Adolescent and Young Adult Perceptions of Online Versus In-Person Cognitive-Behavioral Therapy for Eating Disorders

Objective: This preliminary study investigated adolescent and young adult (AYA) perceptions of online cognitive-behavioral therapy (CBT) for eating disorders (EDs), examining attitudes toward online versus face-to-face treatment and perceived effectiveness of online CBT interventions. Method: Of 258 patients contacted, 75 (29%) completed a survey and 54 (21%) were eligible for inclusion (83.3% female; mean age = 18.33 years), all of whom received telehealth services between March 2020 and December 2022. Measures assessed attitudes toward online and face-to-face counseling, satisfaction with online therapy, and perceived effectiveness of CBT interventions delivered online. Data were analyzed using t-tests, Pearson correlations, and chi-square tests. Results: Participants rated online CBT as significantly more valuable than face-to-face CBT (t(53) = 2.64, p = 0.011), with no differences in discomfort between modalities. Most participants (82.4%) reported satisfaction with online CBT, though preferences were split regarding continuing online versus in-person treatment. Proportion of previous online sessions was negatively correlated with perceived value of online counseling (r = −0.43, p = 0.001). Participants rated most CBT interventions as equally effective online, with highest ratings for meal planning (74.0%) and cognitive restructuring (71.7%), and lowest for open weighing (35.7%). Discussion: Participants valued online CBT during the pandemic and viewed most CBT components as acceptable when delivered virtually, though individual preferences varied. Interventions requiring physical presence (e.g., open weighing) were perceived as less suitable for online delivery. While these preliminary findings suggest potential benefits of offering flexible treatment modalities, the low response rate limits generalizability and necessitates further research to examine the long-term viability of online CBT for AYAs with EDs.