Virtual Reality Body Exposure Therapy for Anorexia Nervosa. A Case Report With Follow-Up Results

Abstract

Objective: Exposure-based therapies such as mirror exposure may help to improve the results of classic cognitive behavioral therapy in anorexia nervosa (AN). Virtual reality (VR)-based procedures provide interesting novelties for targeting body-related concerns. This study aimed to provide preliminary evidence of the usefulness of a VR body exposure therapy in a patient diagnosed with AN. Method: Fear of gaining weight (FGW), body anxiety, drive for thinness, body image disturbances, body mass index and body-related attentional bias were assessed before and after the intervention, as well as 5 months later. Five sessions of VR body exposure therapy were included within the standard course of cognitive behavioral therapy. The sessions involved a systematic and hierarchical exposure of the patient to a virtual representation of her own silhouette, with the body mass index of the avatar progressively increasing in subsequent sessions. Results: After the intervention, there was a clear reduction in AN symptoms such as the FGW, drive for thinness, body-related anxiety and dissatisfaction. Body mass index values rose continuously during the intervention and reached healthy levels. Finally, there was a notable change in the dysfunctional body-related attentional bias. Almost all these improvements were maintained after 5 months, except for the FGW. Conclusion: To the best of our knowledge, this study is the first to focus on treating the FGW and body-related concerns in AN using a VR-based paradigm. To pursue this study further and assess the effectiveness of this new VR software, larger controlled clinical trials are needed.

Validity of Virtual Reality Body Exposure to Elicit Fear of Gaining Weight, Body Anxiety and Body-Related Attentional Bias in Patients with Anorexia Nervosa

“…Consequently, focusing on the primary conditioned stimulus (weight gain) rather than on the secondary ones, such as eating, may be an effective strategy. As has been reported, VR embodiment-based techniques are a successful way to change body image disturbances in patients with AN [ 39 , 40 , 41 ]. We propose going one step further.…”

“…Specifically, among AN patients, Keizer et al [ 39 ] found that owning a skinny virtual body significantly reduced the perceived body size in AN patients, as well as in healthy participants. These results were later replicated by two case report studies, which showed that VR embodiment-based techniques (e.g., using a visuo-tactile stimulation procedure) allowed the modification of body image disturbances either in the short term [ 40 ] or over several sessions [ 41 ].…”

“…Following the rubber hand illusion paradigm, a previous study found that ED patients tend to experience a stronger illusion over a fake hand than healthy individuals [ 34 ]. Alternatively, a large number of studies have investigated the effects of the FBI on the whole body to assess body image disturbances, for a review, see [ 28 ], finding that the perception of body size and weight may be changed in nonclinical samples [ 35 , 36 , 37 , 38 ] and ED patients [ 39 , 40 , 41 ]. Specifically, among AN patients, Keizer et al [ 39 ] found that owning a skinny virtual body significantly reduced the perceived body size in AN patients, as well as in healthy participants.…”

“…These limitations can be overcome by the application of VR techniques that do not rely on the patient’s visualization ability and reduce the possibility of avoidance behaviors. Therefore, VR exposure therapy provides a useful approach to targeting FGW [ 41 ].…”

Extended Reality for the Clinical, Affective, and Social Neurosciences

“…Obviously, to be realistic, the VR model tries to mimic the brain model as much as possible: the more the VR model is similar to the brain model, the more the individual feels present in the VR world" (p. 89). These features allow clinical XR platforms (e.g., VR) to structure, augment, and/or replace the patient's bodily experience in novel ways that can be used in clinical applications [37][38][39][40]. Further, clinical XR provides novel embodied paths to assess patient brain function [41] by directly targeting the processes underpinning real-world behaviors [42][43][44].…”