How MVHS students are tackling the problem of eating disorders during a pandemic through the creation of a simple journal style app.

By: ANgelina Alex Roopa

Having to social distance because of the widespread fear of COVID-19 and unable to enjoy the “high school experience,” many of us were discontent with the pandemic and all of its limits. Sophomore Liana Khorasani describes her experiences with COVID-19 as they apply to students throughout the Silicon Valley.

“Students all over the Bay feel frustrated because of how difficult it is to learn virtually without any face to face interaction,” Khorasani said. “Without the dances and socials that are typically hosted, it’s even harder to persevere through.” 

While most of us struggle with time management and motivation, a silent majority’s struggles are overlooked during  quarantine, as they feel as if they had nowhere to go and no one to confide in. For those spiraling into an eating disorder or those barely recovering from one, the ongoing quarantine has turned into a living nightmare. In a study done by psychologists at the University of Munich, out of 150 patients who had just been discharged from an outpatient center in 2019, almost 70 percent of them reported having feelings about their eating habits, shape and weight concerns, drive for physical activity, loneliness, sadness, and inner restlessness being increased during the lockdown. Being stuck with their own negative thoughts has been extremely challenging for those who had recently overcome their eating disorders, but those who had either recently developed one due to the stress of our current situation were the ones struggling silently. 

According to the National Association of Anorexia Nervosa and Associated Disorders, in the United States alone, over 28.8 million individuals have or are struggling with an eating disorder and many of us are unaware or apathetic to the different manifestations, shapes and sizes that eating disorders come in. There are 4 main disorders that are commonly seen: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and Avoidant Restrictive Food Intake Disorder (ARFID).

Each disrupts one’s day to day life and interferes with both the emotional and physical aspects of one’s health. The National Centre of Eating Disorders recognizes the “Five Phases of Restrictive Eating” that are most commonly seen in patients who are developing and recovering from an eating disorder. In Stage One, most patients hear a voice in their head that convinces them to lose weight because it will help them feel better.

Stage Two is similar to Stage One which is why it is hard to distinguish when someone has transitioned between the two. The voice in their head continues to push them, telling them that they have not reached their end goal yet.

As they segway into Stage Three, their thoughts start to turn obsessive and depressive, snapping at those who offer help.

 In Stage Four, the patient becomes aware of their condition and starts the road to recovery, acknowledging that the process will take a while but they are willing to do what it takes to recover.

Finally in Stage Five, the patient has been working towards recovery, but has mostly strayed away from the behaviors exhibited in Stages Two and Three.

Most patients are still hyper sensitive and emotionally vulnerable to their illness, and sometimes they can start to retain behaviors from the past when put under extreme amounts of stress. Although the reactions to stress varies, those who are not able to find healthy coping mechanisms and experience frequent bouts of lower self esteem or self confidence, are much more susceptible to eating disorders. 

These disorders mainly affect the younger generation, with data from the National Eating Disorder Association suggesting that those around the ages of 15 and 24 are the most susceptible to eating disorders. To counteract the high rates of young adults who experience this illness, family-based therapy has had a high success rate when the intervention takes place early on in the process. With therapy, many therapists have been able to address the psychological component of the disorder, while also helping them express their emotions much more freely. Patience and sensitivity from the patient’s therapist helps to really uncover the emotional pain that is the root of the eating disorder, but with the rise of the coronavirus, therapists have not been able to connect with their clients as easily as before.

Michelle Mangiardi, an Associate Professional Clinical Counselor for the Bay Area Clinical Associates discusses the effects of the pandemic on her practice and how she has been overcoming the challenges posed by the pandemic.

“I mean, really, the biggest [challenge]…is the energy in the room that you have in therapy. It’s really hard to create that over the screen…you don’t get the same energy in the room as you would in person. So you lose that element of the therapeutic setting,” Mangiardi said.

Some of the frequent challenges that she has faced while keeping in touch with patients online, and moving towards a more tele-health oriented approach. Using Google Meets and Zoom to stay in touch with her clients, she elaborates on how exhausting it is for her teenage clients to constantly be on and off calls for both school and therapy, but also on how hard it is to gauge where their patients with disordered eating are in their process.

“Yeah, with eating disorders…you can’t really determine where they are,” Mangiardi said. “You can’t have someone come in and maybe get weighed like they would in a doctor’s office in person, you can’t really assess them in person. So it’s a scary, scary thing for some patients with different types of health issues. But you do the best you can.”

“Yeah, with eating disorders…you can’t really determine where they are,” Mangiardi said. “You can’t have someone come in and maybe get weighed like they would in a doctor’s office in person, you can’t really assess them in person. So it’s a scary, scary thing for some patients with different types of health issues. But you do the best you can.”

This has especially been a major issue since the spike in eating disorders rates a few months into the pandemic. Researchers at the University of North Carolina in Chapel Hill have seen a significant increase in the number of eating disorder cases since the start of the lockdown and have been closely monitoring the number of calls made to the National Eating Disorder Association’s (NEDA) emergency helplines, which has noted a steep 78 percent rise in the number of phone calls and text messages they have received.  Those who had been diagnosed before the pandemic have a hard time seeking our resources during quarantine and those who recently developed a disorder due to prolonged exposure to social media and being in a potentially harmful living situation have struggled immensely during this time, not being able to receive the help or diagnosis as soon as they need it. Due to this, many therapists have turned to the world of journaling and meditation apps to help aid their patients remotely after they meet for their weekly sessions. When discussing the effectiveness of these apps as recovery tools, Mangiardi expressed her positive views on the matter, discussing how she employs them in her practice.

“Yeah, these apps are definitely supplemental. I’m all for them. I use one that’s CBT [cognitive behavioral therapy] based and it’s really good,” Mangiardi said. “I think with patients, they have their phones at the tip of their fingertips half the time . . . So it’s like being able to log into an app and track your feelings and thoughts and emotions and behaviors is easier than if you would do it on paper and pen.”

Although these apps on the market have helped a wide variety of therapists and patients, none of them have a cohesive system that really integrates all of the features that are commonly used in recovery into one app. Many patients have to go through the hassle of installing and uninstalling multiple apps until they find all the apps necessary to proceed with their recovery. The process is inefficient,especially during a time where remote access to recovery resources is extremely important and apps with multiple recovery features are needed the most. 

To combat this, 2 MVHS juniors, Vaishnavi Suresh and Gabriella Morali, have created an app called Recove, which aids patients through their recovery process during isolation and provides the patient’s therapist a window into their patients recovery outside of standard sessions. 

 “The main goal of Recove is to give people a method of recovery outside of their once a week therapy sessions and to also have a deeper therapist-patient relationship that can allow them to grow in a much faster and more effective way. I had an eating disorder for about 3 years during middle school and it was really painful and…I didn’t get the necessary help that I needed,” Suresh said. “After I was hospitalized…I did not have a therapist for a really long time and even after I got discharged I didn’t have as much access to therapy resources. After I started to see a therapist, I thought it really helped me but one of the main problems with that therapy was once every three weeks and my therapist had no idea about how much better or worse it had gotten in between sessions.”

The lack of resources Suresh was provided with appalled her during her in person visits, and she goes further to describe how one could only imagine how long those who have been suffering during quarantine have gone without proper care. With the help of Recove, the therapists that are moving towards tele-helath and apps to manage their patients’ data during time away from session can easily patch the gap between patient-therapist communications while providing them with as many resources as possible from a remote setting. 

 Morali elaborates on the developmental process that their team has been using, describing the basics of their design so far.

A mockup of the Recove apps homepage

“We have had our dev team working very diligently at building this app. One of the main things that they’re starting to do is think of an architecture that is more ready to use by a lot of therapists, and after they start incorporating elements of what we’ve already done and elements of their architecture, we can build a good app that feeds the needs of the [therapists], while being effective and safe for the use of a patient.” 

Morali adds on by describing the key features in the app and emphasizes the different aspects that are see in the Recove app that are not usually present in the other apps on the market.

 “One of the greatest features on the app is probably the journal feature. Even though there are a lot of different apps that allow you to journal your feelings and thoughts, this feature really complements the patient’s progress. They can see how far they’ve come along and it even sends reminders to log your feelings and gives you a streak for logging in consistently,” Morali said.

A mockup of the journal and log section of the app

“Even if you break that streak, it’s totally okay because you have the support of your therapist right there in your hand and the app sends encouraging messages until you get back on track.” Unlike a regular journaling app, Recove’s app integrates the use of a journal and a food log so that patients are able to keep track of triggering factors, while monitoring their food intake with the help of professionals. All features on the app can be disabled by the therapist who is administering the accounts can choose which features will help their patients recovery and which ones could trigger a negative reaction. 

As the pandemic takes over our lives and many others, many industries have started to virtualize their processes. Particularly, the telehealth industry expands as more clinics and hospitals utilize online systems to manage patient’s progress and recovery. Apps and website based applications are the future and apps such as Recove are the key to successfully carrying out day-to-day patient care during this time where remote access is extremely important. Recove’s aim to bridge the gap where most therapists struggle to follow-up with their clients during their recovery process, offers those struggling with their journey a unique solution towards their road to recovery that takes into account the effects of in person treatment and how it can efficiently be replicated and adapted to fit the patents situation during these uncertain times.

 

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