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Abstract
ObjectiveExposure-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.MethodFear 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.ResultsAfter 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.ConclusionTo 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.
Highlights
Anorexia nervosa (AN) affects approximately 1–4% of European women (Keski-Rahkonen and Mustelin, 2016) and is considered a serious mental health disorder
The patient completed the hierarchy of the exposure, indicating that the level of anxiety experienced regarding each body part and the whole body had decreased by at least 40% in each session
Reliable changes and clinically significant changes were only calculated for the measures with clinical and/or community norms available (e.g., body mass index (BMI), EDI-Drive for Thinness (DT), EDI-body dissatisfaction (BD), and Physical Appearance State and Trait Anxiety Scale (PASTAS)). aReliable change.bClinically significant change
Summary
Anorexia nervosa (AN) affects approximately 1–4% of European women (Keski-Rahkonen and Mustelin, 2016) and is considered a serious mental health disorder. Fear of gaining weight (FGW) and body image disturbances have been typically considered to be the core components of eating disorders (ED), including AN (DSM-5, American Psychiatric Association [APA], 2013). Exposure-based therapies may help to improve the effects of classic cognitive behavioral therapy (CBT) for EDs (Murray et al, 2016; Reilly et al, 2017) by targeting body-related fears such as the FGW in AN patients (Reilly et al, 2017). Imaginal exposure may have some significant limitations, for example, difficulties in achieving or maintaining visualization and the risk that patients will deliberately avoid the most feared stimulus during visualization. These limitations can be overcome by the application of virtual reality (VR)
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