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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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Jeanningros A, Baillot A, Corno G, Rivard MC, Aimé A, Bouchard S. Validation of a Virtual Environment to Induce State Social Physique Anxiety in Women with Obesity and Social Physique Anxiety. J Clin Med 2023; 12:6065. [PMID: 37763006 PMCID: PMC10531808 DOI: 10.3390/jcm12186065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
State Social Physique Anxiety (SPA), in contrast to Trait SPA, is triggered by specific situations that elicit SPA. To date, no research has used virtual reality (VR) to recreate a situation that may elicit State SPA. The purpose of this study is to validate a virtual environment (VE) that simulates an anxiogenic situation to induce State SPA in women with obesity and high SPA. The high SPA group consisted of 25 self-identified women living with obesity and high Trait SPA. The low SPA group consisted of 20 self-identified women with low SPA. All participants were immersed in a virtual swimming pool environment for 10 min using a virtual reality headset. After the immersion, State SPA and fear of being negatively judged felt during immersion were measured with self-report questionnaires. A questionnaire assessing unwanted negative side effects was administered before and after the immersion. Using an ANCOVA with Trait SPA as covariate, State SPA was found to be significantly higher in the high SPA group. Fear of being judged negatively was also significantly higher in the high SPA group. Unwanted negative side effects scores did not increase post-immersion in either group. This study documents the validity of a novel VE for inducing State SPA in women with obesity and high SPA.
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Affiliation(s)
- Alice Jeanningros
- Psychoeducation and Psychology Department, Université du Québec en Outaouais (UQO), Gatineau, QC J8X 3X7, Canada
| | - Aurélie Baillot
- Interdisciplinary Health School, Université du Québec en Outaouais (UQO), 283 Boul. Alexandre-Taché, Gatineau, QC J8X 3X7, Canada
- Psychosocial Medicine Research Center, Centre Intégré de Santé et Services Sociaux de l’Outaouais (CISSSO), Gatineau, QC J8T 4J3, Canada
- Institut du Savoir de Montfort-Research Hospital, Ottawa, ON K1K 0T2, Canada
| | - Giulia Corno
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal IUSMM, Montreal, QC H1N 3V2, Canada
| | - Marie-Christine Rivard
- Cyberpsychology Laboratory, Université du Québec en Outaouais (UQO), Gatineau, QC J8X 3X7, Canada
| | - Annie Aimé
- Psychoeducation and Psychology Department, Université du Québec en Outaouais (UQO), Gatineau, QC J8X 3X7, Canada
| | - Stéphane Bouchard
- Psychoeducation and Psychology Department, Université du Québec en Outaouais (UQO), Gatineau, QC J8X 3X7, Canada
- Psychosocial Medicine Research Center, Centre Intégré de Santé et Services Sociaux de l’Outaouais (CISSSO), Gatineau, QC J8T 4J3, Canada
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3
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Manasse SM, Trainor C, Payne-Reichert A, Abber SR, Lampe EW, Gillikin LM, Juarascio AS, Forman EM. Does virtual reality enhance the effects of inhibitory control training for loss-of-control eating? A pilot factorial experiment. Eat Behav 2023; 50:101749. [PMID: 37301016 DOI: 10.1016/j.eatbeh.2023.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
Inhibitory control, one's ability to inhibit automatic responses to desirable stimuli, may be inadequately targeted in interventions for loss-of-control eating (LOC). Promising evidence has identified inhibitory control trainings (ICTs) as an avenue to target inhibitory control directly; however, effects of ICTs on real-world behavior are limited. Compared to typical computerized trainings, virtual reality (VR) presents several potential advantages that may address key shortcomings of traditional ICTs, i.e. poor approximation to everyday life. The present study utilized a 2 × 2 factorial design of treatment type (ICT vs sham) by treatment modality (VR vs standard computer), which allows for increased statistical power by collapsing across conditions. Our primary aim was to examine the feasibility and acceptability of six weeks of daily training among groups. A secondary aim was to preliminarily assess main and interactive effects of treatment type and modality on target engagement and efficacy (i.e., training compliance, change in LOC episodes, inhibitory control, and implicit liking of foods). Participants (N = 35) with ≥1×/weekly LOC were assigned to one of four conditions and completed ICTs daily for six weeks. The trainings were feasible and acceptable, evinced by high retention and compliance across time and condition. Although completing daily trainings across treatment types and modalities was associated with large decreases in LOC, there were no meaningful effects of either treatment type or modality, nor a significant interaction effect, on LOC or mechanistic variables. Future research should aim to increase the efficacy of ICT (both standard and VR-based) and test in fully-powered clinical trials.
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Affiliation(s)
- Stephanie M Manasse
- Department of Psychology, Drexel University, 3141 Chestnut St. Philadelphia, PA 19104, United States; Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA 19104, United States.
| | - Claire Trainor
- Department of Psychology, Drexel University, 3141 Chestnut St. Philadelphia, PA 19104, United States; Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA 19104, United States
| | - Adam Payne-Reichert
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA 19104, United States
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, FL 31302, United States
| | - Elizabeth W Lampe
- Department of Psychology, Drexel University, 3141 Chestnut St. Philadelphia, PA 19104, United States; Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA 19104, United States
| | - Lindsay M Gillikin
- Department of Psychology, University of Wyoming, Laramie, WY 83027, United States
| | - Adrienne S Juarascio
- Department of Psychology, Drexel University, 3141 Chestnut St. Philadelphia, PA 19104, United States; Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA 19104, United States
| | - Evan M Forman
- Department of Psychology, Drexel University, 3141 Chestnut St. Philadelphia, PA 19104, United States; Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA 19104, United States
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Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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5
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Edwards CG, Sajjadi P, Fatemi A, Krieger EN, Klippel A, Masterson TD. The Immersive Virtual Alimentation and Nutrition Application: An Interactive Digital Dietitian. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:481-484. [PMID: 35534104 DOI: 10.1016/j.jneb.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Caitlyn G Edwards
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - Pejman Sajjadi
- The Center for Immersive Experiences, The Pennsylvania State University, University Park, PA
| | - Alex Fatemi
- The Center for Immersive Experiences, The Pennsylvania State University, University Park, PA
| | - Erica N Krieger
- The Center for Immersive Experiences, The Pennsylvania State University, University Park, PA
| | - Alexander Klippel
- Department of Environmental Sciences, Wageningen University and Research, Wageningen, the Netherlands
| | - Travis D Masterson
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA.
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6
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Xu C, Siegrist M, Hartmann C. The application of virtual reality in food consumer behavior research: A systematic review. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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Della Libera C, Quertemont E, Laloyaux J, Thonon B, Larøi F. Using 360° immersive videos to assess paranoia in a non-clinical population. Cogn Neuropsychiatry 2021; 26:357-375. [PMID: 34284703 DOI: 10.1080/13546805.2021.1956885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: For the past two decades, virtual reality (VR) has proven to be an innovative approach for the assessment of state paranoia. However, the use of VR remains costly, and avatars are still far from realistic in terms of facial and bodily expressions. The present study aimed to test the validity of three 360° immersive videos (360IVs) as an accessible and realistic alternative for the assessment of non-clinical state paranoia.Method: Three 360IVs were created (a Lift, a Library and a Bar) and included actors behaving naturally. One hundred and fifty healthy students were assessed in terms of their proneness towards trait paranoia, were then exposed to one of the three 360IVs, and finally completed measures of state paranoia, sense of presence and cybersickness.Results: Results revealed the presence of various interpretations about the actor's attitudes in the three 360IVs. Also, paranoid thoughts were predicted by proneness towards trait paranoia in two out of the three 360IVs. Furthermore, moderate levels of sense of presence and low levels of cybersickness were observed for each 360IV.Conclusion: The present study provides evidence in favour of the use of 360IVs as a new accessible, realistic, and standardised tool to assess state paranoia in non-clinical samples.
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Affiliation(s)
- Clara Della Libera
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Etienne Quertemont
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Julien Laloyaux
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Bénédicte Thonon
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Frank Larøi
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Norwegian Center for Mental Disorders Research, University of Oslo, Oslo, Norway
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8
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Colombo D, Díaz-García A, Fernandez-Álvarez J, Botella C. Virtual reality for the enhancement of emotion regulation. Clin Psychol Psychother 2021; 28:519-537. [PMID: 34048621 DOI: 10.1002/cpp.2618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 01/21/2023]
Abstract
In recent decades, a growing body of literature has focused on emotion regulation (ER), which refers to the ability to implement strategies in order to modulate emotional responses and reach desirable goals. To date, impaired ER (i.e., emotion dysregulation) has been identified as a transdiagnostic factor across a wide range of psychopathological conditions, which shows the importance of improving patients' ability to regulate negative and positive emotions in clinical practice. In addition to the increasing evidence showing its efficacy in the treatment of several clinical conditions, virtual reality (VR) has recently emerged as a potentially powerful tool for enhancing ER, thus breaking new ground in the development of cutting-edge transdiagnostic interventions. In the present narrative review, we will provide an overview of the existing evidence about VR-based interventions in the field of ER, emphasizing the promising findings and the barriers that still have to be addressed. To this aim, the available VR-based literature will be analysed in relation to four categories of ER strategies: situational strategies, attentional strategies, cognitive strategies, and response modulation strategies. Furthermore, new emerging fields of research targeting innovative aspects of ER will be highlighted, including the use of VR to promote positive emotions and interpersonal ER skills. Besides, its cost-effectiveness will be discussed, taking into account the costs for both developers (e.g., clinicians and researchers) and end-users. Finally, future directions in this promising field of research will be outlined.
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Affiliation(s)
- Desirée Colombo
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | - Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Cristina Botella
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
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9
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Riva G, Malighetti C, Serino S. Virtual reality in the treatment of eating disorders. Clin Psychol Psychother 2021; 28:477-488. [PMID: 34048622 PMCID: PMC8362149 DOI: 10.1002/cpp.2622] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/07/2021] [Accepted: 05/21/2021] [Indexed: 12/19/2022]
Abstract
Over the last 25 years, virtual reality (VR) has offered innovative solutions for targeting different key symptoms of eating disorders: from craving to negative emotions, from attentional biases to body dissatisfaction. The present narrative review assesses the existing literature in these areas trying to identify their different levels of clinical evidence. Specifically, the review presents four clinical approaches based upon VR and their implications in the treatment of eating disorders: VR cue exposure, VR reference frame shifting, VR for correcting body distortions and attentional biases. In general, existing findings demonstrate the clinical value of VR. On one side, the present review suggests that two VR-based techniques-VR exposure and reference frame shifting-have a significant research support and provide a possible advantage over traditional cognitive-behavioural therapy (CBT) for bulimia nervosa and binge eating disorder. On the other side, two emerging VR applications-multisensory body illusions and the use of VR for the modification of attentional biases-even if supported by preliminary data still need further research.
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Affiliation(s)
- Giuseppe Riva
- Applied Technology for Neuro‐Psychology Lab.Istituto Auxologico ItalianoMilanItaly
- Humane Technology Lab.Università Cattolica del Sacro CuoreMilanItaly
| | - Clelia Malighetti
- Humane Technology Lab.Università Cattolica del Sacro CuoreMilanItaly
| | - Silvia Serino
- Humane Technology Lab.Università Cattolica del Sacro CuoreMilanItaly
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10
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Using virtual reality to train inhibitory control and reduce binge eating: A proof-of-concept study. Appetite 2020; 157:104988. [PMID: 33049341 DOI: 10.1016/j.appet.2020.104988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE One reason for limited efficacy of treatments for binge eating disorder (BED) and bulimia nervosa (BN) is a failure to directly target deficits in inhibitory control (i.e., the ability to withhold a pre-potent response). Inhibitory control trainings (ICTs; computerized tasks meant to improve inhibitory control) have shown promise but appear not to be powerful enough to generalize to real-word eating behavior or engaging enough for to sustain long-term compliance. Delivering an ICT through virtual reality (VR) technology should increase intervention power because 3D imagery and actual real hand/arm movements are lifelike and may improve compliance because the VR environment is highly engaging. Thus, we created the first-ever VR-based ICT to test its initial feasibility, acceptability, and impact on binge eating. METHOD We recruited participants (N = 14) with once-weekly loss-of-control (LOC) eating to use the VR ICT daily, at home, for two weeks, and measured feasibility, acceptability and change in LOC eating at post-intervention and 2-week follow-up. RESULTS The VR ICT was feasible to construct and deploy, and demonstrated high acceptability and compliance (i.e., 86.8% of daily trainings completed). Users of the VR ICT experienced large decreases in LOC eating at post-intervention and 2-week follow-up. DISCUSSION Results from this initial pilot indicate that delivering ICT through VR is feasible, acceptable, and is associated with reductions in binge eating. Future study is warranted and should examine whether a VR ICT can serve as a useful adjunct to standard treatment for BN and BED.
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11
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Ye Y, Wong SC, Li YC, Lau YK. Risks to pedestrians in traffic systems with unfamiliar driving rules: a virtual reality approach. ACCIDENT; ANALYSIS AND PREVENTION 2020; 142:105565. [PMID: 32361475 DOI: 10.1016/j.aap.2020.105565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
In this study, a virtual-reality (VR) pedestrian simulation method was used to evaluate the risks to pedestrians crossing streets in a traffic system with driving rules that were unfamiliar to them. Pedestrians from mainland China (which has a right-side driving (RD) system) and Hong Kong (which has a left-side driving (LD) system) were studied. Significant differences were observed between pedestrians from the different locations in terms of the direction in which the pedestrians habitually first looked before crossing. When exposed to an unfamiliar driving rule (i.e., traffic coming from an inconsistent direction in terms of participants' habitual driving system), the odds of participants from mainland China making an error in their looking behavior were 2.93 times those when exposed to a familiar driving rule. Road markings and traffic sound did not improve these participants' looking behavior. The results also show a negative correlation between inattentive looking behavior and time to collision (significant at the 1% level), as these errors lead to a shorter time to collision and increased the risk to pedestrians. The results of this study confirmed the risks for pedestrians traveling to places with unfamiliar driving rules and confirmed the existence of habitual looking behavior, and therefore provide evidence of the need for future studies to improve this problem. These may help decision makers take the risks of pedestrians from different driving rules into consideration in future traffic policymaking or traffic-facility improvements. The use of a VR simulation-based approach in this study provided a safe and controllable way to trial interventions and potential improvements without risking injury to participants, and thus may also be used for similar future studies.
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Affiliation(s)
- Yun Ye
- Department of Civil Engineering, The University of Hong Kong, China.
| | - S C Wong
- Department of Civil Engineering, The University of Hong Kong, China.
| | - Y C Li
- Department of Civil Engineering, The University of Hong Kong, China.
| | - Y K Lau
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, China.
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12
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Comparison of body image evaluation by virtual reality and paper-based figure rating scales in adolescents with anorexia nervosa: retrospective study. Eat Weight Disord 2020; 25:735-743. [PMID: 30977098 DOI: 10.1007/s40519-019-00680-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/15/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Assessment of the symptoms of body image disorder (BID) is crucial in anorexia nervosa (AN). Recent technological advancements such as virtual reality (VR) have improved the visual perception with 3D avatars and the feeling to be the avatar with the immersive conditions. This retrospective study examines the hypothesis that VR with standardized 3D avatars would improve body image perception and then body image evaluation by adolescents with AN, compared to the paper-based figure rating scales (FRS). METHODS Data of 31 female adolescents with AN were retrospectively studied. Paired data of perceived and desired body forms in addition to body perception index (BPI) (p = 0.2) and body dissatisfaction (p = 0.6), obtained by both VR and FRS were compared. Furthermore, correlation with validated psychometric questionnaires was also studied. Head-tracking technology allowed for the implicit measurement of explicit choices of patients. RESULTS Participants with AN overestimated own body size regardless of the assessment tool used. BPI and body dissatisfaction did not differ significantly between FRS and VR. VR-based evaluation was correlated with the psychometric parameters BID and body dissatisfaction. Head tracking revealed significantly longer participant engagement with avatars representing malnutrition and underweight states, while those least engaged corresponded to obesity. CONCLUSIONS Results of BID evaluation by VR standardized 3D avatars are comparable to those obtained by paper-based FRS. These findings suggest that comparable results obtained by both tools of evaluation reflect primarily the role of affective-cognitive perturbation in BID. The perceptive component could be better evaluated using biometric-enhanced assessment tools. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study (evaluation data retrospectively studied).
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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? Eat Weight Disord 2019; 24:757-765. [PMID: 28752497 DOI: 10.1007/s40519-017-0419-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/13/2017] [Indexed: 01/26/2023] Open
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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Where would you like to eat? A formative evaluation of mixed-reality solitary meals in virtual environments for older adults with mobility impairments who live alone. Food Res Int 2019; 117:30-39. [DOI: 10.1016/j.foodres.2018.02.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/21/2022]
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Riva G, Gutiérrez-Maldonado J, Dakanalis A, Ferrer-García M. Virtual Reality in the Assessment and Treatment of Weight-Related Disorders. VIRTUAL REALITY FOR PSYCHOLOGICAL AND NEUROCOGNITIVE INTERVENTIONS 2019. [DOI: 10.1007/978-1-4939-9482-3_7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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16
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Ferrer-Garcia M, Pla-Sanjuanelo J, Dakanalis A, Vilalta-Abella F, Riva G, Fernandez-Aranda F, Forcano L, Riesco N, Sánchez I, Clerici M, Ribas-Sabaté J, Andreu-Gracia A, Escandón-Nagel N, Gomez-Tricio O, Tena V, Gutiérrez-Maldonado J. A Randomized Trial of Virtual Reality-Based Cue Exposure Second-Level Therapy and Cognitive Behavior Second-Level Therapy for Bulimia Nervosa and Binge-Eating Disorder: Outcome at Six-Month Followup. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 22:60-68. [PMID: 30059240 DOI: 10.1089/cyber.2017.0675] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article reviews the 6-month followup data of a randomized, multicenter, parallel-group study conducted at five clinical sites in three European cities, which compared two second-level treatments for bulimia nervosa (BN) and binge eating disorder (BED): virtual reality-based cue exposure therapy (VR-CET) versus additional cognitive behavioral therapy (A-CBT). Post-treatment outcomes of this study were previously published and details of its design can be found at clinicaltrials.gov (identifier: NCT02237300). This article focuses on the evolution of symptoms assessed after 6 months of followup in a subgroup of 58 patients from the original study. In this study 64 patients with eating disorders (EDs) (35 with BN and 29 with BED), who still showed active episodes of binge eating by the end of a structured CBT program (first-level treatment), were randomly assigned to one of two second-level treatments (A-CBT or VR-CET). Frequency of binge and purge episodes, and attitudinal features of binge-related EDs (bulimia, drive for thinness, and body dissatisfaction) were assessed before starting the second-level treatment (n = 64), at the end (n = 64), and at 6-month followup (n = 58). Mixed between-within subject analyses of variance were used to compare outcomes of both second-level treatments over time. Although both treatment conditions showed statistically significant improvements at the end and after 6-month followup, obtained reductions were greater after VR-CET, regarding binge and purge episodes, as well as the decrease of self-reported tendency to engage in overeating episodes. Accordingly, abstinence from binge episodes were higher in VR-CET than A-CBT at followup (70 percent vs. 26 percent, respectively; χ2 = 11.711, p = 0.001). These results provide further support for the use of VR-CET as an effective second-level intervention for BN and BED treatment-resistant patients.
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Affiliation(s)
- Marta Ferrer-Garcia
- 1 Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Joana Pla-Sanjuanelo
- 1 Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Antonios Dakanalis
- 2 Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.,3 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ferran Vilalta-Abella
- 1 Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Giuseppe Riva
- 3 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,4 Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.,5 Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain.,6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain.,7 Department of Psychiatry, University Hospital Joan XXIII, Tarragona, Spain.,8 Unit of Eating Disorders, Centro ABB Tarragona, Tarragona, Spain.,9 Department of Psychology, Universidad Católica de Temuco, Temuco, Chile.,10 Department of Psychology, University Cattolica del Sacro Cuore, Milan, Italy
| | - Fernando Fernandez-Aranda
- 6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
| | - Laura Forcano
- 6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
| | - Nadine Riesco
- 6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
| | - Isabel Sánchez
- 6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
| | - Massimo Clerici
- 4 Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Joan Ribas-Sabaté
- 5 Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain
| | - Alexis Andreu-Gracia
- 5 Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain
| | | | - Osane Gomez-Tricio
- 7 Department of Psychiatry, University Hospital Joan XXIII, Tarragona, Spain
| | - Virginia Tena
- 8 Unit of Eating Disorders, Centro ABB Tarragona, Tarragona, Spain
| | - José Gutiérrez-Maldonado
- 1 Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
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Clus D, Larsen ME, Lemey C, Berrouiguet S. The Use of Virtual Reality in Patients with Eating Disorders: Systematic Review. J Med Internet Res 2018; 20:e157. [PMID: 29703715 PMCID: PMC5948410 DOI: 10.2196/jmir.7898] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/28/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022] Open
Abstract
Background Patients with eating disorders are characterized by pathological eating habits and a tendency to overestimate their weight and body shape. Virtual reality shows promise for the evaluation and management of patients with eating disorders. This technology, when accepted by this population, allows immersion in virtual environments, assessment, and therapeutic approaches, by exposing users to high-calorie foods or changes in body shape. Objective To better understand the value of virtual reality, we conducted a review of the literature, including clinical studies proposing the use of virtual reality for the evaluation and management of patients with eating disorders. Methods We searched PubMed, PsycINFO, ScienceDirect, the Cochrane Library, Scopus, and Web of Science up to April 2017. We created the list of keywords based on two domains: virtual reality and eating disorders. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify, select, and critically appraise relevant research while minimizing bias. Results The initial database searches identified 311 articles, 149 of which we removed as duplicates. We analyzed the resulting set of 26 unique studies that met the inclusion criteria. Of these, 8 studies were randomized controlled trials, 13 were nonrandomized studies, and 5 were clinical trials with only 1 participant. Most articles focused on clinical populations (19/26, 73%), with the remainder reporting case-control studies (7/26, 27%). Most of the studies used visual immersive equipment (16/26, 62%) with a head-mounted display (15/16, 94%). Two main areas of interest emerged from these studies: virtual work on patients’ body image (7/26, 27%) and exposure to virtual food stimuli (10/26, 38%). Conclusions We conducted a broad analysis of studies on the use of virtual reality in patients with eating disorders. This review of the literature showed that virtual reality is an acceptable and promising therapeutic tool for patients with eating disorders.
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Affiliation(s)
- Damien Clus
- Department of Mental Health, University Hospital of Brest, Brest, France
| | - Mark Erik Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Christophe Lemey
- Department of Mental Health, University Hospital of Brest, Université de Bretagne Occidentale, Brest, France
| | - Sofian Berrouiguet
- UMR CNRS 6285 Lab-STICC, Institut Mines Télécom Atlantique, Université Bretagne Loire F-29238 Brest, Brest, France.,EA 7479 Soins Primaires, Santé Publique et Registre des cancers de Bretagne Occidentale, Department of Mental Health, Université de Bretagne Occidentale, Brest, France
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Perpiñá C, Segura M, Sánchez-Reales S. Cognitive flexibility and decision-making in eating disorders and obesity. Eat Weight Disord 2017; 22:435-444. [PMID: 27744608 DOI: 10.1007/s40519-016-0331-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/04/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of the present study was to compare decision-making and cognitive flexibility in patients with disordered eating and weight, ranging from anorexia nervosa to obesity, and a healthy group. METHOD Participants were 113 patients (86 with eating disorders and 27 with obesity), and a group of 39 healthy subjects; all completed the Iowa gambling task, the Wisconsin Card Sorting Test and several clinical self-report measures. RESULTS Eating disordered and obese patients showed impaired performance on the decision-making task, and the obese group showed the worst performance on the set-shifting task. There were no associations between neuropsychological performance and eating or obsessive symptomatology, although significant associations were found with anxiety and depression measures. DISCUSSION Considering the executive functions as a transdiagnostic process in ED and obesity could provide explanations for the inability to regulate food intake, present in both ED and obese patients. Implications of these executive impairments in the development and maintenance of ED and obesity are discussed.
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Affiliation(s)
- Conxa Perpiñá
- Dpto. Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Av. Blasco Ibáñez, 21, 46010, Valencia, Spain. .,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.
| | - Mara Segura
- Dpto. Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Av. Blasco Ibáñez, 21, 46010, Valencia, Spain
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[What do virtual reality tools bring to child and adolescent psychiatry?]. Encephale 2017; 44:280-285. [PMID: 28870688 DOI: 10.1016/j.encep.2017.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 06/20/2017] [Accepted: 06/24/2017] [Indexed: 11/20/2022]
Abstract
Virtual reality is a relatively new technology that enables individuals to immerse themselves in a virtual world. It offers several advantages including a more realistic, lifelike environment that may allow subjects to "forget" they are being assessed, allow a better participation and an increased generalization of learning. Moreover, the virtual reality system can provide multimodal stimuli, such as visual and auditory stimuli, and can also be used to evaluate the patient's multimodal integration and to aid rehabilitation of cognitive abilities. The use of virtual reality to treat various psychiatric disorders in adults (phobic anxiety disorders, post-traumatic stress disorder, eating disorders, addictions…) and its efficacy is supported by numerous studies. Similar research for children and adolescents is lagging behind. This may be particularly beneficial to children who often show great interest and considerable success on computer, console or videogame tasks. This article will expose the main studies that have used virtual reality with children and adolescents suffering from psychiatric disorders. The use of virtual reality to treat anxiety disorders in adults is gaining popularity and its efficacy is supported by various studies. Most of the studies attest to the significant efficacy of the virtual reality exposure therapy (or in virtuo exposure). In children, studies have covered arachnophobia social anxiety and school refusal phobia. Despite the limited number of studies, results are very encouraging for treatment in anxiety disorders. Several studies have reported the clinical use of virtual reality technology for children and adolescents with autistic spectrum disorders (ASD). Extensive research has proven the efficiency of technologies as support tools for therapy. Researches are found to be focused on communication and on learning and social imitation skills. Virtual reality is also well accepted by subjects with ASD. The virtual environment offers the opportunity to administer controlled tasks such as the typical neuropsychological tools, but in an environment much more like a standard classroom. The virtual reality classroom offers several advantages compared to classical tools such as more realistic and lifelike environment but also records various measures in standardized conditions. Most of the studies using a virtual classroom have found that children with Attention Deficit/Hyperactivity Disorder make significantly fewer correct hits and more commission errors compared with controls. The virtual classroom has proven to be a good clinical tool for evaluation of attention in ADHD. For eating disorders, cognitive behavioural therapy (CBT) program enhanced by a body image specific component using virtual reality techniques was shown to be more efficient than cognitive behavioural therapy alone. The body image-specific component using virtual reality techniques boots efficiency and accelerates the CBT change process for eating disorders. Virtual reality is a relatively new technology and its application in child and adolescent psychiatry is recent. However, this technique is still in its infancy and much work is needed including controlled trials before it can be introduced in routine clinical use. Virtual reality interventions should also investigate how newly acquired skills are transferred to the real world. At present virtual reality can be considered a useful tool in evaluation and treatment for child and adolescent disorders.
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Ferrer-García M, Gutiérrez-Maldonado J, Pla-Sanjuanelo J, Vilalta-Abella F, Riva G, Clerici M, Ribas-Sabaté J, Andreu-Gracia A, Fernandez-Aranda F, Forcano L, Riesco N, Sánchez I, Escandón-Nagel N, Gomez-Tricio O, Tena V, Dakanalis A. A Randomised Controlled Comparison of Second-Level Treatment Approaches for Treatment-Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy. EUROPEAN EATING DISORDERS REVIEW 2017; 25:479-490. [PMID: 28804985 DOI: 10.1002/erv.2538] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/25/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022]
Abstract
A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Marta Ferrer-García
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Spain
| | | | - Joana Pla-Sanjuanelo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Spain
| | | | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Joan Ribas-Sabaté
- Department of Psychiatry and Mental Health, Igualada General Hospital, Spain
| | | | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Laura Forcano
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | | | | | | | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
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Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review. Behav Sci (Basel) 2017; 7:bs7030043. [PMID: 28698483 PMCID: PMC5618051 DOI: 10.3390/bs7030043] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022] Open
Abstract
Several lines of evidence suggest that Virtual Reality (VR) has a potential utility in eating disorders. The objective of this study is to review the literature on the use of VR in bulimia nervosa (BN) and binge eating disorder (BED). Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting systematic reviews, we performed a PubMed, Web of Knowledge and SCOPUS search to identify studies employing VR in the assessment and treatment of BN and BED. The following search terms were used: "virtual reality", "eating disorders", "binge eating", and "bulimia nervosa". From the 420 articles identified, 19 were selected, nine investigated VR in assessment and 10 were treatment studies (one case-report, two non-controlled and six randomized controlled trials). The studies using VR in BN and BED are at an early stage. However, considering the available evidence, the use of VR in the assessment of those conditions showed some promise in identifying: (1) how those patients experienced their body image; and (2) environments or specific kinds of foods that may trigger binge-purging cycle. Some studies using VR-based environments associated to cognitive behavioral techniques showed their potential utility in improving motivation for change, self-esteem, body image disturbances and in reducing binge eating and purging behavior.
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Wiederhold BK, Riva G, Gutiérrez-Maldonado J. Virtual Reality in the Assessment and Treatment of Weight-Related Disorders. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2016; 19:67-73. [PMID: 26882323 DOI: 10.1089/cyber.2016.0012] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Virtual Reality (VR) has, for the past two decades, proven to be a useful adjunctive tool for both assessment and treatment of patients with eating disorders and obesity. VR allows an individual to enter scenarios that simulate real-life situations and to encounter food cues known to trigger his/her disordered eating behavior. As well, VR enables three-dimensional figures of the patient's body to be presented, helping him/her to reach an awareness of body image distortion and then providing the opportunity to confront and correct distortions, resulting in a more realistic body image and a decrease in body image dissatisfaction. In this paper, we describe seminal studies in this research area.
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Affiliation(s)
- Brenda K Wiederhold
- 1 Virtual Reality Medical Center , San Diego, California.,2 Virtual Reality Medical Institute , Brussels, Belgium
| | - Giuseppe Riva
- 3 Department of Psychology, Università Cattolica del Sacro Cuore , Milan, Italy .,4 Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano , Milan, Italy
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St-Pierre-Delorme ME, O'Connor K. Using Virtual Reality in the Inference-Based Treatment of Compulsive Hoarding. Front Public Health 2016; 4:149. [PMID: 27486574 PMCID: PMC4949239 DOI: 10.3389/fpubh.2016.00149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/04/2016] [Indexed: 12/04/2022] Open
Abstract
The present study evaluated the efficacy of adding a virtual reality (VR) component to the treatment of compulsive hoarding (CH), following inference-based therapy (IBT). Participants were randomly assigned to either an experimental or a control condition. Seven participants received the experimental and seven received the control condition. Five sessions of 1 h were administered weekly. A significant difference indicated that the level of clutter in the bedroom tended to diminish more in the experimental group as compared to the control group F(2,24) = 2.28, p = 0.10. In addition, the results demonstrated that both groups were immersed and present in the environment. The results on posttreatment measures of CH (Saving Inventory revised, Saving Cognition Inventory and Clutter Image Rating scale) demonstrate the efficacy of IBT in terms of symptom reduction. Overall, these results suggest that the creation of a virtual environment may be effective in the treatment of CH by helping the compulsive hoarders take action over their clutter.
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Affiliation(s)
| | - Kieron O'Connor
- Institut universitaire en santé mentale de Montréal , Montreal, QC , Canada
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Perpiñá C, Roncero M. Similarities and differences between eating disorders and obese patients in a virtual environment for normalizing eating patterns. Compr Psychiatry 2016; 67:39-45. [PMID: 27095333 DOI: 10.1016/j.comppsych.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 10/22/2022] Open
Abstract
Virtual reality has demonstrated promising results in the treatment of eating disorders (ED); however, few studies have examined its usefulness in treating obesity. The aim of this study was to compare ED and obese patients on their reality judgment of a virtual environment (VE) designed to normalize their eating pattern. A second objective was to study which variables predicted the reality of the experience of eating a virtual forbidden-fattening food. ED patients, obese patients, and a non-clinical group (N=62) experienced a non-immersive VE, and then completed reality judgment and presence measures. All participants rated the VE with similar scores for quality, interaction, engagement, and ecological validity; however, ED patients obtained the highest scores on emotional involvement, attention, reality judgment/presence, and negative effects. The obese group gave the lowest scores to reality judgment/presence, satisfaction and sense of physical space, and they held an intermediate position in the attribution of reality to virtually eating a "fattening" food. The palatability of a virtual food was predicted by attention capturing and belonging to the obese group, while the attribution of reality to the virtual eating was predicted by engagement and belonging to the ED group. This study offers preliminary results about the differential impact on ED and obese patients of the exposure to virtual food, and about the need to implement a VE that can be useful as a virtual lab for studying eating behavior and treating obesity.
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Affiliation(s)
- Conxa Perpiñá
- University of Valencia, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain.
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Giner-Bartolomé C, Fagundo AB, Sánchez I, Jiménez-Murcia S, Santamaría JJ, Ladouceur R, Menchón JM, Fernández-Aranda F. Can an intervention based on a serious videogame prior to cognitive behavioral therapy be helpful in bulimia nervosa? A clinical case study. Front Psychol 2015; 6:982. [PMID: 26236261 PMCID: PMC4500862 DOI: 10.3389/fpsyg.2015.00982] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity. DESIGN Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an "A-B-A-C-A" single case experimental design. Impulsivity levels were assessed with the Conner's Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. RESULTS After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention. DISCUSSION This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN.
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Affiliation(s)
- Cristina Giner-Bartolomé
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | - Ana B Fagundo
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain
| | - Juan J Santamaría
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | | | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain ; Ciber Salud Mental, Instituto de Salud Carlos III , Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain
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Roncero M, Perpiñá C. Normalizing the eating pattern with virtual reality for bulimia nervosa: a case report. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rmta.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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