AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure

Abstract

In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.

New developments in cognitive-behavioural therapy for eating disorders (CBT-ED)

“…For example, Nameth et al [ 50 ] have shown that virtual reality can be used to deliver cue exposure among patients who binge. Similarly, Porras-Garcia et al [ 51 ▪ ] have demonstrated that virtual reality body exposure has positive effects on body image.…”

Clinical efficacy of a virtual reality tool for the treatment of obesity: study protocol of a randomised controlled trial

“…Assuming an alpha of 0.05 and a power of 0.80 (β−1) in a two-way repeated measure analysis of variance, a minimum of 27 participants would be required per study arm (three treatment conditions × four assessment factors). Allowing for a dropout rate of 20% of study participants from baseline, taking the average score of similar previous studies evaluating VR interventions, [17][18][19] a total of 96 participants need to be recruited.…”

Mirror, mirror, on the wall: During pandemics, how can self-perception research in people with eating disorders happen at all?

“…Such characteristics indicate that ED and non-ED populations may show differences involving the multisensory integration processes underlying embodiment illusions and self-perception more broadly, as explained according to the previously outlined predictive coding theory [10,11]. As indicated in Table 3, researchers have begun to employ the classic embodiment and tactile-reduced paradigms to study the extent to which embodiment illusions occur in ED patients (e.g., [1,2,9,[27][28][29][30][31]).…”

“…According to our search of the literature for such studies involving ED participants, there are at least seven studies that have been published since 2014 (the details of these studies are provided in Table 3; [2,[27][28][29][38][39][40]). Encouragingly, six out of these seven studies have reported evidence for improvements involving image related concerns (usually as indicated via reduced size over-estimations).…”