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Testing virtual reality-based cue-exposure software: Which cue-elicited responses best discriminate between patients with eating disorders and healthy controls?

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Virtual reality (VR) technologies have been proposed as a new tool able to improve on in vivo exposure in patients with eating disorders. This study assessed the validity of a VR-based software for cue exposure therapy (CET) in people with bulimia nervosa (BN) and binge eating disorder (BED).

Methods

Fifty eight outpatients (33 BN and 25 BED) and 135 healthy participants were exposed to 10 craved virtual foods and a neutral cue in four experimental virtual environments (kitchen, dining room, bedroom, and cafeteria). After exposure to each VR scenario, food craving and anxiety were assessed. The frequency/severity of episodes of uncontrollable overeating was also assessed and body mass index was measured prior to the exposure.

Results

In both groups, craving and anxiety responses when exposed to the food-related virtual environments were significantly higher than in the neutral-cue virtual environment. However, craving and anxiety levels were higher in the clinical group. Furthermore, cue-elicited anxiety was better at discriminating between clinical and healthy groups than cue-elicited craving.

Conclusions

This study provides evidence of the ability of food-related VR environments to provoke food craving and anxiety responses in BN and BED patients and highlights the need to consider both responses during treatment. The results support the use of VR-CET in the treatment of eating disorder patients characterized by binge-eating and people with high bulimic symptoms.

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Notes

  1. In order to define a common single criterion for both populations and to establish the appropriate exposure hierarchy, we only assessed food craving associated with images. Craving in presence of food is a common response in both populations, while anxiety is considered a specific anticipatory response commonly associated with binge episodes in ED patients [15], but not usually in non-clinical samples. Nevertheless, during the exposure sessions, we assessed both anxiety and craving in order to establish which of these two responses best discriminated between groups.

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Acknowledgments

This study was supported by the Spanish Ministry of Science and Innovation (MINECO/FEDER/UE; project PSI2011-28801: “Virtual Reality Cue-Exposure Treatment for Bulimia Nervosa”) and a scholarship granted to the first author (Grants for the recruitment of early stage research staff FI-DGR 2014 supported by the Ministry of Economy and Knowledge. Generalitat de Catalunya).

Author information

Authors and Affiliations

  1. Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Paseo Valle de Hebrón, 171, 08035, Barcelona, Spain

    Joana Pla-Sanjuanelo, Marta Ferrer-García, Ferran Vilalta-Abella & José Gutiérrez-Maldonado

  2. Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy

    Giuseppe Riva

  3. Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy

    Giuseppe Riva

  4. Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy

    Antonios Dakanalis

  5. Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain

    Joan Ribas-Sabaté & Alexis Andreu-Gracia

  6. Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBEROBN, Barcelona, Spain

    Fernando Fernandez-Aranda & Isabel Sanchez-Diaz

  7. Department of Psychology, Temuco Catholic University, Temuco, Chile

    Neli Escandón-Nagel

  8. Department of Psychiatry, University Hospital Joan XXIII, Tarragona, Spain

    Osane Gomez-Tricio

  9. Centro ABB Tarragona, Tarragona, Spain

    Virgínia Tena

Authors
  1. Joana Pla-Sanjuanelo
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  2. Marta Ferrer-García
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  3. Ferran Vilalta-Abella
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  13. José Gutiérrez-Maldonado
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Correspondence to José Gutiérrez-Maldonado.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pla-Sanjuanelo, J., Ferrer-García, M., Vilalta-Abella, F. et al. Testing virtual reality-based cue-exposure software: Which cue-elicited responses best discriminate between patients with eating disorders and healthy controls?. Eat Weight Disord 24, 757–765 (2019). https://doi.org/10.1007/s40519-017-0419-4

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