Date of Award

5-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School

College of Humanities and Social Sciences

Department/Program

Psychology

Thesis Sponsor/Dissertation Chair/Project Chair

Jazmin Reyes-Portillo

Committee Member

Sally Grapin

Committee Member

Nicole Lytle

Committee Member

Shannon O'Connor

Abstract

Background: Most college students with elevated eating disorder (ED) symptoms do not receive mental health treatment. These students commonly report preference for self-management and lack of perceived need for therapy as barriers to seeking help and engaging with mental health services. Screening surveys and digital mental health interventions (DMHIs) may help address these perceived barriers to treatment. Evidence suggests that DMHIs can be effective at reducing ED symptoms. However, student engagement (e.g., uptake and adherence) with DMHIs is low, which significantly limits their effectiveness. Objective: We adapted an engagement strategy for DMHIs, known as the Supporting Technology Engagement for Prevention (STEP), for college students at risk for EDs. In addition, we tailored a DMHI, Therapy Assisted Online (TAO), for this population. This pilot study aims to evaluate STEP+TAO's feasibility and acceptability. Methods: We conducted an open pilot with 20 undergraduate students who reported elevated ED symptoms. Participants received the STEP+TAO over a four-week intervention period. DMHI engagement rates - including uptake, adherence, and attrition - as well as mental health symptom change were assessed. Results: STEP+TAO was found to be feasible and acceptable to students as evidenced by high uptake (i.e., percentage of participants who accessed TAO at least once), high adherence (i.e., mean number of modules completed by all participants, and the percentage of participants who completed all offered modules), low attrition (i.e., percentage of participants who did not complete the post-intervention assessment), and moderate satisfaction. Additionally, STEP+TAO was associated with significant reductions in anxiety, depression, and ED-related symptoms, from pre- to post-intervention, with large to medium effect sizes. Conclusions: Findings inform future research aimed at increasing DMHI engagement among college students with elevated ED symptoms and other common mental health problems. College counseling centers may increase their impact and cost-effectiveness by strategically incorporating DMHIs into stepped-cared models.

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