Digital CBT Effective for College Students with Eating Disorders

Woman having stress about weight loss, diet or gaining weight. Eating disorder, anorexia or bulimia concept. Young girl crying and sitting on the floor with scale. Underweight person sad about obesity
While eating disorders are common, serious psychiatric disorders on college campuses, most affected individuals do not receive treatment. Digital interventions have the potential to bridge the gap.

Study data published in JAMA Network Open supports the efficacy of digital cognitive behavior therapy (CBT) for the treatment of eating disorders among women in college. Compared to usual care, a digital CBT-guided self-help program was associated with reduced eating disorder psychopathology over 2 years of follow-up. These results may inform efforts to develop treatment programs at universities, where eating disorders are highly prevalent.

Digital technologies may improve treatment accessibility for patients with eating disorders. To test the efficacy of digital CBT for eating disorders in college students, investigators conducted a randomized clinical trial of women at 27 universities around the United States. Women with binge-purge eating disorders were randomized to receive either digital CBT or usual care. Women in the CBT condition received access to the Student Bodies-Eating Disorders program, a digital platform tailored for college students. The program comprised 40 core sessions focused on psychoeducation, meal planning, and other eating disorder treatment strategies. Participants were also assigned a coach with whom to discuss CBT goals and progress.

Women randomized to the care-as-usual condition were given instructions on how to schedule an appointment with the university counseling center. The primary outcome was reduction in overall eating disorder psychopathology per the Eating Disorder Examination Questionnaire (EDE-Q). The EDE-Q was administered at baseline, postintervention (8 months), 1 year, and 2 years.

A total of 690 women with eating disorders were included in analyses. Mean age was 22.12 ± 4.85 years. The majority of women were undergraduate students (74.2%), and 60.0% were white. In the digital CBT group, the EDE-Q Global score decreased from 3.62 (95% CI, 3.51-3.73) at baseline to 2.70 (95% CI, 2.52-2.87) at the 8-month postintervention timepoint. In the control group, the score decreased from 3.55 (95% CI, 3.43-3.67) to 3.05 (95% CI, 2.90-3.20). The between-group difference in score reduction was statistically significant (P <.001).

Over 2 years of follow-up, the intervention group maintained a lower EDE-Q Global score compared to the control group (P <.001). At postintervention, the digital CBT group also had significantly greater reductions in binge eating (P =.02), compensatory behaviors (P <.001), depression symptoms (P =.01), and clinical impairment (P =.01) compared to the control group. These trends largely persisted through the 2-year follow-up period, though reductions in binge eating lessened over time. The majority (83%) participants randomized to the digital CBT intervention engaged in their treatment plan. Among participants randomized to the control condition, however, just 28% reported actually seeking treatment for their eating disorder at any point.

Results from this study support the efficacy of a digital CBT intervention for college-aged women with binge-purge eating disorders. Digital intervention may be an accessible intervention option for students, who often report fear of stigma and time constraints as treatment barriers. Regarding study limitations, investigators noted that overall engagement with digital CBT was low, with participants completing a mean of 31% of content offered. Even so, the intervention group retained greater symptom improvement compared to the control group, suggesting that even short engagement has positive effects. Further research is necessary to address retention issues with digital CBT.

“Overall, these findings support the use of a coached, digital CBT intervention, compared with referral to usual care, for college women with a wide range of [eating disorders],” the investigators wrote. “Given its scalability, a digital CBT-guided self-help intervention…has great potential to address the wide treatment gap for this problem.”

Disclosure: Two study authors declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of authors’ disclosures.


Fitzsimmons-Craft EE, Taylor CB, Graham AK, et al. Effectiveness of a digital cognitive behavior therapy-guided self-help intervention for eating disorders in college women: a cluster randomized clinical trial. JAMA Netw Open. 2020;3(8):e2015633.