Is Evidence-Based ED Treatment Effective via Telemedicine?

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Eating disorders are serious mental illnesses. Finding the most effective treatment options is really important. Telemedicine (aka Telehealth) became more popular at the start of the COVID-19 pandemic. But is this approach effective for treating eating disorders? Keep reading to find out.

Benefits of Telemedicine

During the COVID-19 health crisis, many mental health treatment programs moved to telemedicine out of necessity. Researchers are looking into whether these virtual programs are effective because providers may continue to use them even when pandemic-related restrictions are lifted and life goes back to normal.

There are several benefits of Telehealth. These include:

  • Increases access to treatment for people who live in rural areas who don’t live close enough to in-person treatment facilities
  • Reduces delays in getting care
  • Reduced treatment burden due to increased accessibility
  • Accessible for people with transportation barriers or physical disabilities
  • Limits need for taking time off from work or arranging childcare. This may be especially beneficial for low-income individuals who can’t afford to take time off work for treatment
  • Gives providers more insight into a client’s life due to treating them in their home environment
  • Covered by government-issued insurance in all 50 states and Washington, D.C. [1,3]

Is It Effective?

Given all the benefits that come with Telehealth, it makes sense that clients and providers would want to continue offering Telehealth as a treatment option. Healthcare professionals, especially mental health clinicians, have questioned whether virtual treatment is effective [3].

The American Psychiatric Association states that telemedicine for psychiatric issues is effective [1]. Researchers have looked into whether this applies to eating disorders, too.

Even before the pandemic, research showed that Telehealth was helpful in treating eating disorders [3].

However, even though it’s been shown to be effective, there tends to be a lot of resistance among mental health providers to provide treatment in this way [3]. This has proven to be a barrier to providing this treatment method.

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Barriers about Virtual Eating Disorder Treatment

  • Clinician concerns about the impact of Telehealth on the therapeutic alliance. The therapeutic alliance is the connection that a client and therapist have. This connection creates feelings of safety. Without this, it can be extremely difficult for a client to meet their treatment goals.
  • Virtual Evidence-Based Treatment (EBT). Clinicians have also expressed concern about how to use evidence-based methods, such as Family-Based Treatment (FBT), in a virtual format [2,3]. In response to this, researchers are putting together manuals for how to use certain evidence-based approaches in Telemedicine [2].
  • Client’s and Family’s Feelings about Telehealth. There was research done recently to examine how clients and their families felt about Telehealth during the COVID-19 shelter-in-place orders [3]. The participants in this study stated that they were happy with their treatment and they felt understood by their therapist [3].
  • Treatment Preference. Some of the pushback about allowing Telehealth to be a continued option even after COVID-19 restrictions are lifted is whether clients and family’s prefer in-person treatment to virtual. Research shows that clients tend to prefer in-person treatment while parents prefer virtual treatment [3].
  • Relationally Distant. People reported feeling that online treatment felt more relationally distant. Because of this, clients reported being less honest, increased difficulty sitting with difficult emotions, and having difficulty reading body language [3].
  • Access to Technology. Online treatment depends on someone having access to updated technology and internet. For low-income families, this may be an issue.
  • Confidentiality. Clients and their families are legally entitled to confidentiality. One of the benefits of in-person treatment is that they don’t have to worry about the other people in their home hearing what they say in treatment. This may be difficult to do at home, especially if someone is living in a small space or doesn’t have a private location in their home.

It is important to note that even with these barriers, Telehealth is still found to be effective. There are pros and cons, but for some people online treatment may make treatment possible when it wasn’t before. That’s worth celebrating and holding in mind as the world transitions back to in-person treatment.


  • [1] American Psychiatric Association (n.d) What is Telepsychiatry?
  • [2] Hambleton, A., Grange, D.L., Miskovic-Wheatley, J., Touyz, S., Cunich, M., & Maguire, S. (2020). Translating evidence-based treatment for digital health delivery: A protocol for family-based treatment for anorexia nervosa using telemedicine. Journal of Eating Disorders, 8(50), 1-12.
  • [3] Stewart, C., Konstantellou, A., Kassamali, F., McLaughlin, N., Cutinha, D., Bryant-Waugh, R., Simic, M., & Baudinet, J. (2021). Is this the ‘new normal’? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic. Journal of Eating Disorders, 9(78), 1-11.

About the Author:

Samantha Bothwell PhotoSamantha Bothwell, LMFT, is a licensed Marriage and Family Therapist, writer, explorer, and lipstick aficionado. She became a therapist after doing her own healing work so she could become whole after spending many years living with her mind and body disconnected. She has focused her clinical work to support the healing process of survivors of sexual violence and eating disorders. She is passionate about guiding people in their return to their truest Self so they can live their most authentic, peaceful life.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published August 2, 2021, on
Reviewed & Approved on August 2, 2021, by Jacquelyn Ekern MS, LPC