Eating disorders rank among the most lethal types of mental health conditions, yet fewer than 20% of individuals experiencing these disorders seek assistance.
“There’s a significant demand for access to treatment,” remarked Ellen Fitzsimmons-Craft, an associate professor of psychological and brain sciences within the Arts & Sciences, as well as psychiatry at the School of Medicine, all affiliated with Washington University in St. Louis.
Mental health care providers are limited, and the availability of trained therapists specializing in eating disorders is even scarcer. Even if a person locates a clinic, they may face lengthy waiting times and substantial treatment expenses, she noted.
In light of this issue, Fitzsimmons-Craft and her colleagues, including Denise Wilfley, a psychiatry professor at WashU Medicine, are developing various digital interventions based on cognitive-behavioral therapy for eating disorders. With a five-year $3.7 million grant from the National Institutes of Health (NIH) — and collaborating with additional partners at the University of South Carolina and New York University — they aim to enhance a self-directed, chatbot-based digital intervention designed to make eating disorder counseling more accessible to everyone.
Previous studies have demonstrated that chatbots can assist in behavior change interventions, such as supporting individuals in smoking cessation initiatives. However, the design of these chatbots is critical.
At present, those utilizing ChatGPT-style large language models risk contaminating data with information sourced from the internet. A recent study indicated that these systems produced harmful content related to eating disorders 41% of the time.
This will not be the case with this particular intervention, which employs a rule-based artificial intelligence (AI) framework, rather than generative AI at this stage, Fitzsimmons-Craft stated. The current iteration of the chatbot operates as a closed system, meticulously designed with dialogues written by field experts and fine-tuned based on user feedback. The tool will be hosted by Wysa, a global AI-driven mental health organization celebrated for its commitment to clinical safety and privacy.
The researchers will evaluate their method with approximately 800 individuals suffering from eating disorders who are not currently undergoing treatment. An “optimization randomized controlled trial” will assist the scientists in discovering which features of this self-directed cognitive-behavioral intervention yield the best results. To ensure the effectiveness of this intervention, they will identify the most impactful components for reducing eating disorder symptoms and the sequence of these elements that keep the user engaged—an area that has yet to be explored in chatbot research, Fitzsimmons-Craft remarked.
While chatbots offer benefits for behavioral interventions, the intention is not to supplant healthcare providers.
“My objective has never been to replace human interaction. I would be thrilled if everyone could access a competent healthcare professional, but that is not the reality at the moment,” Fitzsimmons-Craft commented.
One primary benefit is the simplicity of access. Due to the stigma surrounding eating disorders, some individuals might hesitate to confide in a real person about their struggles. “Even if they could obtain care, they may not be prepared or willing to do so,” she stated.
Conversing with an infinitely patient chatbot may feel less daunting. For various individuals, it might represent a significantly less intimidating initial step toward seeking help. Through additional data derived from this initiative, Fitzsimmons-Craft and her colleagues aspire to ultimately develop personalized mental health interventions. Subsequently, the tool will be distributed to eating disorder and mental health nonprofits to reach the broader public.
“We have formed numerous collaborations,” she expressed. “I never intend to pursue anything that will collect dust. I aim to engage in research that can produce a tangible impact in the short term.”
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