Recovery Record - brug af app i behandling af spiseforstyrrelser Bo Skytte Anette Hollesen Kristian Rokkedal Loa Clausen Aarhus Universitetshospitals Center for Spiseforstyrrelser Børne- og Ungdomspsykiatrisk Center

Baggrund Selv-monitorering som hjørnesten i behandling Øger både patient og behandlers opmærksomhed omkring det faktiske madindtag samt symptomer Hjælp til at identificere mønstre mellem symptomer - tanker - følelser - situationer Støtte til at bryde automatiseret adfærd Adherence to homework tasks is associated with improved outcomes in CBT (Kazantzis, Deane, & Ronan, 2002) The more consistent the monitoring, the better the treatment outcomes (Baker & Kirschenbaum, 1993)

Traditionel selv-monitorering: papirdagbøger Wish to use an app

Recovery Record Udviklet af Jenny Tregarthen et al., Stanford University Allerede fuldt udviklet og velfungerende system Nye funktioner implementeres løbende Searching for a solution and discovered Recovery Record, which is used worldwide. Been implementing the american app Rcovery Record in the treatment of young patients with bulimia – I will return to our experiences later on. But for know it’s enough to say that we were positive and decided to cooporate with Jenny and Standford Univarsity about translating the app into a Danish version.

North America 70,000 Europe 38,000 Australasia 15,000 Asia 3,000 Middle East Africa 2,000 Central America 80

Recovery Record Platform RR Application Servers Patient tools (iPhone & Android) Clinician Tools (iPhone, iPad & Web) Clinic-Level Web Interface Several options. The next part of the presentation will be about the patients tools and Clinician tool. The Clinic-Level interface gives the opportunity at center-level to get ovrwie of the users and their data.

Patient app Mere avanceret / detaljeret selv-monitorering Coping-skills Thoughts and feelings Disturbed behavior Meals Mere avanceret / detaljeret selv-monitorering With this app you can both use the basics – logging meals and symptoms. You can choose to use a broader variety of selv-monitoring. The patient will, together with the clinician, personalize or customize their profile and the settings to fit the individual. With some patients the more basic selv-monitoreing is more than enough and other patient can master and profit from the more advanced or detailed logging. Meals – what the patient ate, when, and where, and with whom/alone. The patients is asked to consider whether the amount was adwquate, restrictive or excessive Disturbed behavior – monitor binging, purging, excersice etc. And the urge to engage in compensatory behavior Thoughts and feelings – when logging meals, asked a range of feelings and the intensity of the feeling + physical sensations such as headache, physical pain, dizzyness etc. Coping-skills – næste slide! Simpel selv-monitorering

Patient app – flere muligheder Personlig kostplan Sætte mål: kortsigtede og langsigtede Mød andre Grafer med udvikling over tid EDE-Q Forbinde med behandler

Behandler app Giver behandleren mulighed for at se patientens logs få hurtig oversigt over symptomer og tendenser/mønstre forberede sig før sessioner kommentere på logs mellem sessioner foreslå mål, coping strategier, tilføje kostplan mm… With acces – the opportunity to prepare before session

Erfaringer fra gruppebehandling med unge med bulimi Fordele Flere udfører selv-monitorering Bedre forberedelse før sessioner Gennemgang af den unges selv-monitorering som ”et fælles tredje” mellem ung og forældre 20 session groutherapy for yong pt. with bulimia, parents attending the group every other week Higher compliance – still som patients have resistance Preparemnet – not always explicit used in groupsession but a knowledge of how last week has been and the possibility to refer to this knowledge in the groupsession

Ulemper På engelsk indtil nu Nogle patienter forventer øjeblikkelig feedback eller interaktion Brug for klar forventningsafstemning! Hvor meget kommunikation via app’en? Og hvorfor? Udvander denne gruppe-sessionerne? Language barriers We have become aware of the fact that many patient expect, that we respond on their logs when we see them. Different situation than with paper and pen. The possibility Boundaries – pt. writing about suicidal thoughts and impulses. Read it 5 days later.

Demonstration Vis log Vis indstillinger Kostplan + LOGGE TANKER/FØLELSER MELLEM MÅLTIDER BEHANDLER-APP Oversigter over pt Eksempel: Sara: logs, + tanker + hurtig oversigt over forstyrret adfærd Diagrammer – tendenser – forstyrret adfærd de seneste 6 uger Håndter mål – tilføj behandlingsmål Beskeder Indstil log spørgsmål EDE-Q – Stine Lad alle patienter vide, at deres logs er blevet gennemset diagrammer