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Learn more: PMC Disclaimer | PMC Copyright Notice Eat Weight Disord . 2026 Mar 9;31(1):33. doi: 10.1007/s40519-026-01836-6 Search in PMC Search in PubMed View in NLM Catalog Add to search Benefits of a brief, remote psychoeducation intervention in treating eating disorders: a preliminary study in a predominantly AN/BN sample Laurent Cruchet Laurent Cruchet 1 GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Clinique des Maladies Mentales et de l’Encéphale (CMME), 75014 Paris, France Find articles by Laurent Cruchet 1, ✉ , Lucia Romo Lucia Romo 2 Université Paris Nanterre, Laboratoire EVACLIPSY, UR 4430 CLIPSYD, UFR SPSE, 92001 Nanterre, France 3 Hôpital Universitaire Raymond-Poincaré, Service de Pathologies Professionnelles (AP-HP), 92380 Garches, France 5 INSERM CESP 1018 UPS, 94 805, Villejuif Cedex, France Find articles by Lucia Romo 2, 3, 5 , Philibert Duriez Philibert Duriez 1 GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Clinique des Maladies Mentales et de l’Encéphale (CMME), 75014 Paris, France 4 Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Vulnerability to Psychiatric and Addictive Disorders, 75014 Paris, France Find articles by Philibert Duriez 1, 4 , Maria Alejandra Laszcz Maria Alejandra Laszcz 1 GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Clinique des Maladies Mentales et de l’Encéphale (CMME), 75014 Paris, France 2 Université Paris Nanterre, Laboratoire EVACLIPSY, UR 4430 CLIPSYD, UFR SPSE, 92001 Nanterre, France Find articles by Maria Alejandra Laszcz 1, 2 , Daphnée Poupon Daphnée Poupon 1 GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Clinique des Maladies Mentales et de l’Encéphale (CMME), 75014 Paris, France Find articles by Daphnée Poupon 1 , Philip Gorwood Philip Gorwood 1 GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Clinique des Maladies Mentales et de l’Encéphale (CMME), 75014 Paris, France 4 Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Vulnerability to Psychiatric and Addictive Disorders, 75014 Paris, France Find articles by Philip Gorwood 1, 4 Author information Article notes Copyright and License information 1 GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Clinique des Maladies Mentales et de l’Encéphale (CMME), 75014 Paris, France 2 Université Paris Nanterre, Laboratoire EVACLIPSY, UR 4430 CLIPSYD, UFR SPSE, 92001 Nanterre, France 3 Hôpital Universitaire Raymond-Poincaré, Service de Pathologies Professionnelles (AP-HP), 92380 Garches, France 4 Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Vulnerability to Psychiatric and Addictive Disorders, 75014 Paris, France 5 INSERM CESP 1018 UPS, 94 805, Villejuif Cedex, France ✉ Corresponding author. Received 2024 Apr 19; Accepted 2026 Feb 27; Issue date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13086656 PMID: 41801613 Abstract Purpose Engagement in care is particularly problematic among patients suffering from eating disorders (ED). We aimed to assess whether a brief, remote, psychoeducation (PE) intervention could facilitate engagement and/or potentiate treatment. We also aimed to study whether the acquisition of knowledge, a key aspect of PE, could relate to its efficacy. Methods We designed a brief, remote PE intervention, based on cognitive behavioural therapy (CBT) principles and literature recommendations. Eighteen ED patients receiving the intervention in addition to treatment as usual (TAU) were compared to 17 ED patients receiving TAU only on: self-reported symptomatology and motivation, actual engagement in a treatment, as well as ED-related knowledge. Assessment times were pre-, post-, and 2 months past the intervention. Results Within-group improvements in symptomatology (at follow-up) and increases in motivation (post- and follow-up) were observed in the TAU + PE group, but not in TAU. Level of knowledge and changes in motivation were identified as potential mediators of the association between the intervention and ED symptomatology. Conclusion These preliminary findings suggest that a simple, easily accessible remote PE intervention may represent a promising adjunct to standard ED treatment. They also highlight the potential role of knowledge acquisition as a component associated with intervention-related change. Level of evidence IV : Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Keywords: Eating disorders, Anorexia nervosa, Bulimia nervosa, Psychoeducational intervention, Remote intervention Introduction Eating Disorders (ED) are serious psychiatric conditions requiring complex, multidisciplinary care [ 1 , 2 ]. With an increasing prevalence, and with few structures currently able to offer specialized treatment [ 3 ], in particular in France [ 4 ], ED constitute a public health problem [ 5 ]. What is more, engagement in care is particularly problematic among patients suffering from these conditions [ 3 ]. Hence, complementary interventions that could facilitate engagement and/or potentiate treatment could be of great interest. Psychoeducation (PE), a simple, cost-effective psychological intervention, could help in the healing process: previous studies suggest that it reduces ED symptoms [ 6 , 7 ] and facilitates engagement in care [ 6 ]. Motivation could play a central role in these processes [ 8 , 9 ]. While these elements suggest that face-to-face PE could be a good adjunct to standard treatment of ED, little is known regarding the effectiveness of remote interventions in clinical populations, as this kind of interventions are essentially carried out outside the clinical context (e.g. [ 10 – 12 ]). Our aim is to fill this gap, as an important aspect of remote interventions lies in their ability to provide easy access while limiting the logistical burden of specialized structures. We designed a brief (4-week), remote PE intervention based on a cognitive and behavioural understanding of ED, and recommendations regarding e-health interventions [ 13 ]. More specifically, the aim of this brief report is to compare the outcomes of a group of patients receiving this intervention in addition to treatment as usual (TAU) with another group receiving TAU only on: 1) ED symptomatology, 2) engagement in care, and 3) motivation. Furthermore, as the transmission of knowledge is, by definition, a key aspect of PE, another aim is to explore whether the acquisition of knowledge was related to any of the aforementioned efficacy criteria. Method Design This research consisted in a two-factor design trial, conducted on a sequential cohort. The two conditions were TAU and TAU + PE (Fig. 1 ). Participants were randomly assigned to one these two conditions. Participants were assessed at baseline (T1), post-intervention (T2) and 2 months after intervention (T3). All assessments consisted of self-report questionnaires. First evaluation was filled in person at the recruitment site, while subsequent evaluations were filled online (using a unique identifier to ensure anonymity). A 2-month follow-up was chosen to capture potential delayed or maintained effects of the intervention, while limiting attrition in this pilot study. Fig. 1. Open in a new tab Flowchart of the study, representing the two conditions: TAU (left), and TAU plus PE (right) Participants Recruitment took place between mid-September 2021 and mid-March 2022. Patients attending their first appointment at Centre Expert TCA (Clinique des Maladies Mentales et de l’Encéphale, Sainte-Anne Hospital, GHU Paris) were proposed to receive the PE intervention, in addition to standard treatment. Eligible participants were adults with a diagnosis of anorexia nervosa (AN), bulimia nervosa (BN) or binge eating disorder (BED), and a body mass index (BMI) higher than 13 kg/m 2 . A condition that required hospitalization, psychotic symptoms hindering reality, or a depressive state considered too severe, were exclusion criteria. Intervention TAU consisted mainly of diagnostic assessment and individualized orientation toward appropriate care. While informal psychoeducational elements could occur, no systematic, standardized psychoeducational intervention was provided. We designed a remote intervention based on a cognitive and behavioural understanding of ED and on cognitive behavioural therapy (CBT) techniques, as well as recommendations proposed by Linardon and colleagues [ 13 ] regarding e-Health interventions. During four weeks, each participant received PE documents by email once a week, completed by a weekly 15–20-min phone call. The intervention covered four themes—information about ED, behavioural activation, cognitive restructuring, and emotion regulation—each supplemented by short, practical exercises. Phone calls were added to separate from the “one-fits-all” intervention, so that we could adapt the learning process to each participant (answering questions, exploring difficulties regarding practical application), but also to limit attrition, by adding additional support [ 14 ]. Our intervention was manualized to ensure consistency across the study. It differs from PE usually found in other PE treatments (such as those found in TAU), as it articulates theoretical knowledge with hands-on, CBT-based exercises. The first week of the intervention began with written general information about ED (such as symptomatology, mechanisms, vicious circles and related problems), and participants were asked to reflect on their eating difficulties and ED symptoms (what?, since when?, how often?). Patients were also asked to reflect on the advantages and disadvantages of changing an eating behaviour or habit. In the second week, the documents articulated behavioural activation techniques that could help in maintain mood without resorting to ED-related, problematic behaviours. Exercises invited participants to plan pleasurable activities, and to define S.M.A.R.T. goals ( i.e. Specific, Measurable, Achievable, Relevant, Time-bound) goals that could facilitate adaptive behaviours. Week 3 focused on dysfunctional thoughts and their impact on mood and problem behaviours. Exercises involved participant identifying situations that activate such thoughts and generating alternative thoughts. Week 4 approached emotion regulation as a central process in ED. Integrating previous knowledge and techniques helps participants to gain insight into dysfunctional eating regulation strategies and to experiment with and develop more adaptive ones. Weekly telephone calls were made a few days after the PE materials were sent out, and were structured as follows: first, the participant was asked if they needed any clarification regarding the PE materials, then they were given the opportunity to give feedback on the suggested exercises, and to discuss any difficulties they had encountered in completing them. Measures Symptomatology was assessed using a summary score of the Eating Disorders Inventory (EDI; [ 15 ]) called ED severity which consists in the summing of three dimensions of the EDI: drive for thinness, bulimia , and body dissatisfaction . These three dimensions cover essential aspects of eating disorders, with Drive for Thinness reflecting the extreme desire to lose weight, a central symptom in AN and BN, Bulimia measuring eating impulsivity, binge eating episodes and inappropriate regulation of eating behaviour and Body Dissatisfaction being at the heart of the body image distortion often observed in these disorders. The advantage of this score is that it provides a homogeneous score of ED symptomatology even in samples that include patients with AN, BN and BED. Welch et al. [ 16 ] have provided a factor analytic justification for combining these dimensions. The addition of these three dimensions has been consistently used in the literature as a means of measuring the primary eating disordered attitudes and behaviours (e.g. [ 17 , 18 ]). The internal consistency of these subscales has been demonstrated with Cronbach's alpha coefficients of 0.85, 0.90, and 0.90, respectively. Engagement in a process of care was evaluated at each follow-up by asking participants whether they had started, continued, or stopped any treatment since the last evaluation. If a treatment was stopped, participants were asked for the reason. This assessment captured any additional therapeutic interventions beyond the study program. Motivation was assessed using three 10-point visual scales (VS) relating, respectively, to importance, confidence, and readiness to change. VS of this type have been used in several studies to assess motivation as a three-dimensional concept (e.g. [ 17 , 19 ]). Questions were: How important is it for you to change your eating behaviour? How confident are you in your ability to change your eating behaviour? How ready do you feel to change your eating behaviour? Level of knowledge was evaluated using an on-purpose designed, multiple-choice questionnaire, targeting all the addressed topics during the intervention. This outcome was only assessed at T2. In addition, age, gender, diagnosis, and BMI were gathered at baseline only. Statistics Due to small sample size, one-sample Wilcoxon rank tests, with baseline (T1) as reference, were used for within-subject analyses on ED severit y, Importance to change , Confidence to change , and Readiness to change . Mann–Whitney U independent tests were used to handle between-group analyses on these outcomes, as well as Level of knowledge (T2 only). Fisher's exact test was used to compare engagement rates between both groups. Correlations between Level of knowledge (at T2) and outcomes showing a significant change between T1 and T2 were tested using Spearman’s rho . We also computed correlations between any pair of continuous outcomes that reported significant change in the primary analyses. Mediation was studied by conducting path analyses based on Montoya & Hayes commendations [ 20 ]. Since this is a "pilot study", statistical p-values were reported uncorrected (due to the small sample size and the design of the protocol, which was a pilot study), but also corrected by the number of independent tests (0.05 * number of tests) for clarity and scientific rigor. Power analyses indicate that 27 subjects are required to detect medium effects with a statistical power of 0.8 and a type I error of 0.05 using a paired-sample test. For between-group analyses, 51 subjects per group are required for the same sensitivity, power, and type I error. Results Fifty-six participants fulfilled evaluation at baseline (T1), 46 at T2, and 35 at T3, hence a 37.5% attrition rate between baseline and follow-up. This 35-participant sample consisted of 18 persons suffering from AN (51.4%), 15 from BN (42.9%) and 2 from BED. Mean duration of the disorder was 11.3 years (Standard Deviation 8.01), mean BMI 19.94 (4.92) kg/m 2 , mean age 29.59 (7.44) years. There were 2 men (5.7%). No significant differences were found between the 35 patients who completed the study and the 21 who abandoned ( p ≥ 0.120), except for a trend towards lower age with a mean of 26.55 (8.45) among the dropouts ( p = 0.070). Diagnoses in the TAU group included AN ( n = 10) and BN ( n = 7), whereas in the TAU + PE group diagnoses included AN ( n = 8), BN ( n = 8), and BED ( n = 2). Comparison between TAU ( N = 17) and TAU + PE ( N = 18) at baseline (T1) revealed no significant differences between these two groups ( p ≥ 0.154), except for Importance to change with the TUA + PE group reporting a slightly but significant higher score ( M diff = 1.12, p = 0.038). At baseline (T1), 19 of the 35 participants (54.3%) were already engaged in some kind of treatment, 10 (58.8%) in the TAU group vs 9 (50%) in TAU + PE ( p = 0.738). ED symptomatology Within-group analyses revealed a significant decrease in ED severity at T3 in the TAU + PE group ( M diff = − 7.94, p = 0.020 ( p bonf = 0.039)) compared to baseline (T1), but not at T2 ( M diff = − 1.65, p = 0.776 ( p bonf = 1.000)). No significant change was found in the TAU group ( p ≥ 0.299, ( p bonf ≥ 0.599)). Between-group analyses were not significant ( p ≥ 0.188 ( p bonf ≥ 0.376); Fig. 2 A). Fig. 2. Open in a new tab ED severity decrease ( A ) and Confidence to change increase ( B ) at T2 and T3, compared to baseline, in the TAU (in blue) vs TAU + PE (in yellow) groups; error bars represent Standard Error of Mean; * p < 0.05, ** p < 0.01; C , D : path analyses of the impact of PE intervention on ED severity at follow-up (T3) compared to baseline (T1), directly, and through its impact on Level of knowledge ( C ) and Confidence to change ( D ), respectively; the triangle in ( D ) illustrates the fact that the analysis was conducted in a within-participant framework Engagement in treatment Among participants that were not already engaged in care at T1, 72.7% in the TAU + PE group had started a treatment at T2, compared to 55.6% in the TAU group, but this difference was not significant ( p = 0.642 ( p bonf = 1.000)). A similar result was obtained at T3 with 75% being engaged in care in the intervention group and 57.1% in controls ( p = 0.608 ( p bonf = 1.000)). Regarding disengagement, only one stopped their treatment (at T2), reporting that they were “not feeling the need anymore” (T2) and “feeling cured” (T3), which was in line with their reduction of ED severity . Motivation In the TAU + PE group, confidence to change significantly increased between T1 and T2 ( M diff = 1.39, p = 0.002 ( p bonf = 0.013)), and between T1 and T3 ( M diff = 2.06, p = 0.004 ( p bonf = 0.026)). No significant change was found in the TAU group ( p ≥ 0.108 ( p bonf ≥ 0.651)). Between-group analyses revealed a significant difference at T3 ( p = 0.023 ( p bonf = 0.139)), but not at T2 ( p = 0.190 ( p bonf = 1.000); Fig. 2 B). No significant changes were found in importance to change in neither TAU nor TAU + PE groups ( p ≥ 0.125 ( p bonf ≥ 0.748)). Within-group analyses revealed a trend in increase in readiness to change at T3 ( M diff = 0.94, p = 0.077 ( p bonf = 0.459)), compared to baseline, in the TAU + PE group, but not at T2 ( p = 0.108, ( p bonf = 0.648)). No significant changes were found in the TAU group ( p ≥ 0.263 ( p bonf = 1.000)). Between-group analyses revealed a trend at T2 ( p = 0.060, ( p bonf = 0.361)) and a significant difference at T3 ( p = 0.050 ( p bonf = 0.299)). Level of knowledge Level of knowledge was significantly higher in the TAU + PE group compared to TAU ( M diff = 2.91, p = 0.015) at T2. Secondary analyses: outcome correlations and path analyses We found three significant correlations in the TAU + PE group: one between decrease in ED severity at T3 and Level of knowledge ( rho = 0.518, p = 0.040 ( p bonf = 0.240)), one between decrease in ED severity at T3 and increase in confidence to change at T2 ( rho = 0.584, p = 0.018 ( p bonf = 0.111)), and another one between the increase in c onfidence to change at T2 and the increase in c onfidence to change at T3 ( rho = 0.782, p < 0.001 ( p bonf < 0.001)). No other significant correlations were found ( p ≥ 0.153 ( p bonf ≥ 0.916)). Path analyses revealed a significant bootstrapping indirect effect of PE intervention on ED severity improvement at T3 through Level of knowledge (95% CI [− 11.83, − 0.37]; Fig. 2 C). Increase in motivation was also found to mediate the effect of the intervention on ED severity improvement (95% CI [− 16.04, − 0.07]; Fig. 2 D). Baseline analyses Baseline differences in Importance to change were tested for their potential predictive value on subsequent changes in motivation ( Confidence to change at T2 and T3) and ED severity . No significant associations were found ( rho = − 0.077 to 0.148, p ≥ 0.396), indicating that baseline differences did not account for observed changes. Discussion This pilot study explored the effects of a brief, remotely delivered PE intervention as an adjunct to TAU in individuals with ED, primarily AN and BN. Given the exploratory design and limited sample size, findings should be interpreted cautiously. Within these constraints, results suggest potential changes in motivation, knowledge acquisition, and symptomatology following the intervention. Mediation analyses further suggested that changes in motivation and level of knowledge may be associated with symptom improvement. Results regarding improvement in symptomatology and motivation are in line with those found with face-to-face, PE interventions [ 6 – 8 ]. Although not formally reported, exploratory analyses suggested that the overall reduction in ED severity may have been primarily driven by decreases in drive for thinness and bulimia dimensions. The time shift between motivation increase and symptomatology reduction, as well as the statistically significant mediation effect of the former on the latter suggest that part of the observed changes following PE may be related to motivational processes [ 9 ]. Similarly, the mediating effect of Level of knowledge suggests that the transmission of knowledge may also represent an important component in facilitating the healing process. While psychoeducation and knowledge acquisition have been widely discussed in ED treatment (e.g., [ 21 ]), our findings provide a preliminary, incremental contribution by empirically examining knowledge acquisition as a measured mediator within a brief, remote PE intervention. The relationship between the two mediators suggests some degree of independence, as no correlation was found between changes in motivation and Level of knowledge . Finally, regarding engagement in treatment, our results did not support an effect of PE. Instead, in view of the improvement in symptomatology and motivation, it may suggest that PE is not associated with a higher likelihood of engaging in care, but may be related to qualitative aspects of engagement. Limitations The limitations of this study were essentially related to the limited sample size, precluding parametric and controlled statistics (adjustment for relevant variables), and resulting in a lack of power for between-group comparisons. More precisely, although the study was of adequate size to detect a medium effect of PE intervention, it was significantly underpowered for between-group analyses. Most problematic was the comparison on engagement rate, for which non-significance (despite the higher rate, at a descriptive level, in the TAU + PE group) could reasonably be attributed to a lack of sensitivity. As the sample was predominantly composed of patients with AN and BN, the generalizability of the findings to ED as a whole should be approached with caution; moreover, diagnostic heterogeneity, although not statistically significant across groups, may still represent a potential source of bias. The attrition rate of 37.5% may call into question the generalisability and reliability of the findings, as a high attrition rate may limit the extent to which these findings apply to the target population. However, the observed dropout rate is within the range generally observed in such studies [ 14 , 22 ], and we did not observe a significant difference between completers and dropouts. The main impact of the attrition rate of this sample may be more detrimental on the statistical power of the analyses we performed. Although our study ensured comparability between groups in terms of concurrent treatments and ED severity at baseline, other factors such as duration of the ED, prior treatment history (including the number and type of previous treatment attempts), or psychiatric and somatic comorbidities may have differed between the two groups and therefore potentially influenced the results. Future studies with larger samples should consider these variables to better characterize their impact. Finally, due to their self-reported nature, and the fact that they were time-limited (2-month follow-up only), evaluations themselves also limited the strength of conclusion to be drawn from our results. What is already known on this subject? Eating disorders are serious psychiatric conditions with high prevalence and few specialized structures able to offer adapted treatment. Moreover, engagement in care is often challenging for patients with these disorders. Brief, remote, psychoeducation interventions may help facilitate engagement and/or potentiate treatment, while potentially limiting the burden on specialized structures. However, evidence regarding this specific modality in clinical populations remains scarce. What this study adds? This pilot study suggests that a brief, remotely delivered psychoeducational intervention may represent a feasible and accessible adjunct to standard ED care, with limited additional burden on specialized services. The findings indicate that changes in motivation are associated with PE-related improvements and provide exploratory support for a potential contribution of knowledge acquisition. Acknowledgements The authors would like to thank Etienne Kimmel, Laura di Ludovico, Mathilde Septier, Aurore Paillez, Marion Deloulay, Marie Fadigas and Diana Zala, who all contributed to help in the process of the study and manuscript, as well as Michel Danon and Lila Mekaoui for encouraging this manuscript. The authors also thank Camille Bordin for her help with recording the audio documents of the intervention. Author contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by L.C., L.R. and P.G.. The first draft of the manuscript was written by L.C., M.A.L., D.P. and P.G., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding Open access funding was provided by the Association pour la recherche en psychiatrie (ARP) [Association for Research in Psychiatry]. Data availability The data that support the findings of this study are available on request from the corresponding author. Declarations Ethics approval and consent to participate This research was conducted in accordance to the Declaration of Helsinki and the legal framework in France. It was declared to and authorized by the French national committee for informatics and liberty ‘CNIL’ (authorization number: 2231283 v 0). Participants received oral and written information about the study. Informed consent was obtained from all participants. Competing interests Philip Gorwood received during the last 5 years fees for presentations at congresses or participation in scientific boards from Biogen, Janssen, Lundbeck, Merk, Otsuka, Richter and Viatris. 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Int J Eat Disord 56(6):1254–1268. 10.1002/eat.23961 [ DOI ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement The data that support the findings of this study are available on request from the corresponding author. 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