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Randomized Controlled Trial
. 2025 May 21:27:e70874.
doi: 10.2196/70874.

The Effectiveness of a Chatbot Single-Session Intervention for People on Waitlists for Eating Disorder Treatment: Randomized Controlled Trial

Gemma Sharp  1 , Bronwyn Dwyer  1 , Alisha Randhawa  1 , Isabella McGrath  2 , Hao Hu  1
Affiliations
Randomized Controlled Trial

The Effectiveness of a Chatbot Single-Session Intervention for People on Waitlists for Eating Disorder Treatment: Randomized Controlled Trial

Gemma Sharp et al. J Med Internet Res. .

Abstract

Background: Early treatment is critical for improving eating disorder prognosis. Single-session interventions (SSIs) can provide short-term support to people on waitlists for eating disorder treatment; however, it is not always possible to access SSIs. We co-designed and developed a rule-based chatbot called ED ESSI (Eating Disorder Electronic Single-Session Intervention), which delivered an SSI and demonstrated its acceptability and feasibility. However, the effectiveness of ED ESSI is yet to be investigated.

Objective: This study aimed to investigate the effectiveness of an SSI delivered by ED ESSI. We examined the chatbot's impact on eating disorder pathology, psychosocial impairment, depression, anxiety, stress, and motivation for change or treatment in individuals aged ≥16 years on waitlists for treatment for all types of eating disorders.

Methods: This multicenter 2-armed randomized controlled trial included 60 people on waitlists for eating disorder treatment in the chatbot intervention group (n=30, 50%) or the control group (n=30, 50%). The ED ESSI chatbot guided participants through a 30-minute SSI of assessment and psychoeducation, while the control group received web-based information on the same core topics covered in the SSI. There were 4 time points: before intervention or baseline (time point 1 [T1]), after intervention within 72 hours of baseline (T2), 1 month after baseline (T3), and 3 months after baseline (T4). Eating disorder pathology (primary outcome) and psychosocial impairment, depression, anxiety, and stress (secondary outcomes) were measured at T1, T3, and T4, and motivation for change or treatment (secondary outcome) was measured at all 4 time points. Furthermore, the System Usability Scale was implemented at T2 for the chatbot intervention group only.

Results: ED ESSI induced significantly greater reductions compared to the control group in the primary outcome of eating disorder pathology (P=.003) and secondary outcomes of psychosocial impairment (P=.008), depression (P=.002), and anxiety (P=.040) over the 1- and 3-month time points, with small to moderate effects (Cohen d=0.15-0.53). Chatbot use also induced an increase in participants' confidence in their ability to change (secondary outcome) immediately after use (T2), with a moderate effect (P<.001; Cohen d=0.74). The chatbot was rated as "excellent" in terms of usability. A significantly higher proportion of participants in the chatbot group (28/30, 93%) entered treatment by 3 months upon the opportunity being offered to them, compared to the control group, with a moderate effect (21/30, 70%; P=.042; ϕ=0.30).

Conclusions: ED ESSI promptly induced improvements in eating disorder pathology, psychosocial impairment, depression, and anxiety, which were detectable at 1 month and maintained to 3 months. ED ESSI potentially represents an effective, accessible, and scalable form of early intervention for people aged ≥16 years waiting for eating disorder treatment. Further research is needed to determine the longer-term effectiveness of ED ESSI.

Trial registration: Australian New Zealand Clinical Trial Registry ACTRN12623000680662; https://tinyurl.com/2h9v7hh7.

Keywords: AI; artificial intelligence; chatbot; cognitive behavioral therapy; conversational agent; digital health; eating disorder; enhanced cognitive behavioral therapy; mental health; randomized controlled trial; single-session intervention.

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Conflict of interest statement

Conflicts of Interest: GS is a section editor for JMIR Mental Health. GS is also the creator and owner of the ED ESSI chatbot and the trademark ED ESSI. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
An example of an ED ESSI (Eating Disorder Electronic Single-Session Intervention) conversation providing psychoeducation on starvation syndrome via conversation and video.
Figure 2
Figure 2
Overview of participant flow through stages of the randomized controlled trial.
See this image and copyright information in PMC

References

    1. American Psychiatric Association . Diagnostic and Statistical Manual Of Mental Disorders: DSM-5-TR, 5th edition, Text revision. Washington, DC: American Psychiatric Association; 2022.
    1. Hay P, Aouad P, Le A, Marks P, Maloney D, National Eating Disorder Research Consortium. Touyz S, Maguire S. Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia-a rapid review. J Eat Disord. 2023 Mar 15;11(1):23. doi: 10.1186/s40337-023-00738-7. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-023-00738-7 10.1186/s40337-023-00738-7 - DOI - PMC - PubMed
    1. Allen KL, Mountford VA, Elwyn R, Flynn M, Fursland A, Obeid N, Partida G, Richards K, Schmidt U, Serpell L, Silverstein S, Wade T. A framework for conceptualising early intervention for eating disorders. Eur Eat Disord Rev. 2023 Mar 25;31(2):320–34. doi: 10.1002/erv.2959. https://europepmc.org/abstract/MED/36426567 - DOI - PMC - PubMed
    1. Sukunesan S, Huynh M, Sharp G. Examining the pro-eating disorders community on twitter via the hashtag #proana: statistical modeling approach. JMIR Ment Health. 2021 Jul 09;8(7):e24340. doi: 10.2196/24340. https://mental.jmir.org/2021/7/e24340/ v8i7e24340 - DOI - PMC - PubMed
    1. Treasure J, Russell G. The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br J Psychiatry. 2011 Jul 02;199(1):5–7. doi: 10.1192/bjp.bp.110.087585.S0007125000255712 - DOI - PubMed

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