{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:17:30Z","timestamp":1790727450888,"version":"4.1.0"},"reference-count":15,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Anorexia nervosa is a severe psychiatric disorder with high morbidity and mortality, particularly among adolescents. Family-based treatment (FBT) is the leading evidence-based intervention for adolescent anorexia nervosa, involving parents in renourishment and behavior interruption. Despite its effectiveness, challenges in distress tolerance and emotion regulation during high-stress situations, such as mealtimes, contribute to suboptimal treatment outcomes, with only 35% to 50% of adolescents achieving full recovery. Enhancing distress tolerance skills during FBT may improve treatment responses and recovery rates. The BALANCE mobile app was developed to address this need, offering real-time, dialectical behavior therapy (DBT)\u2013based distress tolerance skills to support adolescents and families during mealtimes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n Our aim was to explore the feasibility and acceptability of a mobile app designed to deliver distress tolerance skills to adolescents with and adolescents without anorexia nervosa. When fully programmed and optimized, we plan to use the mobile app to improve distress tolerance during mealtimes for adolescents with anorexia nervosa undergoing FBT.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n BALANCE was developed collaboratively with Stanford University\u2019s Center for Biodesign, leveraging the expertise of clinical psychologists and using biodesign student input and the Stanford Spezi ecosystem. The app underwent an iterative development process, with feedback from adolescent users. The initial feasibility and acceptability of the app were assessed through self-reported questionnaires and structured interviews with 24 adolescents aged 12 to 18 years, including 4 diagnosed with anorexia nervosa and 20 healthy controls. Adolescents with anorexia nervosa specifically used the app during mealtimes, and healthy controls used it as needed. Participants assessed the app\u2019s usability, perceived effectiveness, and its impact on their distress tolerance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The app demonstrated high usability and acceptability. Of 24 participants, 83% (n=20) reported enjoying the app, 88% (n=21) would recommend it to peers, and 100% (n=24) found it user-friendly. Adolescents with anorexia nervosa reported that BALANCE helped them manage stressful mealtimes more effectively, highlighting features such as guided meditation, breathing exercises, and gamification elements as particularly effective. Healthy controls provided additional feedback, confirming the app\u2019s broad appeal to the target audience and potential scalability. Preliminary findings suggest that BALANCE may enhance distress tolerance in adolescents with and adolescents without anorexia nervosa.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n BALANCE shows promise as an innovative mobile health intervention for enhancing distress tolerance in adolescents with anorexia nervosa. Its user-friendly design and tailored DBT-based skills make it a feasible tool for integration into FBT. Future research should explore its integration into clinical practice and its impact on treatment outcomes. As distress tolerance skills are relevant to a range of mental health conditions, future research may also expand BALANCE\u2019s application to broader adolescent populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/70278","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:14:16Z","timestamp":1738628056000},"page":"e70278-e70278","source":"Crossref","is-referenced-by-count":5,"title":["Enhancing Distress Tolerance Skills in Adolescents With Anorexia Nervosa Through the BALANCE Mobile App: Feasibility and Acceptability Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9973-6127","authenticated-orcid":false,"given":"Christina","family":"Miranda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8607-5019","authenticated-orcid":false,"given":"Brittany","family":"Matheson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6109-7385","authenticated-orcid":false,"given":"Nandini","family":"Datta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8474-5197","authenticated-orcid":false,"given":"Aileen","family":"Whyte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4424-2514","authenticated-orcid":false,"given":"Hyun-Joon","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8607-9148","authenticated-orcid":false,"given":"Paul","family":"Schmiedmayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0359-1275","authenticated-orcid":false,"given":"Vishnu","family":"Ravi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-2429","authenticated-orcid":false,"given":"Oliver","family":"Aalami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5169-1484","authenticated-orcid":false,"given":"James","family":"Lock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"issue":"10","key":"R1","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1001\/archgenpsychiatry.2010.128","article-title":"Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa","volume":"67","author":"Lock","journal-title":"Arch Gen Psychiatry"},{"issue":"11","key":"R2","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1016\/j.jaac.2015.08.008","article-title":"Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa","volume":"54","author":"Le Grange","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1016\/j.jaac.2023.10.012","article-title":"Who responds to an adaptive intervention for adolescents with anorexia nervosa being treated with family-based treatment? 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CS342 \/ MED253 - building for digital health: winter quarter \u2013 academic year 2023\/2024. Notion. 2023. URL: https:\/\/stanfordbdhg.notion.site\/CS342-MED253-Building-for-Digital-Health-115008f9653881e3b42ddf7dfbf5a156 [Accessed 18-02-2025]"},{"key":"R9","unstructured":"Schmiedmayer P Bauer A Zagar P Ravi V Aalami O . Stanford Spezi. Zenodo. Oct29, 2024. 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