Sharp Gemma, Dwyer Bronwyn, Randhawa Alisha, McGrath Isabella, Hu Hao
Department of Neuroscience, Monash University, Melbourne, Australia.
School of Psychology, University of Queensland, St Lucia, Australia.
J Med Internet Res. 2025 May 21;27:e70874. doi: 10.2196/70874.
Early treatment is critical for improving eating disorder prognosis. Single-session interventions (SSIs) can provide short-term support to people on waitlists for eating disorder treatment; however, it is not always possible to access SSIs. We co-designed and developed a rule-based chatbot called ED ESSI (Eating Disorder Electronic Single-Session Intervention), which delivered an SSI and demonstrated its acceptability and feasibility. However, the effectiveness of ED ESSI is yet to be investigated.
This study aimed to investigate the effectiveness of an SSI delivered by ED ESSI. We examined the chatbot's impact on eating disorder pathology, psychosocial impairment, depression, anxiety, stress, and motivation for change or treatment in individuals aged ≥16 years on waitlists for treatment for all types of eating disorders.
This multicenter 2-armed randomized controlled trial included 60 people on waitlists for eating disorder treatment in the chatbot intervention group (n=30, 50%) or the control group (n=30, 50%). The ED ESSI chatbot guided participants through a 30-minute SSI of assessment and psychoeducation, while the control group received web-based information on the same core topics covered in the SSI. There were 4 time points: before intervention or baseline (time point 1 [T1]), after intervention within 72 hours of baseline (T2), 1 month after baseline (T3), and 3 months after baseline (T4). Eating disorder pathology (primary outcome) and psychosocial impairment, depression, anxiety, and stress (secondary outcomes) were measured at T1, T3, and T4, and motivation for change or treatment (secondary outcome) was measured at all 4 time points. Furthermore, the System Usability Scale was implemented at T2 for the chatbot intervention group only.
ED ESSI induced significantly greater reductions compared to the control group in the primary outcome of eating disorder pathology (P=.003) and secondary outcomes of psychosocial impairment (P=.008), depression (P=.002), and anxiety (P=.040) over the 1- and 3-month time points, with small to moderate effects (Cohen d=0.15-0.53). Chatbot use also induced an increase in participants' confidence in their ability to change (secondary outcome) immediately after use (T2), with a moderate effect (P<.001; Cohen d=0.74). The chatbot was rated as "excellent" in terms of usability. A significantly higher proportion of participants in the chatbot group (28/30, 93%) entered treatment by 3 months upon the opportunity being offered to them, compared to the control group, with a moderate effect (21/30, 70%; P=.042; ϕ=0.30).
ED ESSI promptly induced improvements in eating disorder pathology, psychosocial impairment, depression, and anxiety, which were detectable at 1 month and maintained to 3 months. ED ESSI potentially represents an effective, accessible, and scalable form of early intervention for people aged ≥16 years waiting for eating disorder treatment. Further research is needed to determine the longer-term effectiveness of ED ESSI.
Australian New Zealand Clinical Trial Registry ACTRN12623000680662; https://tinyurl.com/2h9v7hh7.
早期治疗对于改善饮食失调的预后至关重要。单次干预（SSIs）可以为等待饮食失调治疗的人群提供短期支持；然而，并非总能获得单次干预服务。我们共同设计并开发了一个名为ED ESSI（饮食失调电子单次干预）的基于规则的聊天机器人，它提供了单次干预服务，并证明了其可接受性和可行性。然而，ED ESSI的有效性还有待研究。
本研究旨在调查ED ESSI提供的单次干预的有效性。我们研究了该聊天机器人对年龄≥16岁、等待各类饮食失调治疗的个体的饮食失调病理、心理社会功能损害、抑郁、焦虑、压力以及改变或治疗动机的影响。
这项多中心双臂随机对照试验纳入了60名等待饮食失调治疗的患者，其中聊天机器人干预组（n = 30，50%）和对照组（n = 30，50%）各30人。ED ESSI聊天机器人引导参与者进行了一次30分钟的单次干预评估和心理教育，而对照组则收到了关于单次干预所涵盖的相同核心主题的网络信息。有4个时间点：干预前或基线（时间点1 [T1]）、基线后72小时内（T2）、基线后1个月（T3）和基线后3个月（T4）。在T1、T3和T4测量饮食失调病理（主要结局）以及心理社会功能损害、抑郁、焦虑和压力（次要结局），并在所有4个时间点测量改变或治疗动机（次要结局）。此外，仅在T2对聊天机器人干预组实施了系统可用性量表评估。
与对照组相比，在1个月和3个月的时间点上，ED ESSI在饮食失调病理的主要结局（P = 0.003）以及心理社会功能损害（P = 0.008）、抑郁（P = 0.002）和焦虑（P = 0.040）的次要结局方面诱导了显著更大程度的降低，效应大小为小到中等（Cohen d = 0.15 - 0.53）。使用聊天机器人还在使用后立即（T2）使参与者对自己改变能力的信心（次要结局）增加，效应中等（P < 0.001；Cohen d = 0.74）。该聊天机器人在可用性方面被评为“优秀”。与对照组相比，聊天机器人组中显著更高比例的参与者（28/30，93%）在有机会接受治疗后的3个月内进入了治疗，效应中等（21/30，70%；P = 0.042；ϕ = 0.30）。
ED ESSI迅速改善了饮食失调病理、心理社会功能损害、抑郁和焦虑，这些改善在1个月时即可检测到，并持续到3个月。ED ESSI可能是一种对年龄≥16岁等待饮食失调治疗的人群有效的、可及的且可扩展的早期干预形式。需要进一步研究来确定ED ESSI的长期有效性。
澳大利亚新西兰临床试验注册中心ACTRN1262300068
