Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 28, 2025
Date Accepted: Jul 21, 2025
Digitally Delivered Cognitive Behavioral Therapy for Adults with an Eating Disorder: Analysis of Retrospective Outcomes from a Real-World Patient Sample
ABSTRACT
Background:
Evidence suggests that cognitive behavioral therapy (CBT) is an effective treatment for eating disorders. However, less is known about the effectiveness of CBT in real world treatment settings or about delivery by multidisciplinary teams and via telemedicine.
Objective:
The aim of this paper is to evaluate the effectiveness of enhanced cognitive behavioral therapy (CBT-E) adapted to be delivered via telehealth in a real-world, clinic treatment setting by a multi-disciplinary team for adults with an eating disorder.
Methods:
A retrospective analysis of treatment outcomes was conducted on adult patients (18+) who received adapted CBT-E, a transdiagnostic treatment approach specifically modified for the treatment of eating disorders. Outcome included weight and eating disorder, depression, and anxiety symptoms. Survival analyses were used to assess length of stay, weight restoration and alleviation of eating disorder, depression, and anxiety symptoms; multilevel models assessed outcome trajectories over treatment time.
Results:
The patient sample (n = 1,718) was predominantly white (73%), cisgender women (86%), with a mean age of 30 (SD = 12). Diagnoses included anorexia nervosa (AN, 56%), binge-eating disorder (BED, 24%), bulimia nervosa (BN, 7%), and other specified feeding and eating disorder (OSFED, 11%). Approximately 51% of patients with weight restoration targets achieved weight restoration (95% of their target weight) by week 40 of treatment. By week 40 in treatment, 49% of patients reached subclinical levels on the EDE-Q, 58% on the PHQ-8, and 56% on the GAD-7.
Conclusions:
Adapted CBT-E delivered via telehealth by a multi-disciplinary team is effective in improving transdiagnostic eating disorder symptoms, depression, and anxiety in an outpatient setting. Outcomes were consistent across diagnoses, demonstrating the feasibility and effectiveness of virtual CBT-E. However, variability in treatment length makes direct comparison with clinical trial end-of-treatment outcomes challenging.
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