Therapist-Guided Smartphone-Based Aftercare for Inpatients With Severe Anorexia Nervosa (SMART-AN): A Randomized...

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).

In this single-center randomized clinical trial, 186 female inpatients with DSM-5 AN (≥ 13 years; body mass index (BMI) ≥ 15.0 kg/m² 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.

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.

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.

ClinicalTrials.gov identifier: NCT04228939.