0.62), and clinical impairment (d = 1.15). In addition, there were significant improvements in target mechanisms: mindfulness (d = 0.79), emotion regulation difficulties (d = 0.65), and savoring beliefs (d = 0.58).

Mindful Courage is a viable and potentially effective intervention. A future randomized-controlled trial is warranted.