By: Dr. Lisa Beckman
If you have an eating disorder, you may have realized that there are different types of treatment modalities available.
Since the Covid-19 pandemic, there has been a significant increase in the amount of therapy being done virtually and you may be wondering, what type of treatment is better, online or in person? A recent study found that individuals with an eating disorder show similar improvement in eating symptoms, weight gain, and treatment satisfaction regardless of whether they participated in virtual or in-person therapy (Steiger et al., 2022). Given that research has shown both forms of treatment modalities to be effective, you may want to further understand the differences in these treatment options in order to make an informed decision. Let’s first take a look at what eating disorders are and a general overview of what treatment consists of, then we can examine the pros and cons of different treatment options.
Eating disorders are mental health conditions that can have significant physical health consequences due to persistent eating and compensatory behaviors that have a negative impact on overall health. As defined by the National Institute of Mental Health, an eating disorder is a “serious, biologically influenced medical illness marked by severe disturbances to one’s eating behaviors.” Symptoms often include concern about weight, health, appearance, obsessions with weight loss, body weight and shape, and controlling food intake. Diagnosis of an eating disorder typically includes a physical exam and psychological evaluation. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Eating Disorder Treatment Goals
The goals of eating disorder treatment are often to restore nutrition, achieve a healthy weight, decrease excessive exercise and other compensatory behaviors, and/or end binge-purge behaviors. Treatment of eating disorders can include several forms of support including medical evaluation, nutrition counseling, medication management, and psychotherapy.
The type of treatment modality may vary depending on the clinician, but it can include Cognitive-Behavior therapy, Stress management skills, mindfulness and relaxation, and distress tolerance. Other effective types of treatment include Family-based therapy and group therapy. Preparing for therapy whether or in person or online is important. Before your appointment, make a list of the symptoms you are experiencing and identify current life stressors or recent life changes. It is also helpful to prepare a list of questions that you may have for your therapist.
For certain types of eating disorders or severity of symptoms, it may be necessary to receive in-person treatment in the form of partial hospitalization, inpatient, or residential settings due to serious physical health problems such as electrolyte imbalances, cardiovascular problems, gastrointestinal difficulties, and hormonal changes. Given that eating disorders can have life-threatening consequences, it is important to consult with a physician as part of your recovery plan.
What is online eating disorder therapy like?
While online therapy is not a new form of receiving mental healthcare, it has become much more popular since the Covid-19 pandemic. Virtual therapy, or telehealth, is similar to a zoom meeting and is typically done on a smartphone or laptop. Some individuals choose to schedule therapy sessions during their lunch breaks and will sit in their vehicle, while others will find a quiet room in their house or sit at the kitchen table.
In-person treatment for eating disorders
PROS:
Social connections: Some individuals prefer a face-to-face meeting with a therapist to feel more connected through direct eye contact and body language that is easier to observe, interpret, and respond to. Additionally, in-person group therapy offers an opportunity to find support through social interactions among individuals that are experiencing similar challenges.
Fewer distractions: Pets, children, family, roommates, Amazon delivery, neighbors mowing their lawn … the number of distractions at home is seemingly limitless! This is one reason why some people prefer to have therapy outside of their homes and in a less distracting environment.
Privacy: Going to a therapist’s office often gives a sense of anonymity which can increase a sense of security. This level of discretion can help some individuals to open up and share their innermost thoughts and feelings more easily.
CONS:
Difficulty finding a therapist: In general, finding a therapist that is taking new clients can be difficult, and needing to limit the geographic location of said therapist can be even more challenging. Once you have located a therapist who lives nearby and has availability, differing schedules might delay the start of therapy even more.
Commute time: As noted above, finding a therapist with availability can be challenging, but finding a therapist that is near to where you live or work can be especially difficult. The amount of time spent traveling to and from the therapist’s office can be a real barrier to being able to engage in consistent care. Furthermore, depending on how far the commute is, the cost of gas or the cost of public transit can increase the financial burden.
Online Treatment for eating disorders
PROS:
Ease of access: For individuals who live in remote areas or have mobility limitations, remote access to therapy can decrease limitations by not needing to be physically present in a different location. For individuals that provide childcare or other caretaking responsibilities, online therapy can reduce the amount of time spent away from these duties.
Flexibility: Being able to schedule a time for therapy that works around childcare, commuting, or work schedules can be a significant factor in choosing telehealth. It is also much more likely that you would be able to find a therapist that works virtually offering appointments in the early morning or late evening hours.
Less stigmatizing: It seems like everyone has zoom meetings these days! Feeling judged or shamed for having a mental health condition can be a factor that decreases the likelihood that one will seek the necessary help that they need. Being able to access therapy through a virtual meeting can decrease the feelings of shame or fear of being judged which may otherwise decrease the likelihood of engaging in treatment.
CONS:
Privacy: Most individuals prefer sharing their innermost thoughts and feelings in a private location so friends, family, and co-workers do not overhear or interrupt them. This can be a challenge when engaging in virtual therapy if you aren’t able to find a private space to have the session.
Internet access: Having access to reliable internet access can provide better quality audio and visuals for your telehealth appointment. When internet access is slow, or altogether unavailable, it can cause disruptions during the session that can be frustrating.
Access to reliable technology: We have all been there, the camera doesn’t work, there is no audio, your iPhone battery is running low and you can’t find a charger, the computer decides it is time to install a new update, the technology challenges are seemingly limitless! If you do not have reliable technology, this can lead to possible late cancellations or missed appointments which could result in cancellation fees.
So which type of treatment is better?
Well, that all depends on what feels right to you. In-person therapy can provide a neutral therapeutic space, while virtual therapy can bring flexibility and comfort. Whether you decide to engage in online therapy or in person, early intervention and consistent engagement in therapy are key to successfully recovering from an eating disorder. The good news is, there is hope, and regardless of format, recovery is possible.
Begin Eating Disorder Treatment in Tampa, FL
If you think you might be suffering from an eating disorder or are just looking to understand your relationship with food and body image in a healthier way, please contact us to talk to a therapist. Our team is happy to offer support in Tampa, St. Pete, and across the state. You can start your therapy journey with Wellness Psychological Services by following these simple steps:
- Contact Wellness Psychological Services
- Meet with a caring therapist
- Start improving your relationship with couples therapy
OTHER SERVICES OFFERED AT WELLNESS PSYCHOLOGICAL SERVICES
Our Tampa, FL-based counseling practice offers a variety of services in addition to eating disorder treatment. Our team also offers couples counseling, divorce discernment counseling, support through a divorce, and mediation for couples. We also offer mental health support services including anxiety treatment, trauma therapy, depression counseling, OCD treatment, stress management, and testing and evaluation services for individuals as well! Additionally, we are happy to offer PCIT therapy, DBT, child therapy, therapy for professionals, and health psychology. Feel free to learn more by visiting our blog page or FAQ today!
Resources:
NIMH » Eating Disorders: About More Than Food (nih.gov)
Steiger, H., Booij, L., Crescenzi, O., … Israel, M. (2022). In-person versus virtual therapy in outpatient eating-disorder treatment: A COVID-19 inspired study. International Journal of Eating Disorders, 55(1), 145-150. doi: 10.1002/eat.23655