Clinician Tips for Treating Patients with Eating Disorders via Telehealth

This week's article was published in the International Journal of Eating Disorders in March of 2020. In this article, titled “Cognitive-behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth

when face-to-face meetings are not possible”, authors Waller and colleagues provide a culmination of thoughts from numerous clinicians specifically pertaining to how to best deliver cognitive-behavioral therapy for eating disorders (CBT-ED) in a telehealth setting.

Why did they do it?

We are amidst a global pandemic, which has resulted in a forced shift in how mental health clinicians deliver their services. This shift to telecare (i.e., care delivered via telephone and/or video screen share) means that the standard treatment protocols we previously followed, many of which were developed to be delivered in traditional therapy settings, have to be delivered in an entirely different environment, which is a true challenge. Further, while some interventions have been demonstrated to be highly effective in telecare settings, the authors highlight that the evidence-base for eating disorder telehealth treatment is relatively less well-developed.

Accordingly, these authors thought quickly and determined that it would be helpful to gather thoughts from experts in the field who are making the transition to telehealth to treat their patients with eating disorders. The primary aim of this article was to share the clinical techniques and process considerations from a number of experienced clinicians.

How did they do it?

The authors reached out to 70 clinicians requesting that they share their experiences and ideas pertaining to delivering CBT to patients with eating disorders via telehealth. A shared document was created on March 24, 2020, and remained “active” for 96 hours. The authors highlight the short time frame, and explain that their immediate priority was to quickly make these clinical recommendations available to the wider clinical community. Participants were specifically asked to share their thoughts on how to deliver CBT-ED via telehealth; maintain confidentiality; and avoid commercial promotions. The authors compiled comments from 22 clinicians (the authors of this study) and identified common themes to focus on.

What did they find?

In order to organize the thoughts and ideas of participating clinicians more accurately, the authors developed 4 domains (listed below). Please take a look at the original article to review the more specific points within each of the domains below.

1. Patient and therapist concerns about telehealth approaches: In this section, the authors discuss how the patient may see telehealth approaches as “second best” compared to traditional therapeutic methods. 
2. Technical Issues: In this domain, many practical and software related issues were raised as things therapists must be cognizant of when delivering telecare. 

• Impact of changes in the environment: Here, more recommendations specific to CBT-ED are presented. For example, the authors highlight in this section that many clients are likely experiencing a reduction in opportunities to exercise (e.g., closure of gyms), which can lead to elevated concerns about impacts on weight or fitness. It is collectively recommended here, that therapists can use this environmental change as a learning moment, and stress the potential positives of these changes by giving clients the opportunity to learn that these behaviors are not essential. This section also highlights some recommendations for clients who may be experiencing increased anxiety due to COVID-19.

• CBT-ED related techniques, and how to apply them in a telehealth context: This domain includes adaptations of existing CBT-ED techniques and covers many evidence based approaches. 

What does it all mean (our take)?

COVID-19 has led many clinicians to completely change the way they are treating their patients. With essentially no time to transition from in-person care to telecare, questions about how to continue delivering high fidelity treatment to patients have surfaced quickly. This article represents much more than a list of treatment considerations/recommendations - it demonstrates the community within mental health and our willingness to think quickly and work together to ensure that patient care does not suffer as a result of this rather significant transition. 

We thank these authors for putting this paper together, and we anticipate that continued refinement of these initial recommendations will lead clinicians to feeling much more comfortable treating their patients via telecare.