Using immersive virtual reality to modify body image

An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders

Given the widespread debate on the definition of the terms "Body Schema" and "Body Image", this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role.

Digital communication and virtual reality for extending the behavioural treatment of obesity - the patients' perspective: results of an online survey in Germany

BACKGROUND

CBT has been found effective for the treatment of EDs and obesity. However not all patients achieve clinically significant weight loss and weight regain is common. In this context, technology-based interventions can be used to enhance traditional CBT but are not yet widespread. This survey therefore explores the status quo of pathways of communication between patients and therapists, the use of digital applications for therapy as well as attitudes towards VR from the perspective of patients with obesity in Germany.

METHODS

This cross-sectional online survey was conducted in October 2020. Participants were recruited digitally through social media, obesity associations and self-help groups. The standardized questionnaire included items concerning current treatment, paths of communication with their therapists, and attitudes toward VR. The descriptive analyses were performed with Stata.

RESULTS

The 152 participants were mostly female (90%), had a mean age of 46.5 years (SD = 9.2) and an average BMI of 43.0 kg/m² (SD = 8.4). Face-to-face communication with their therapist was considered of high importance in current treatment (M = 4.30; SD = 0.86) and messenger apps were the most frequently used digital application for communication. Participants were mostly neutral regarding the inclusion of VR methods in obesity treatment (M = 3.27; SD = 1.19). Only one participant had already used VR glasses as part of treatment. Participants considered VR suitable for exercises promoting body image change (M = 3.40; SD = 1.02).

DISCUSSION

Technological approaches in obesity therapy are not widespread. Face-to-face communication remains the most important setting for treatment. Participants had low familiarity with VR but a neutral to positive attitude toward the technology. Further studies are needed to provide a clearer picture of potential treatment barriers or educational needs and to facilitate the transfer of developed VR systems into clinical practice.

Distortions of Body Perception during Immersion in Computer Virtual Reality Using Full-Body Tracking

Person’s immersion in computer virtual reality (VR) is accompanied by numerous distortions in his/her perception due to the replacement of sensory stimuli coming through visual, auditory and partially proprioceptive channels. In this case, the person’s own body becomes an immersion tool, since its movements indirectly affect the movement of the avatar in VR. Performing actions in VR on behalf of the avatar contributes to the appearance of distortions in the perception of one’s own body due to the diffuse effect of actualizing the operational image at the moment of purposeful activity (the subjective body image is modified in accordance with the need to adapt to VR conditions). There are various ways of immersing in VR, taking into account the different degree of involvement of individual parts of the recipient’s real body in controlling a digital character. Thus, the full-body tracking (FBT) technology is becoming widespread, allowing the use of almost all human gross motor skills for projection onto the movements of the avatar. The purpose of the study was to establish the specific features of the distortion of a person’s perception of the size of his/her own body, after its being immersed in computer virtual reality, and the control over the avatar using the FBT technology. The study was conducted in two stages (in 2020 and 2021) in order to compare the intensity and direction of body image distortions of the subjects when they were immersed with and without the FBT technology. The OhShape VR app for mobile immersion without FBT and a modification of the VR Chat app for mobile immersion with FBT were used as experimental exposures. Psychometric data on the subjects’ perception of their own bodies were obtained using the psychometric data on the subjects’ perception of their own bodies were obtained using Moshe Feldenkrais’ methods for physical measurements. According to the results of the study, the use of FBT during immersion in VR leads to distortions in the perception of various body sizes by the subjects, including the trunk and legs, while mobile immersion without the use of FBT only causes distortions in the perception of the dimensions of the upper shoulder girdle. It should be noted that this observation testifies to the connection of distortions with the facts of the involvement of the corresponding parts of the real body of the subjects in the process of controlling the avatar. It is concluded that there are specific distortions in the perception of a person’s own body when being immersed in VR using FBT. Finally, an assumption is made about the possible connection of these distortions with the success of performing intra-environment mobile tasks.

Various Types of Virtual Reality-Based Therapy for Eating Disorders: A Systematic Review

(1) Background: Interactive VR (virtual reality) environments (i.e., using three-dimensional graphics presented with a head-mounted display) have recently become a popular professional tool for the treatment of patients with eating disorders (EDs). However, there are no published review reports that have analyzed the original papers between 2015 and 2021, which additionally focused only on HMD (head-mounted display) 3DVR (three-dimensional virtual reality) exposure and included only three therapeutic categories for ED patients. (2) Methods: The EbscoHost and Scopus databases were searched to identify relevant papers on VR research employing VR in the assessment and treatment of eating disorders. (3) Results: In addition to the known therapeutic divisions for ED, there are new forms of therapy based on 360 cameras, eye-tracking, and remote therapy. (4) Conclusions: The potential of VR in combination with different therapies may offer an alternative for future research. More rigorous testing, especially in terms of larger sample sizes, the inclusion of control groups or multisessions, and follow-up measures, is still needed. The current state of research highlights the importance of the nature and content of VR interventions for ED patients. Future research should look to incorporate more home-based and remote forms of VR tools.

Changes in the Prevalence of Thin Bodies Bias Young Women's Judgments About Body Size

Body dissatisfaction is pervasive among young women in Western countries. Among the many forces that contribute to body dissatisfaction, the overrepresentation of thin bodies in visual media has received notable attention. In this study, we proposed that prevalence-induced concept change may be one of the cognitive mechanisms that explain how beauty standards shift. We conducted a preregistered online experiment with young women (N = 419) and found that when the prevalence of thin bodies in the environment increased, the concept of being overweight expanded to include bodies that would otherwise be judged as "normal." Exploratory analyses revealed significant individual differences in sensitivity to this effect, in terms of women's judgments about other bodies as well as their own. These results suggest that women's judgments about other women's bodies are biased by an overrepresentation of thinness and lend initial support to policies designed to increase size-inclusive representation in the media.

Affecting Explicit and Implicit Body Image with Thin-Idealized Avatars in Virtual Reality: The Role of Sense of Embodiment

A large number of previous studies have examined the effects of thin-ideal avatars on body image in virtual reality (VR), reporting mixed results. A possible explanation is that individuals' sense of embodiment (SoE) can influence the effects of avatars. Using the body discontinuity paradigm, a paradigm rarely used in prior studies, this study explores how SoE affects users' body image when using thin-ideal avatars in VR. A group of 77 female participants were randomly assigned to one of the SoE conditions to complete a VR task using a thin-ideal avatar. The body image was assessed not only using explicit but also with implicit measures. The result shows that participants in a high SoE condition were more likely to have a more positive actual body image than others in a low SoE condition, regardless of whether implicit or explicit measures were used. Furthermore, the ownership subcomponent of the SoE significantly mediated the relationship between thin-ideal avatars exposure and the actual body image using implicit measures. However, no substantial difference in ideal body image was found. These findings extend our understanding of avatar effects in VR, thereby providing additional evidence for using avatars to explore body image-related phenomena and to use them in psychotherapeutic applications such as treatments for eating disorders.

Two components of body-image disturbance are differentially associated with distinct eating disorder characteristics in healthy young women

Body-image disturbance comprises two components. The first is perceptual in nature, and is measured by a discrepancy between one’s actual body and perceived self-image (“perceived–actual discrepancy”). The other component is affective, and is measured by a discrepancy between one’s perceived self-image and ideal body image (“perceived–ideal discrepancy”). The present study evaluated the relationships between body-image disturbance and characteristics of eating disorders such as symptoms and related personality traits. In a psychophysiological experiment, female university students (mean ± SD age = 21.0 ± 1.38 years) were presented with silhouette images of their own bodies that were distorted in terms of width. The participants were asked whether each silhouette image was more overweight than their actual or ideal body images. Eating-disorder characteristics were assessed using six factors from the Japanese version of the Eating Disorder Inventory 2 (EDI2). We found that perceived–actual discrepancies correlated with negative self-evaluation (i.e., factor 3 of the EDI2), whereas perceived–ideal discrepancies correlated with dissatisfaction with one’s own body (i.e., factor 2 of EDI2). These results imply that distinct psychological mechanisms underlie the two components of body-image disturbance.

Anorexia Nervosa, Body Image Perception and Virtual Reality Therapeutic Applications: State of the Art and Operational Proposal

Anorexia Nervosa (AN) patients exhibit distorted body representation. The purpose of this study was to explore studies that analyze virtual reality (VR) applications, related to body image issues, to propose a new tool in this field. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Scopus, and Web of Science databases were explored; the review included 25 studies. Research has increased over the last five years. The selected studies, clinical observational studies (n = 16), mostly concerning patients' population with AN (n = 14) or eating disorders (EDs) diagnosis, presented multiple designs, populations involved, and procedures. Some of these studies included healthy control groups (n = 7). Studies on community sample populations were also selected if oriented toward clinical applications (n = 9). The VR technologies in the examined period (about 20 years) have evolved significantly, going from very complex and bulky systems, requiring very powerful computers, to agile systems. The advent of low-cost VR devices has given a big boost to research works. Moreover, the operational proposal that emerges from this work supports the use of biofeedback techniques aimed at evaluating the results of therapeutic interventions in the treatment of adolescent patients diagnosed with AN.

EXPRESS: The Influence of Three-Dimensional Cues on Body Size Judgements

Research has shown that body size judgements are frequently biased, or inaccurate. Critically, judgement biases are further exaggerated for individuals with eating disorders, a finding that has been attributed to difficulties integrating body features into a perceptual whole. However, current understanding of which body features are integrated when judging body size is lacking. In this study, we examine whether individuals integrate three-dimensional (3D) cues to body volume when making body size judgements. Computer-generated body stimuli were presented in a 3D Virtual Reality (VR) environment. Participants (N = 412) were randomly assigned to one of two conditions: in one condition the to-be-judged body was displayed binocularly (containing 3D cues to body volume), in the other, bodies were presented monocularly (2D cues only). Across 150 trials, participants were required to make a body size judgement of a target female body from a third-person point of view using an unmarked visual analogue scale (VAS). It was found that 3D cues significantly influenced body size judgements. Namely, thin 3D bodies were judged smaller, and overweight 3D bodies were judged larger, than their 2D counterpart. Furthermore, to reconcile these effects, we present evidence that the two perceptual biases, regression to the mean and serial dependence, were reduced by the additional 3D feature information. Our findings increase our understanding of how body size is perceptually encoded and creates testable predictions for clinical populations exhibiting integration difficulties.

How immersive virtual reality can become a key tool to advance research and psychotherapy of eating and weight disorders

Immersive virtual reality technology (VR) still waits for its wide dissemination in research and psychotherapy of eating and weight disorders. Given the comparably high efforts in producing a VR setup, we outline that the technology's breakthrough needs tailored exploitation of specific features of VR and user-centered design of setups. In this paper, we introduce VR hardware and review the specific properties of immersive VR versus real-world setups providing examples how they improved existing setups. We then summarize current approaches to make VR a tool for psychotherapy of eating and weight disorders and introduce user-centered design of VR environments as a solution to support their further development. Overall, we argue that exploitation of the specific properties of VR can substantially improve existing approaches for research and therapy of eating and weight disorders. To produce more than pilot setups, iterative development of VR setups within a user-centered design approach is needed.

Drawings or 3D models: Do illustration methods matter when assessing perceived body size and body dissatisfaction?

Research has reported that both men and women experience body dissatisfaction. Among other instruments, a widely used method to assess perceived body size and body dissatisfaction are figure rating scales. Although a variety of illustration methods (e.g., three-dimensional, or 3D, models and line-drawing models) have been used to create these figure rating scales, to date, they have not been directly compared to one another. Thus, in the first study, which includes 511 participants at a mean age of 46 years old (range: 20–70), the present research work aims to assess how the line-drawing and 3D model scales, representing different body illustration methods, relate to each other. Furthermore, the first study assesses the validity of the indication of body dissatisfaction measured using these figure rating scales by comparing them to body checking or scrutinizing behavior and body appreciation levels. The project’s second study examines the two figure rating scales using objectively measured anthropometric data. In total, 239 participants at a mean age of 54 years (range: 18–94) were included. The results show that figure rating scales can be considered tools that measure perceptual body image due to their positive correlations with body checking behavior (for women) and their negative correlations with body appreciation. The 3D model and line-drawing scales show good to excellent inter-scale reliability, and both scales agree equally well with body mass index (BMI) measurements. Thus, the 3D model and line-drawing scales both seem well suited for assessing perceived body size and perceptual body dissatisfaction, suggesting that neither illustration method is superior to the other.

Views of Practitioners and Researchers on the Use of Virtual Reality in Treatments for Substance Use Disorders

Virtual Reality Therapy (VRT) has been shown to be effective in treating anxiety disorders and phobias, but has not yet been widely tested for Substance Use Disorders (SUDs) and it is not known whether health care practitioners working with SUDs would use VRT if it were available. We report the results of an interview study exploring practitioners’ and researchers’ views on the utility of VRT for SUD treatment. Practitioners and researchers with at least two years’ experience delivering or researching and designing SUD treatments were recruited (n = 14). Interviews were thematically analyzed, resulting in themes relating to the safety and realism of VRT, and the opportunity for the additional insight it could offer to during SUD treatment. Participants were positive about employing VRT as an additional treatment for SUD. VRT was thought suitable for treating adults and people with mental health issues or trauma, provided that risks were appropriately managed. Subsequent relapse, trauma and over-confidence in the success of treatment were identified as risks. The opportunity VRT offered to include other actors in therapy (via avatar use), and observe reactions, were benefits that could not currently be achieved with other forms of therapy. Overall, VRT was thought to offer the potential for safe, realistic, personalized and insightful exposure to diverse triggering scenarios, and to be acceptable for integration into a wide range of SUD treatments.

Targeting body image in eating disorders

Eating disorders, such as anorexia nervosa, are challenging to treat successfully and have a very high relapse rate. Body image disturbance (BID) is a core component of these eating disorders. It is a predictor of onset, treatment outcome and future relapse. However, recent studies suggest that BID can be improved by an adaptation of cognitive bias training. This does not target the accuracy of body size judgements, but instead focuses on how a body of a particular size is categorized by a patient. This recalibration of the categorical boundary at which bodies are judged as overweight, which challenges a patient's existing preconceptions about which constitutes an acceptable body size, seems to lead to a more general reassessment of eating disordered attitudes and a significant improvement in their psychological profile. These promising findings need further trials to determine the long-term effectiveness of such a targeted intervention, but it potentially provides an important additional treatment option. In addition, this cognitive bias training may also be an effective augmentation to treatment in other conditions that feature BID, such as bulimia nervosa and body dysmorphia.

Beyond BMI for self-estimates of body size and shape: A new method for developing stimuli correctly calibrated for body composition

Accurate self-assessment of body shape and size plays a key role in the prevention, diagnosis, and treatment of both obesity and eating disorders. These chronic conditions cause significant health problems, reduced quality of life, and represent a major problem for health services. Variation in body shape depends on two aspects of composition: adiposity and muscularity. However, most self-assessment tools are unidimensional. They depict variation in adiposity only, typically quantified by the body mass index. This can lead to substantial, and clinically meaningful, errors in estimates of body shape and size. To solve this problem, we detail a method of creating biometrically valid body stimuli. We obtained high-resolution 3D body shape scans and composition measures from 397 volunteers (aged 18-45 years) and produced a statistical mapping between the two. This allowed us to create 3D computer-generated models of bodies, correctly calibrated for body composition (i.e., muscularity and adiposity). We show how these stimuli, whose shape changes are based on change in composition in two dimensions, can be used to match the body size and shape participants believe themselves to have, to the stimulus they see. We also show how multivariate multiple regression can be used to model shape change predicted by these 2D outcomes, so that participants' choices can be explained by their measured body composition together with other psychometric variables. Together, this approach should substantially improve the accuracy and precision with which self-assessments of body size and shape can be made in obese individuals and those suffering from eating disorders.