Pilot outcomes from a multidisciplinary telehealth versus in‐person intensive outpatient program for eating disorders during versus before the Covid‐19 pandemic

Abstract

Introduction Eating disorders (EDs) are serious mental illnesses with high rates of mortality, morbidity, and personal and societal costs. Onset of the Covid‐19 pandemic led to increased ED diagnoses in the general public, as well as worsening of ED symptoms in those with an existing ED diagnosis. Heightened prevalence and severity of EDs during the pandemic is complicated by the fact that traditional modes of ED care (specialty intensive treatment provided by a multidisciplinary team) have been difficult to access during the pandemic. Methods The current between‐groups study (N = 93 ED) tested a multidisciplinary intensive outpatient program (IOP) delivered via in‐person (pre‐pandemic; n = 60) and virtually via telehealth (during the pandemic; n = 33). Results We found no differences in outcomes via delivery mode, such that regardless of in‐person versus telehealth programming, ED symptoms, depression, and perfectionism significantly decreased and body mass index significantly increased. Conclusions Our findings suggest that a multi‐disciplinary telehealth ED IOP program is feasible and has comparable outcomes to in‐person IOP treatment. These findings have implications for treatment beyond the pandemic, suggesting that adoption of telehealth IOPs is warranted. Such delivery modes of intensive treatments for EDs could be expanded to reach underserved populations, especially in rural areas where treatment is often difficult to access.

A systematic scoping review of research on COVID‐19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

“…Although sample sizes were small (ns = 9, 25, and 93), each study found the online service to be safe, tolerated, and effective for improving general mental health and eating disorder symptoms from pre-to posttest periods. In two studies (66%), the degree of symptom improvement experienced from the online treatment was highly comparable to historical benchmarks at the same clinic (Levinson et al, 2021;Raykos et al, 2021), highlighting the viability of digitallydelivered treatments during the pandemic.…”

“…Three non‐randomized pilot studies evaluated the preliminary effectiveness of treatment services delivered via digital means (i.e., telehealth, videoconferencing) due to social distancing policies (Levinson et al, 2021 ; Plumley et al, 2021 ; Raykos et al, 2021 ). Although sample sizes were small ( n s = 9, 25, and 93), each study found the online service to be safe, tolerated, and effective for improving general mental health and eating disorder symptoms from pre‐ to posttest periods.…”

“…While studies showed that some patients were accepting of being transferred from face‐to‐face to telehealth treatment modalities (Raykos et al, 2021 ; Stewart et al, 2021 ), others showed that many patients reported dissatisfaction with online treatment services and a desire to return to traditional delivery modes as soon as possible (Brothwood et al, 2021 ; Lewis et al, 2021 ). Despite this dissatisfaction, three uncontrolled pilot studies showed large symptom improvement following the forced transition to online treatment (Levinson et al, 2021 ; Plumley et al, 2021 ; Raykos et al, 2021 ). It is important to point out that expectations of and prior experience with online modes of treatment delivery were not assessed in any of these studies, nor was it clear whether COVID‐19 had facilitated the decision to seek help in previously reluctant individuals.…”

In‐person versus virtual therapy in outpatient eating‐disorder treatment: A COVID‐19 inspired study

“…Two of these, both uncontrolled, documented promising pre-post symptom changes in small groups (n = 9 and n = 25, respectively) receiving routine treatments that were adapted to virtual formats (Plumley, Kristensen, & Jenkins, 2021;Raykos, Erceg-Hurn, Hill, Campbell, & McEvoy, 2021). The third study found responses of 33 people treated in a virtual day program to be indistinguishable from those of 60 people treated in a comparable in-person day program run prior to the COVID-19 outbreak (Levinson, Spoor, Keshishian, & Pruitt, 2021).…”

“…Two of these, both uncontrolled, documented promising pre–post symptom changes in small groups ( n = 9 and n = 25, respectively) receiving routine treatments that were adapted to virtual formats (Plumley, Kristensen, & Jenkins, 2021; Raykos, Erceg‐Hurn, Hill, Campbell, & McEvoy, 2021). The third study found responses of 33 people treated in a virtual day program to be indistinguishable from those of 60 people treated in a comparable in‐person day program run prior to the COVID‐19 outbreak (Levinson, Spoor, Keshishian, & Pruitt, 2021). Here, we report on findings from a study comparing responses of patients who, following the COVID‐19 outbreak, received a virtual adaptation of a routine outpatient treatment “package” offered in a specialized ED program, to responses of a historical sample receiving the same treatment package in person prior to the outbreak.…”