How Chatbots Are Being Used With Eating Disorders

ELIZA would no doubt have stories to tell from the early days of chatbots.

These computer programs utilize artificial intelligence (AI) and natural language processing, and their technology is commonplace today. That smart speaker in your kitchen? The technology is there. That messaging application at work? It’s there too, making it altogether easy to get information without any human assistance (IBM Cloud Education, 2019).

One distinct advantage of chatbots: They work 24/7.

Source: Tyler Lastovich/Unsplash

After all, it was ELIZA, the first chatbot developed in 1966 at MIT, that started the technology by being able to answer simple questions based on a decision tree. The 1980s and 1990s found chatbots in automated phone systems, again using simplistic decision tree models. The growth in chatbot use has exploded to present day where they can be found in an array of channels across social and business technology (Ismail, 2019).

ELIZA would smile—well, if any chatbot could smile in those early days of development—in marveling at its applications today.

Chatbots have matured over the past half-century, and increased interest is sparked in part due to two things. First, chatbots have heightened capabilities to sense. They not only can recognize images, but can also decipher human voices (Ismail, 2019).

Second, and perhaps more importantly, they have become “human-like.” According to Howard Pull, the strategic development director at MullenLowe Profero, it is the AI element that plays a role in pushing chatbot applications. The acceleration in chatbot learning, particularly over the past two years, is a major contributor. The result? “It’s allowing brands and services to create an interface that feels human and interacts in a way that people expect to be spoken to and dealt with,” Pull explained (Ismail, 2019, The rise of AI section).

With their human-like capacities and multifunctionality, chatbot growth is enormous. One can only imagine the role that they can play in psychotherapy. The idea of chatbots as a front-line intervention isn’t just conceivable, it has arrived.

One recent study investigated just that: utilizing chatbots with individuals at risk for eating disorders. The senior investigator, C. Barr Taylor, MD, noted that chatbots have entered the medical field, but research regarding their effectiveness in the mental health domain is lacking (Yasgur, 2022).

In their work with eating disorders, particularly prevention efforts, the investigators encountered a dilemma. Their internet-based program for at-risk women, which was aimed at decreasing weight/shape concerns, required training for moderators who went on to have 45-minute sessions with participants. Given the challenge of offering the program to more people, the researchers turned to a chatbot, thereby eliminating the two obstacles of training moderators and their subsequent face-to-face time with participants (Yasgur, 2022).

The chatbot (named “Tessa”) in the modified program allowed for a semblance of human interaction. “We thought that a chatbot, in addition to providing content in this perhaps more engaging format, could also provide some aspect of human moderation, although the person is chatting with a robot,” said the study’s lead investigator, Ellen Fitzsimmons-Craft, Ph.D. (Yasgur, 2022, p. 12).

Implementing “Tessa” and chatbot technology may have been beneficial. The results of the study, which appeared in a recent issue of the International Journal of Eating Disorders, found a higher reduction among those participants in the intervention group with the chatbot compared to the control group on weight/shape concerns at post-study follow-ups. However, no differences between the two groups were found in thin-ideal internalization (Yasgur, 2022).

Regardless, the chatbot in this arena lives on: The website of the National Eating Disorders Association will be using it for people screening positive for an eating disorder or for those individuals deemed to be at high risk. Fitzsimmons-Craft noted the rapid adaptation from research to practice "where we can so quickly show that it works and make it available to tens of thousands almost immediately” (Yasgur, 2022, p. 12).

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And who knows? Perhaps a descendant of ELIZA will be smiling soon.