Virtual reality-based exposure therapy for Eating Disorders - a systematic review (Preprint)

Abstract

BACKGROUND An interactive VR (virtual reality) environment (i.e. uses three-dimensional graphics presented with a head-mounted display) has recently become a popular serious tool for the treatment of patients with Eating Disorders (ED). However, there are no published review reports that have analyzed the original papers between 2015 and 2021, which additionally focused only on HMD 3DVR exposure. OBJECTIVE The review was registered on PROSPERO webpage, which is an International prospective register of systematic reviews. The number of register is CRD42021272378. We used PRISMA Preferred Reporting Items for Systematic review and Meta-Analyses to identify and analyze the scientific literature on VR research in Eating Disorders, revealing the study objectives, design, diagnostic, sample size, control group (if any), session procedures, methods, intervention and outcomes. We further aimed to capture and describe the methods most commonly used of Virtual reality-based therapy for Eating Disorders patients like Binge Eating Disorder (BED) or Anorexia Nervosa (AN) or Bulimia Nervosa (BN) or Other Specific Feeding Disorder (OSFED), according to Diagnostic and Statistical Manual of Mental Disorders (DSM 3,4,5). METHODS The EbscoHost electronic database was searched to identify relevant papers on VR research to identify studies employing VR in the assessment and treatment of Eating Disorders. The following search terms were used: virtual reality AND treatment or therapy or program or intervention AND eating disorders NOT review or meta-analysis. RESULTS The analysis was based on data from 180 papers and only 15 were selected. Our review demonstrated that VR exposure therapy is effective in provoking realistic reactions to stimuli environment like a usually treatment sometimes even better than the non-immersive world. There are several options for treating EDs, although the review described shows that there are many possible combinations and new alternatives. Reviewed papers showed their potential utility in reducing for example binge eating and increasing justification for change, improving self-esteem, correct body view disturbances. CONCLUSIONS The studies presented in this review suggest that VR-based exposure therapy in ED can be considered a promising addition to treatment as usual therapy or as a self-sufficient therapy. Moreover, the potential of VR in combination with different therapies may offer an alternative for future research. More rigorous testing, especially in terms of larger sample sizes, the inclusion of control groups or multi sessions, and follow-up measures, is still needed. Virtual environments that promote positive stimuli combined with ED knowledge could prove to be a valuable tool for patients with AN, BN, BD, BED, BID, etc. The current state of research highlights the importance of the nature and content of VR interventions for EDs patients. The future research should look to incorporate more home-based forms of VR tools. Searching for studies based on HMD 3DVR exposure was laborious and this proves the lack of many studies on this subject.