2025-06-04
One session, one trigger?
Neurology
#Chatbot #ED #SingleSessionIntervention
#eHealth #EatingDisorder
Eating disorders (ED) are severe psychiatric conditions characterized by a persistent disturbance in eating behavior, weight regulation, and body image. They are associated with major physical complications and a profound psychosocial impact, affecting quality of life, social relationships, and mental health. The longer treatment is delayed, the worse the prognosis becomes. Yet, quick access to care remains a major challenge.
Among the main current limitations are the overload of mental health services, a shortage of trained professionals, and waiting times that can extend for several months. This wait prolongs suffering, reinforces symptoms, and undermines motivation to engage in structured therapy. Furthermore, the available care is not always accessible, particularly outside major cities or for young, vulnerable, or minority populations.
In this context, the major challenge is to offer effective, accessible, and engaging transitional interventions that can help prevent the disorder from worsening during the wait. Single-Session Interventions (SSIs) have emerged as a promising approach, especially when delivered digitally via chatbots. These digital tools, based on validated protocols, can provide an initial psychoeducational response and help foster subsequent therapeutic engagement.
This study was initiated to evaluate the clinical effectiveness of a chatbot, based on the CBT-E (enhanced cognitive behavioral therapy) approach, in reducing ED symptoms and facilitating access to care for patients on treatment waitlists.
This study included 60 participants aged 16 and older, all on a waitlist for outpatient eating disorder treatment. Participants were randomly assigned to two groups:
The intervention, delivered in a single remote session via a digital platform, aimed to compare the chatbot’s effects with those of traditional psychoeducation. The primary outcome was the self-reported severity of eating disorder symptoms. Secondary indicators included psychosocial distress, levels of anxiety and depression, motivation for change, and the actual rate of treatment engagement three months after the intervention.
The results show that the chatbot group experienced a significant reduction in ED symptoms within the first month, with effects maintained at 3 months. Depressive symptoms, psychosocial distress, and anxiety also significantly decreased, with small to moderate effect sizes. Although food cravings did not significantly decline, there was a marked increase in confidence in one’s ability to change immediately after using the chatbot, suggesting a strong motivational effect.
Finally, at 3 months, 93% of the chatbot group had entered a treatment pathway, compared to 70% in the control group, despite similar access to healthcare services. These findings highlight the chatbot’s effectiveness in facilitating treatment initiation, in addition to reducing psychological symptoms.
Eating disorders are complex conditions, involving psychological suffering, physical disturbances, and impaired social functioning. Given the saturation of specialized services and prolonged waiting times, many individuals are left without therapeutic support at a critical moment when they are seeking help. One of the main challenges is to provide effective, accessible, and engaging transitional solutions that can prevent symptom worsening and prepare patients for treatment. In this context, this study was designed to assess the effectiveness of a chatbot, ED ESSI, delivering a one-time CBT-E-based intervention to individuals awaiting treatment.
The results show that ED ESSI is well tolerated, easy to use, and clinically beneficial. While it does not replace long-term psychotherapy, it can significantly reduce ED symptoms, alleviate psychological distress, and accelerate entry into care. It therefore serves as a relevant priming tool, particularly useful during therapeutic waiting periods.
Future research is needed to test the chatbot’s effectiveness in more diverse populations, including different age groups, genders, and diagnoses. Long-term follow-up beyond three months would help assess the durability of observed effects. It would also be valuable to explore integrating this intervention into blended approaches, such as CBT or neuromodulation. Finally, the development of more advanced versions of the chatbot, based on more interactive, secure, and personalized conversational models, could further enhance its clinical impact and accessibility.
Eating disorders (ED) are severe psychiatric conditions characterized by a persistent disturbance in eating behavior, weight regulation, and body image. They are associated with major physical complications and a profound psychosocial impact, affecting quality of life, social relationships, and mental health. The longer treatment is delayed, the worse the prognosis becomes. Yet, quick access to care remains a major challenge.
Among the main current limitations are the overload of mental health services, a shortage of trained professionals, and waiting times that can extend for several months. This wait prolongs suffering, reinforces symptoms, and undermines motivation to engage in structured therapy. Furthermore, the available care is not always accessible, particularly outside major cities or for young, vulnerable, or minority populations.
In this context, the major challenge is to offer effective, accessible, and engaging transitional interventions that can help prevent the disorder from worsening during the wait. Single-Session Interventions (SSIs) have emerged as a promising approach, especially when delivered digitally via chatbots. These digital tools, based on validated protocols, can provide an initial psychoeducational response and help foster subsequent therapeutic engagement.
This study was initiated to evaluate the clinical effectiveness of a chatbot, based on the CBT-E (enhanced cognitive behavioral therapy) approach, in reducing ED symptoms and facilitating access to care for patients on treatment waitlists.
Can a chatbot really ease eating disorders?
This study included 60 participants aged 16 and older, all on a waitlist for outpatient eating disorder treatment. Participants were randomly assigned to two groups:
- A group using an interactive chatbot named ED ESSI, lasting around 30 minutes and based on principles of enhanced cognitive behavioral therapy (CBT-E);
- A group receiving standard digital psychoeducational materials with the same content but without interactivity or personalization.
The intervention, delivered in a single remote session via a digital platform, aimed to compare the chatbot’s effects with those of traditional psychoeducation. The primary outcome was the self-reported severity of eating disorder symptoms. Secondary indicators included psychosocial distress, levels of anxiety and depression, motivation for change, and the actual rate of treatment engagement three months after the intervention.
The results show that the chatbot group experienced a significant reduction in ED symptoms within the first month, with effects maintained at 3 months. Depressive symptoms, psychosocial distress, and anxiety also significantly decreased, with small to moderate effect sizes. Although food cravings did not significantly decline, there was a marked increase in confidence in one’s ability to change immediately after using the chatbot, suggesting a strong motivational effect.
Finally, at 3 months, 93% of the chatbot group had entered a treatment pathway, compared to 70% in the control group, despite similar access to healthcare services. These findings highlight the chatbot’s effectiveness in facilitating treatment initiation, in addition to reducing psychological symptoms.
A digital ally to activate care
Eating disorders are complex conditions, involving psychological suffering, physical disturbances, and impaired social functioning. Given the saturation of specialized services and prolonged waiting times, many individuals are left without therapeutic support at a critical moment when they are seeking help. One of the main challenges is to provide effective, accessible, and engaging transitional solutions that can prevent symptom worsening and prepare patients for treatment. In this context, this study was designed to assess the effectiveness of a chatbot, ED ESSI, delivering a one-time CBT-E-based intervention to individuals awaiting treatment.
The results show that ED ESSI is well tolerated, easy to use, and clinically beneficial. While it does not replace long-term psychotherapy, it can significantly reduce ED symptoms, alleviate psychological distress, and accelerate entry into care. It therefore serves as a relevant priming tool, particularly useful during therapeutic waiting periods.
Future research is needed to test the chatbot’s effectiveness in more diverse populations, including different age groups, genders, and diagnoses. Long-term follow-up beyond three months would help assess the durability of observed effects. It would also be valuable to explore integrating this intervention into blended approaches, such as CBT or neuromodulation. Finally, the development of more advanced versions of the chatbot, based on more interactive, secure, and personalized conversational models, could further enhance its clinical impact and accessibility.
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