Can a chatbot for eating disorders improve access to care? This is what Dr. Ellen Fitzsimmons-Craft is trying to achieve through a new study. She’s an associate professor of psychological and brain sciences in Arts & Sciences at Washington University in St. Louis and an associate professor of psychiatry at WashU School of Medicine.

“This has been something we have been working on for quite some time,” said Fitzsimmons-Craft.

The researcher and her collogues are developing a chat tool for people with eating disorders.

“We developed this tool using rule-based AI, where all of the responses were written by clinical experts including myself, a psychiatrist, individuals on our team,” she said. “We spent years perfecting these responses and deciding all of the rules that would allow individuals to go down different paths within the tool.”

Eating disorders are one of the deadliest forms of mental illness, but less than 20% of people with these disorders end up finding help.

“Up to 10% of the population in the U.S. will experience an eating disorder at some point in their lifetime. That’s a huge number of people, up to 30 million people here in the United States,” she said. “At the same time, 80% of people with eating disorders never receive any kind of treatment. Even when they do receive treatment right now, usually it’s not evidence based.”

Fitzsimmons-Craft said there is limited access to mental health care providers in general, but even fewer trained therapists are available for eating disorders. Even if someone finds a clinic, she said there are often long waits and high treatment costs to pay.

According to a Washington University news release, Fitzsimmons-Craft and colleagues have been developing a range of digital cognitive-behavioral therapy-based interventions for eating disorders. Now, with a five-year $3.7 million grant from the National Institutes of Health (NIH) — and working with additional partners at the University of South Carolina and New York University — they will be optimizing a self-guided, chatbot-based digital intervention with the goal of making eating disorder counseling more readily available to all.

According to the WashU news release, those using ChatGPT-style large language models run the risk of polluting data with what the LLM pulls from the internet. A recent report found that these programs generated harmful content about eating disorders 41% of the time. WashU said that will not be the case with this intervention, which is a rule-based artificial intelligence (AI) system, not generative AI at this stage. This current form of the new chatbot is a closed system, carefully constructed with conversations written by experts in the field and optimized with user feedback. The tool will be hosted by Wysa, a global AI-led mental health company recognized for its best practices across clinical safety and privacy.

The scientists will test their approach with some 800 individuals with eating disorders who aren’t currently in treatment. An “optimization randomized controlled trial” will help the researchers to understand which aspects of this self-guided cognitive-behavioral intervention work best.

“My goal has never been to replace people. I would love it if everyone could access a quality health-care provider, but that’s not currently the case,” Fitzsimmons-Craft said.

One main advantage is ease of entry. Because of shame associated with eating disorders, some people are not ready to talk to a real person about their challenges. “Even if they had access to care, they may not be willing or ready to do that,” she said.

But it may be less scary to talk to an infinitely patient chatbot. For some people, it might be a far less intimidating first step to getting help. With further data from this project, Fitzsimmons-Craft and colleagues hope that eventually they can create personalized mental health interventions. From there, the tool will go to eating disorder and mental health nonprofits to share with the public.

“We have developed a lot of partnerships,” she said. “I never want to do anything that’s just going to sit around. I want to do science that can have a very near-term impact.”