Open Pilot Trial of a Coached Digital Program for Lower-Income Adults With Eating Disorders

Objective: This study evaluated the feasibility, acceptability, and preliminary effectiveness of the first digital intervention tailored for lower-income adults with eating disorders, who are poorly served by the public health care system. Method: Adults (N = 30) with public insurance or without insurance coverage who endorsed ≥ 6 binge eating episodes, ≥ 6 vomiting episodes, and/or ≥ 6 laxative/diuretic episodes in the past three months with a body mass index ≥ 18.5 kg/m² were enrolled in this open pilot trial. Participants received access to the coached digital CBT-based intervention, which included individualized guidance and twice-weekly SMS feedback from a program coach over three months. Results: Almost all participants (93.3%, n = 28) accessed the program after enrollment, completing about half (M = 4.15, SD = 2.68) of the 8 sessions and sending an average of 32.5 (SD = 35.2) texts to their coach over three months. From pre- to post-intervention, there were large improvements in eating disorder psychopathology (d = 0.79, p < 0.001) and moderate decreases in binge eating (d = 0.62, p = 0.003) and self-induced vomiting episodes (d = 0.43, p = 0.031). There were also large improvements in clinical impairment (d = 0.83, p < 0.001) and moderate to large reductions in anxiety (d = 0.47, p = 0.019) and depression (d = 0.84, p < 0.001). Most participants indicated that they were somewhat to very satisfied with the program (67.9%, n = 19). Discussion: The results from this pilot trial testing a brief online guided self-help intervention are promising, with relatively high treatment engagement, indicating good feasibility and acceptability and signals of preliminary effectiveness. Future research is needed to examine longer-term effectiveness relative to other active treatments or waitlist control.