Virtual Reality for Enhancing the Cognitive Behavioral Treatment of Obesity With Binge Eating Disorder: Randomized Controlled Study With One-Year Follow-up

Abstract

BackgroundRecent research identifies unhealthful weight-control behaviors (fasting, vomiting, or laxative abuse) induced by a negative experience of the body, as the common antecedents of both obesity and eating disorders. In particular, according to the allocentric lock hypothesis, individuals with obesity may be locked to an allocentric (observer view) negative memory of the body that is no longer updated by contrasting egocentric representations driven by perception. In other words, these patients may be locked to an allocentric negative representation of their body that their sensory inputs are no longer able to update even after a demanding diet and a significant weight loss.ObjectiveTo test the brief and long-term clinical efficacy of an enhanced cognitive-behavioral therapy including a virtual reality protocol aimed at unlocking the negative memory of the body (ECT) in morbidly obese patients with binge eating disorders (BED) compared with standard cognitive behavior therapy (CBT) and an inpatient multimodal treatment (IP) on weight loss, weight loss maintenance, BED remission, and body satisfaction improvement, including psychonutritional groups, a low-calorie diet (1200 kcal/day), and physical training.Methods90 obese (BMI>40) female patients with BED upon referral to an obesity rehabilitation center were randomly assigned to conditions (31 to ECT, 30 to CBT, and 29 to IP). Before treatment completion, 24 patients discharged themselves from hospital (4 in ECT, 10 in CBT, and 10 in IP). The remaining 66 inpatients received either 15 sessions of ECT, 15 sessions of CBT, or no additional treatment over a 5-week usual care inpatient regimen (IP). ECT and CBT treatments were administered by 3 licensed psychotherapists, and patients were blinded to conditions. At start, upon completion of the inpatient treatment, and at 1-year follow-up, patients' weight, number of binge eating episodes during the previous month, and body satisfaction were assessed by self-report questionnaires and compared across conditions. 22 patients who received all sessions did not provide follow-up data (9 in ECT, 6 in CBT, and 7 in IP).ResultsOnly ECT was effective at improving weight loss at 1-year follow-up. Conversely, control participants regained on average most of the weight they had lost during the inpatient program. Binge eating episodes decreased to zero during the inpatient program but were reported again in all the three groups at 1-year follow-up. However, a substantial regain was observed only in the group who received the inpatient program alone, while both ECT and CBT were successful in maintaining a low rate of monthly binge eating episodes.ConclusionsDespite study limitations, findings support the hypothesis that the integration of a VR-based treatment, aimed at both unlocking the negative memory of the body and at modifying its behavioral and emotional correlates, may improve the long-term outcome of a treatment for obese BED patients. As expected, the VR-based treatment, in comparison with the standard CBT approach, ...

Head-Mounted Virtual Reality and Mental Health: Critical Review of Current Research (Preprint)

“…CBT with a VR body image treatment was found to be more effective than traditional CBT for eating disorders [61]. Similarly, Cesa et al [62] found CBT mixed with VR was more effective at reducing weight in patients with binge eating disorders compared to traditional CBT. In an innovative study, Keizer et al [60] created a full body illusion treatment, the study concluded that disturbed experiences of the body in patients with anorexia nervosa could be altered with VR.…”

“…These varied from body image disturbance (BID) [58,59], anorexia and bulimia nervosa [55][56][60][61], food cravings [57] and obesity [62]. VR's visual ability to induce cravings led to specific virtual reality craving exposure therapy (VRCET) being the most common form of intervention [55,57,63].…”

Realidad virtual y sus aplicaciones en trastornos mentales: una revisión

“…Los resultados mostraron pérdida de peso al año de seguimiento. Por el contrario, los participantes en el grupo, no intervenido, recuperaron en promedio la mayor parte del peso que habían perdido durante el programa de hospitalización 24 . En el caso de la anorexia nerviosa, se ha utilizado la RV bajo el supuesto de la experiencia distorsionada persistente del tamaño de su cuerpo, en donde se ha investigado si una ilusión del cuerpo completo afecta la estimación del tamaño corporal de las partes del cuerpo, con estimulación visotáctil sincrónica.…”

Recommendations for Methodology of Virtual Reality Clinical Trials in Health Care by an International Working Group: Iterative Study (Preprint)

“…VR has been used to assess and treat a wide variety of medical, surgical, psychiatric, and neurocognitive conditions including pain [1,2,4,9,13,18], addiction [20][21][22][23][24][25], anxiety disorders [3,6,7,15,[26][27][28][29][30][31][32][33][34][35], schizophrenia [10,11,[36][37][38][39][40], eating disorders [1,[41][42][43][44][45][46][47][48], stroke rehabilitation [5,16,[48][49][50][51], vestibular disorders [52], and movement disorders [53]<...>…”