The abrupt transition from face-to-face to online treatment for eating disorders: a pilot examination of patients’ perspectives during the COVID-19 lockdown

Abstract

Background Studies investigating patients’ perspectives towards an abrupt transition from face-to-face to online treatment in eating disorders (EDs) are scarce. The current study aimed to (1) conduct a preliminary assessment of patients’ perspectives regarding this transition, and (2) explore potential demographic, clinical, and treatment-related factors associated with these perspectives. Methods Sixty-three patients with EDs whose treatment was moved to an online format, were surveyed during the COVID-19 lockdown (April–May 2020). A 6-item measure was developed to examine their perspectives toward this transition. Exploratory factor analyses (EFAs) were conducted to confirm the rational-theoretical structure of the measure (Eigenvalue = 3.745, explaining 62.4% of variance). The Cronbach’s alpha value was excellent (α = 0.878). Validated questionnaires were used to measure ED symptoms, general psychopathology, therapeutic alliance, and pandemic anxiety, and their associations with our transition-focused scale and telemedicine satisfaction were examined. Results Mixed views were found regarding the transition, with the majority (68%) stating that they would not choose to continue online therapy given the option. Longer duration of treatment (r = 0.291, p = 0.022), stronger therapeutic alliance (r = 0.293, p = 0.028), and higher COVID-19 anxiety (r = 0.276, p = 0.029) were linked with more positive views towards the transition. Conclusions Analyses suggest that patients’ perspectives towards the transition can be measured using a Likert-type 6-item scale. Findings highlight the various responses to online treatment and indicate a need to identify patients who may face difficulties in the transition to this newly ubiquitous treatment mode. Clinicians should be cognizant of these potential difficulties and consider appropriate modes of treatment in the ongoing pandemic situation.

COVID-19 Pandemic and Eating Disorders: What Can We Learn About Psychopathology and Treatment? A Systematic Review

“…The main COVID-19-induced treatment change was a reduced access to in-person treatment [ 26 •, 27 •, 41 , 42 , 45 ]. Schlegl et al [ 26 •] found that the rate of BN patients receiving face-to-face treatment decreased from 82 to 36% during the lockdown.…”

“…The parallel increase of online treatment was often perceived as characterized by impairment in the quality of the therapy [ 26 •, 27 •, 37 •, 38 •, 41 , 42 , 44 – 46 ]. In this line, Lewis et al [ 45 ] also reported that 54% of the ED sample would not recommend the online treatment and 68% would not choose to continue the online therapy. Positive predictors of a good perception of the online therapy were longer illness duration, higher COVID-19-related anxiety, and stronger therapeutic relationship [ 45 ].…”

“…In this line, Lewis et al [ 45 ] also reported that 54% of the ED sample would not recommend the online treatment and 68% would not choose to continue the online therapy. Positive predictors of a good perception of the online therapy were longer illness duration, higher COVID-19-related anxiety, and stronger therapeutic relationship [ 45 ]. Fernández-Aranda et al [ 39 ] found that the patients with AN were those reporting lower satisfaction with the online transition.…”

Virtual Online Home-Based Treatment During the COVID-19 Pandemic for Ultra-Orthodox Young Women With Eating Disorders

“…The findings highlight that at least some patients and families found the online intervention acceptable, despite the unfamiliarity of this intervention and the many obstacles described in its implementation. In this respect it is of note that a recent Israeli study ( 64 ) found mixed views of patients with EDs treated in a mainstream secular ambulatory service regarding the transition from face to-face to online treatment during the COVID-19 pandemic. This, the majority (68%) of the patients stated that they would not choose to continue online therapy given the option.…”

COVID-19 Related Traumatic Distress in Psychotherapy Patients during the Pandemic: The Role of Attachment, Working Alliance, and Therapeutic Agency

“…For those individuals who were in psychotherapy, additional challenges emerged as therapy sessions could not continue in-person due to the social restrictions imposed by health authorities. Millions of in-person therapies transitioned to online therapy via videoconferencing at once, without much preparation or support [12]. With the ongoing pandemic and its ripple effects on individuals' lives, attending online psychotherapy may provide support for patients in managing the experienced COVID-related distress.…”