Virtual CBT’s Success with Eating Disorder Treatment

Girl using online screening tool IOI-S to check for eating disorder symptoms

Virtual services have become more important than ever during the COVID-19 pandemic. Where previously clients had the option to see a provider virtually or face-to-face, it has now become the only way for many to receive mental health treatment at all. Even so, being the only option, virtual services, such as Virtual CBT,  does not mean it is the most effective.

Many are struggling to feel a connection with their treatment team members via telehealth, which can certainly impact the success of treatment. Even the most effective evidence-based treatments, such as Cognitive Behavioral Therapy (CBT), can be more difficult to teach and practice via telehealth. The question becomes, is CBT as effective when it is provided virtually as it is in-person?

Theoretical Foundations

Before considering how this treatment can be altered for virtual mediums, it is valuable to understand the foundational theory behind CBT. The predominant mechanism of change in CBT is for individuals to identify limiting, fear-based, and unhelpful thoughts and beliefs and to replace them with more empowering and effective thinking patterns. CBT centers on the belief that one’s thoughts about a situation impact their feelings and, subsequently, their behaviors.

Those with eating disorders being treated with CBT will likely be encouraged to consider what disordered thoughts, beliefs, and perceptions reinforce their disordered feelings and behaviors. Some of these beliefs could be, “I can’t do anything right,” “I am unworthy,” “I will never be good enough,” “my worth is determined by my appearance,” etc.

Applying Virtual CBT

If reading the foundations of CBT has you considering that it likely wouldn’t be difficult to adapt to virtual treatment or therapy, you would be pretty accurate. Much of this work can only be done by the individual practicing cognitive reframing and thought-stopping skills in their daily lives.

Woman trying Virtual CBTProviding psychoeducation on the thought, feeling, behavior connection, and how this relates to maladaptive coping skills and helping individuals identify their own unhelpful thought patterns can be performed in-person or virtually. However, eating disorders are not only cognitive disorders but include both the mind and the body.

Even so, using CBT for eating disorder treatment would still involve the more cognitive aspects of the disorder and how altering these can help to alter disordered behaviors. Prior to the digital onslaught of service due to COVID, the impact of virtual CBT treatment for eating disorders was being studied.

One study provided digital CBT self-guided eating disorder treatment for college-aged women and, after a 2-year follow-up, determined that “a digital CBT-guided self-help program was associated with reduced eating disorder psychopathology over two years of follow-up [1].” This study also found that “post-intervention, the digital CBT group also had significantly greater reductions in binge eating, compensatory behaviors, depression symptoms, and clinical impairment compared to the control group [1].”

At the time, the study creators reported that “digital intervention may be an accessible intervention option for students, who often report fear of stigma and time constraints as treatment barriers [1].” As the COVID-19 pandemic continues to reduce the accessibility of face-to-face treatment, these results provide an even more promising and hopeful view that opting for virtual CBT eating disorder treatment does not mean settling for less-than-effective care.


[1] Pond, E. (2020). Digital CBT effective for college students with eating disorders. Psychiatry Advisor, retrieved from

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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 December 28, 2020, on
Reviewed & Approved on December 28, 2020, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.