Building an accessible remote eating disorder recovery programme

CASE STUDY · IANTHE HOUSE

Recovery Circles, pilot cohort · Role: Co-founder and COO

Most people with an eating disorder are not in hospital. They are working, studying, holding down relationships, and quietly unwell.

This is the group services are worst at reaching. NHS provision is configured around acuity, so access is gated by thresholds that many people do not meet until they have seriously deteriorated. Being unwell but functioning is not, in practice, a qualifying condition. The private alternative exists but costs more than most people can afford, and tends to be delivered in short blocks, focus on food management, and end long before the underlying pattern has changed.

So the people most likely to recover with sustained support are the people least likely to be offered any. Recovery Circles was built for that group.

I co-founded Ianthe House and, as COO, built and ran the programme end to end: the delivery model, the infrastructure it ran on, the operating rhythm, funding raising and allocation, and the measurement that fed back into the design as it ran.

What we built

A remote programme for adult women with eating disorders, designed to run for twelve months rather than a short term intervention. Therapeutic delivery had two modes, each doing different work.

Individual therapy, in ninety minute sessions with selected practitioners, using somatic work including Emotional Freedom Techniques. Long sessions were a deliberate choice: deep trauma work often requires more than an hour, and the depth reachable in ninety minutes is qualitatively different from what is reachable in less. This is where the personal history underneath the eating disorder was worked on directly.

Group therapy, facilitated by a Clinical Psychologist, running alongside the individual work throughout. Group does what individual work structurally cannot: it breaks isolation, makes disclosure ordinary, and gives women a place to practise being truly seen by peers. In a condition sustained by secrecy, a private therapeutic relationship alone leaves the secrecy largely intact everywhere else in a person's life. The group served as a relational lab and microcosm for more global experiences.

The two modes were designed to be mutually reinforcing rather than parallel. What surfaced in the group could be worked on in individual sessions, and then brought back into the group be met and experienced differently in real life.

This pilot cannot demonstrate that the combination outperformed either mode alone, and nothing here should be read as claiming it. What can be said is that the architecture was intentional, and the pattern in the results is consistent with the intent: the large movements were observed in secrecy, support seeking, and the willingness to voice needs, the domains the group work was built to reach.

"Instead of avoiding my emotions, I'm dealing with them in healthier ways. I'm so much more mindful of what I need. I've learned what setting a boundary actually entails and how to stick to it, and I apply that knowledge to my life regularly now."

-Pilot participant

My role

I built and co-designed the delivery model, and ran it day to day. That meant sourcing and vetting the practitioners, and building the infrastructure the programme ran on: session scheduling systems, client and practitioner onboarding, and a double sided marketplace through which our vetted therapists could offer eating disorder services publicly through our site. Client acquisition and participant experience were managed by me throughout.

I was the participants' central point of contact, with structured check-ins every six weeks. I coordinated the practitioners with at least fortnightly contact, on operational delivery rather than clinical supervision, which sat with the clinicians.

I raised investment and charitable funds to subsidise participants who could not pay, alongside those who paid in full, so the pilot was able to run on a blended model. I refined the programme against feedback and recovery metrics as it ran, so measurement fed back into design at each stage rather than being collected for a report at the end.

Four design decisions

Work at the level of what drives the behaviour, not the behaviour itself. Food-focused intervention tends to address the most visible part of the problem and leave the mechanism intact. The programme was built on relational and trauma informed principles, on the premise that disordered eating in this population is usually a coping structure, and that removing a coping structure without addressing what it is for is unlikely to hold.

Duration. Twelve months rather than eight sessions, because the thing being changed took years to build and the evidence on relapse in this field is not encouraging for brief work.

Remote delivery as a clinical feature, not just a cost saving. Nobody had to be seen entering a building, explain an absence, or travel while unwell. For a population where shame suppresses help seeking, removing the visibility of treatment removes a barrier to starting it.

The circle as a standing structure. Groups were closed and small, four to six women, with the same membership throughout, supported by lived experience mentorship and peer connection. Over twelve months the circle stopped being a session slot and became an ongoing support system: a fixed point that held people between appointments and continued to function as a safe space in its own right. This is the containment the model depends on, and it is a consequence of how the group was constituted rather than of the therapy delivered inside it.

I can't tell you how much this has impacted my life. This is after years of therapy and years of trying different things. I've never seen so much progress in such a condensed amount of time.

What we measured

-Pilot participant

Data was collected at baseline, six weeks, three months, six months and ten months. Five timepoints, so the picture is a trajectory rather than a before and after snapshot. Three validated instruments were used throughout:

Eating Disorder Questionnaire (EDQ) for symptom frequency and severity: preoccupation with food, weight and shape, body checking, secrecy around eating, restriction, and compensatory behaviours
DASS-21 for depression, anxiety and stress
Q-LES-Q-SF for quality of life and satisfaction

Alongside these we tracked a proprietary composite covering social support seeking, active tackling and autonomy, and a set of functional and economic measures: monthly spend on eating disorder related behaviours, absenteeism, and capacity to work. The proprietary composite is not a validated instrument and is reported separately from those that are. Including function and economics was deliberate: symptom reduction alone does not tell a funder, an employer or a participant the full extent to which a life has changed.

The cohort

Six women enrolled. Four completed the full programme. Two withdrew at around six weeks. All figures below refer to the four completers, measured from their own baselines. This cohort is large enough to establish proof of concept, but far too small to show the intervention works beyond this group. It is not evidence that the model works at scale. It is evidence that the model was built, run and measured effectively, and that the results justify a larger, controlled evaluation.

87%

reduction in distraction and distress caused by symptoms

£0–50

monthly spend on ED behaviours, down from up to £500

100%

reduction in eating in secret

+47%

increase in seeking help when struggling (collective)

80%

reduction in restrictive eating

+23%

in quality of life and satisfaction

47%

reduction in body checking

+55%

in autonomy (expressing needs and boundaries)

6 mths

to return to full-time work for those signed off at enrolment

+15%

in active tackling (consistency of effortful recovery behaviour)

"This is such a gentle, loving program where there's no blame or pressure or judgment. It allows you to just naturally move into a freer space, which is why it's been so successful I think.

The approach of focusing on the feelings that are driving the coping mechanisms, rather than the traditional way of solely focusing on food, has been the most helpful thing...you're able to get to the root of the problem. You cure the cause and not the symptom. This has actually tackled everything from the bottom up."

-Pilot participant

All figures are percentage change in self-report scale scores between baseline and ten months.

By the six month point, participants no longer scored above threshold on the measures of restriction, binge eating and compensatory behaviours, and this was sustained through to the final measurement at ten months. This is self-report against clinically validated instruments, not formal diagnostic assessment by a clinician.

Within the EDQ measurement set, body checking moved the least at a 47% reduction. This comparable to what the existing literature suggests: body image distress is typically the most persistent domain.

Within the composite set, significant increases in support seeking and in the willingness to express needs and set boundaries don't merely reflect behavioural changes. To me they represent people who have stopped hiding, started asking for help, and begun treating themselves as someone worth advocating for.

Limits

Four completers. No control or comparison group. No randomisation.
All outcome data is self-report. No clinical reassessment of diagnostic status.
Data was collected, analysed and written up in house, by me, the person who designed and ran the programme. Allegiance effects apply.
No follow up beyond ten months, so nothing here speaks to long term durability.
The programme combined several elements simultaneously. Nothing in this design can isolate whether one of these or all of them combined was the most effective.

Percentage change on small baseline scores can overstate movement, and the underlying scores are not mine to publish. The dataset is held by the organisation and I no longer have access to it. Everything reported here is drawn from the impact report I authored at the time, which remains publicly available.

What I would build differently

Follow up designed in from the start, at twelve and twenty four months. This is the gap that most limits what the pilot can say.
Data analysis conducted by someone independent of delivery. Self-evaluation by the programme designer is standard for a service pilot but not good enough for anything intended to add to an evidence base.
A comparison condition, even a waitlist, so improvement can be separated from time and attention.
Post exit measurement as a condition of the design, so leaving the programme early continues to generate data.