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Adolescent and Young Adult Perceptions of Online Versus In-Person Cognitive-Behavioral Therapy for Eating Disorders
Jasmine Thomas1, Ava M Pasewicz2, Marley G Billman Miller3
1UT Health Austin Pediatric Psychiatry at Dell Children's, Austin, Texas, USA.
The International Journal of Eating Disorders
|April 12, 2026
Summary
Adolescent and young adult patients with eating disorders found online cognitive-behavioral therapy (CBT) more valuable than in-person sessions. Most found online CBT effective, though some interventions like open weighing were less suitable for virtual delivery.
Area of Science:
- Psychiatry
- Clinical Psychology
- Telehealth
Background:
- Eating disorders (EDs) are serious mental health conditions affecting adolescents and young adults (AYAs).
- The COVID-19 pandemic accelerated the adoption of telehealth for mental health services, including cognitive-behavioral therapy (CBT).
- Understanding AYA preferences for online versus face-to-face treatment is crucial for optimizing care delivery.
Purpose of the Study:
- To investigate AYA perceptions of online CBT for EDs.
- To compare attitudes toward online versus face-to-face treatment modalities.
- To assess the perceived effectiveness of online CBT interventions for EDs.
Main Methods:
- A survey was administered to 75 AYAs (29% response rate) who received telehealth services for EDs between March 2020 and December 2022.
- Measures included attitudes toward online and face-to-face counseling, satisfaction with online therapy, and perceived effectiveness of online CBT.
- Data were analyzed using t-tests, Pearson correlations, and chi-square tests.
Main Results:
- Participants rated online CBT as significantly more valuable than face-to-face CBT (p=0.011).
- Most participants (82.4%) were satisfied with online CBT, with preferences for modality continuation being mixed.
- Meal planning and cognitive restructuring were rated as highly effective online interventions, while open weighing was rated lowest.
Conclusions:
- AYAs with EDs valued online CBT during the pandemic, perceiving most components as acceptable for virtual delivery.
- Interventions requiring physical presence, such as open weighing, were seen as less suitable for online formats.
- Preliminary findings suggest benefits of flexible treatment modalities, but low response rates limit generalizability, warranting further research on long-term viability.
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