Virtual Reality Exposure to a Healthy Weight Body Is a Promising Adjunct Treatment for Anorexia Nervosa

Abstract

<b><i>Introduction/Objective:</i></b> Treatment results of anorexia nervosa (AN) are modest, with fear of weight gain being a strong predictor of treatment outcome and relapse. Here, we present a virtual reality (VR) setup for exposure to healthy weight and evaluate its potential as an adjunct treatment for AN. <b><i>Methods:</i></b> In two studies, we investigate VR experience and clinical effects of VR exposure to higher weight in 20 women with high weight concern or shape concern and in 20 women with AN. <b><i>Results:</i></b> In study 1, 90% of participants (18/20) reported symptoms of high arousal but verbalized low to medium levels of fear. Study 2 demonstrated that VR exposure to healthy weight induced high arousal in patients with AN and yielded a trend that four sessions of exposure improved fear of weight gain. Explorative analyses revealed three clusters of individual reactions to exposure, which need further exploration. <b><i>Conclusions:</i></b> VR exposure is a well-accepted and powerful tool for evoking fear of weight gain in patients with AN. We observed a statistical trend that repeated virtual exposure to healthy weight improved fear of weight gain with large effect sizes. Further studies are needed to determine the mechanisms and differential effects.

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“…Furthermore, the inability to update their body image based on new experiences hinders them from accurately interpreting their internal signals related to emotions. To address this issue, as done with anxiety disorders, VR/AR systems are successfully used to extinguish/habituate craving [ 50 ] and anxiety responses to food‐related [ 51 , 52 ] and body-related cues [ 53 , 54 ].…”

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“…To illustrate this, we surveyed all 2022 and 2023 issues of Psychotherapy and Psychosomatics which ranks among the highest-impact psychology journals (Impact Factor 2023: 26.617). We found that of 17 studies that reported results of regression analyses [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], only six made use of at least one of these visualizations [22][23][24][25][26][27]. One of them applied a forest plot variant [22].…”

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“…Consequently, 81 papers were deemed eligible for a full text review; 71 of them being excluded for various reasons (see Supplementary File S3). A total of 10 publications were finally included [116][117][118][119][120][121][122][123][124][125]. The Cohen kappa coefficient demonstrated a substantial level of agreement, being categorized as "good" (κ = 0.67) (range 0.61-0.80) based on the categories developed by Altman [44].…”

“…The majority of the studies were conducted in Spain (n = 5; 50%) [117,118,[121][122][123]. The remaining papers were published in Italy (n = 3; 30%) [120,124,125], Germany (n = 1; 10%) [116] and the Netherlands (n = 1; 10%) [119]. All the studies involved followed a quantitative approach (n = 10; 100%) [116][117][118][119][120][121][122][123][124][125] (Table 1).…”

“…Behrens et al [116] 2023 Germany Quantitative Porras-Garcia et al [117] 2020 Spain Quantitative Porras-Garcia et al [118] 2021 Spain Quantitative Keizer et al [119] 2016 Netherlands Quantitative Malighetti et al [120] 2021 Italy Quantitative Marco et al [121] 2013 Spain Quantitative Porras-Garcia et al [122] 2020 Spain Quantitative Porras-Garcia et al [123] 2020 Spain Quantitative Provenzano et al [124] 2020 Italy Quantitative Serino et al [125] 2019 Italy Quantitative…”