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Frisone F, Brizzi G, Sansoni M, Di Natale AF, Pizzoli SFM, Stanghellini G, Riva G. Autobiographical Memory in Feeding and Eating Disorders: A Systematic Review. Psychopathology 2024:1-25. [PMID: 39378858 DOI: 10.1159/000540901] [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] [Received: 03/30/2024] [Accepted: 07/08/2024] [Indexed: 10/10/2024]
Abstract
INTRODUCTION Prominent eating disorders (EDs) theories identify a critical relationship between body and self. One of the ways to study this relationship is through autobiographical memories (AMs). The present review aimed to evaluate the studies that investigated AM in patients with EDs. METHODS A search of PubMed, ScienceDirect, and Scopus databases was performed to identify relevant articles. Of the 57,113 studies found, 25,016 were not duplicated. After screening, 27 articles were included. RESULTS The studies had some methodological flaws: none of the articles was a randomized control trial and the sample sizes were small. Nevertheless, important evidence emerged because all studies showed that patients with EDs have impaired AM function. This is because the way patients with EDs remember and define themselves is through an allocentric perspective associated with the gazes of others whose role has an impact on AM, body shape, and self. CONCLUSION To our knowledge, this is the first systematic review to examine AM in patients with EDs. Future research is needed in EDs to expand knowledge about the relationship between the body and the self.
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Affiliation(s)
- Fabio Frisone
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giulia Brizzi
- Applied Technology for Neuro-Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Maria Sansoni
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Anna Flavia Di Natale
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Centro de Estudios de Fenomenologia y Psiquiatrías, Diego Portales University, Santiago, Chile
| | - Giuseppe Riva
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Applied Technology for Neuro-Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Di Natale AF, Pizzoli SFM, Brizzi G, Di Lernia D, Frisone F, Gaggioli A, Rabarbari E, Oasi O, Repetto C, Rossi C, Scerrati E, Villani D, Riva G. Harnessing Immersive Virtual Reality: A Comprehensive Scoping Review of its Applications in Assessing, Understanding, and Treating Eating Disorders. Curr Psychiatry Rep 2024; 26:470-486. [PMID: 39083129 PMCID: PMC11344702 DOI: 10.1007/s11920-024-01523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/25/2024]
Abstract
BACKGROUND Immersive Virtual Reality (IVR) has shown promise in the assessment, understanding, and treatment of eating disorders (EDs), providing a dynamic platform for clinical innovation. This scoping review aims to synthesize the recent advancements and applications of IVR in addressing these complex psychological disorders. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols, focusing on studies published in the past five years. It included peer-reviewed papers that used IVR for ED assessment, examination, or treatment. A comprehensive database search provided a selection of relevant articles, which were then methodically screened and analyzed. RESULTS Twenty studies met the inclusion criteria, with a primary focus on Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED). The application of IVR was categorized into three areas: assessment, understanding, and treatment. IVR was found to be an effective tool in assessing body image distortions and emotional responses to food, providing insights that are less accessible through traditional methods. Furthermore, IVR offers innovative treatment approaches by facilitating exposure therapy, modifying body-related biases, and enabling emotional regulation through embodied experiences. The studies demonstrate IVR's potential to improve body image accuracy, reduce food-related anxieties, and support behavioral changes in ED patients. CONCLUSION IVR stands out as a transformative technology in the field of EDs, offering comprehensive benefits across diagnostic, therapeutic, and experiential domains. The IVR's ability to simulate the brain's predictive coding mechanisms provides a powerful avenue for delivering embodied, experiential interventions that can help recalibrate distorted body representations and dysfunctional affective predictive models implicated in EDs. Future research should continue to refine these applications, ensuring consistent methodologies and wider clinical trials to fully harness IVR's potential in clinical settings.
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Affiliation(s)
- Anna Flavia Di Natale
- Research Centre in Communication Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy.
| | | | - Giulia Brizzi
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, Milan, 20149, Italy
| | - Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
| | - Fabio Frisone
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
| | - Andrea Gaggioli
- Research Centre in Communication Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, Milan, 20149, Italy
| | - Elisa Rabarbari
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
| | - Osmano Oasi
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
| | - Claudia Repetto
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
| | - Chiara Rossi
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
| | - Elisa Scerrati
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
| | - Daniela Villani
- Research Centre in Communication Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, Milan, 20149, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy
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Brizzi G, Frisone F, Rossi C, Riva G. Gender differences in bodily experience: Insights from virtual reality body illusion. Acta Psychol (Amst) 2024; 249:104386. [PMID: 39174407 DOI: 10.1016/j.actpsy.2024.104386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/23/2024] [Accepted: 07/01/2024] [Indexed: 08/24/2024] Open
Abstract
Virtual Reality has significantly improved the understanding of body experience, through techniques such as Body Illusion. Body Illusion allows individuals to perceive an artificial body as their own, changing body perceptual and affective components. Prior research has predominantly focused on female participants, leaving the impact of Body Illusion on males less understood. This study seeks to fill this gap by examining the nuanced bodily experiences of men in comparison to women. 40 participants (20 females and 20 males) were proposed with visuo-tactile synchronous and asynchronous Body Illusion to explore changes in body satisfaction and body size estimation across three critical areas: shoulders, hips, and waist. Results revealed significant initial disparities, with females displaying greater body dissatisfaction and a tendency to overestimate body size. After Body Illusion, females adjusted the hips perceived body size closer to that of the virtual body and reported increased body satisfaction independent of the condition. Conversely, males showed changes only in waist size estimation only after synchronous stimulation without significant shifts in body satisfaction. These results suggest a higher sensitivity of women to embodied experiences, potentially due to societal influences and a greater inclination towards self-objectification. These insights pave the way for creating more refined and effective interventions for body image issues, highlighting the importance of incorporating gender-specific considerations in VR-based prevention and therapeutical programs.
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Affiliation(s)
- Giulia Brizzi
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy.
| | - Fabio Frisone
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy
| | - Chiara Rossi
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy
| | - Giuseppe Riva
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy
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Cobbaert L, Hay P, Mitchell PB, Roza SJ, Perkes I. Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories. Int J Eat Disord 2024; 57:1465-1488. [PMID: 38511825 DOI: 10.1002/eat.24184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This review investigated the extant literature regarding the relationship between eating disorder diagnoses and sensory processing as measured by validated and reliable self-report inventories. Increasing evidence highlights the role of sensory processing in cognitive functions. Sensory processing is implicated in mental-ill health, including eating disorders (ED) and body image disturbances. However, the pathophysiological underpinnings of sensory processing, encompassing exteroception and interoception, in relation to ED remain underexplored. METHOD We included studies involving participants aged 15 years or older with an eating disorder diagnosis confirmed by semi-structured or structured interviews. We further limited inclusion to articles using validated and reliable self-report instruments to measure sensory processing. Our meta-analysis focused on studies using the interoceptive awareness subscale from the second version of the Eating Disorder Inventory. We used the Critical Appraisal checklist for quasi-experimental studies to assess the quality of included articles. RESULTS There were 19 studies that met our inclusion criteria. Most studies showed moderate-to-high quality. Anorexia nervosa (AN) and bulimia nervosa (BN) were associated with heightened exteroception. Moreover, people with AN reported a heightened sense of taste compared to those with BN. Our meta-analysis comprising 10 studies, 19 samples, and 6382 participants revealed that AN (binge-purge subtype) and BN were associated with increased interoceptive difficulties compared to AN (restrictive subtype) or binge-eating disorder. DISCUSSION Overall, this review emphasizes the need for a deeper investigation into sensory processing, spanning both exteroception and interoception, in relation to ED. This may prove important for individualizing person-centered care. PUBLIC SIGNIFICANCE How people process internal, for example, hunger, and external, for example, taste and sensations is known to influence cognition and mental-ill health, including ED and body image disturbances. However, the ways in which sensory processing may contribute to ED are incompletely understood. We found that individuals with AN or BN experienced heightened exteroception, while people with an eating disorder characterized by purging reported increased interoceptive difficulties. These patterns could inform the development of more personalized treatments.
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Affiliation(s)
- Laurence Cobbaert
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Mental Health Services, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Philip B Mitchell
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sabine J Roza
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Iain Perkes
- Faculty of Medicine and Health, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Cerasa A, Gaggioli A, Pioggia G, Riva G. Metaverse in Mental Health: The Beginning of a Long History. Curr Psychiatry Rep 2024; 26:294-303. [PMID: 38602624 PMCID: PMC11147936 DOI: 10.1007/s11920-024-01501-8] [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] [Accepted: 03/21/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE OF REVIEW We review the first pilot studies applying metaverse-related technologies in psychiatric patients and discuss the rationale for using this complex federation of technologies to treat mental diseases. Concerning previous virtual-reality applications in medical care, metaverse technologies provide the unique opportunity to define, control, and shape virtual scenarios shared by multi-users to exploit the "synchronized brains" potential exacerbated by social interactions. RECENT FINDINGS The application of an avatar-based sexual therapy program conducted on a metaverse platform has been demonstrated to be more effective concerning traditional sexual coaching for treating female orgasm disorders. Again, a metaverse-based social skills training program has been tested on children with autism spectrum disorders, demonstrating a significant impact on social interaction abilities. Metaverse-related technologies could enable us to develop new reliable approaches for treating diseases where behavioral symptoms can be addressed using socio-attentive tasks and social-interaction strategies.
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Affiliation(s)
- Antonio Cerasa
- Institute for Biomedical Research and Innovation, National Research Council, IRIB-CNR, 98164, Messina, Italy.
- S. Anna Institute, 88900, Crotone, Italy.
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036, Arcavacata, Italy.
| | - Andrea Gaggioli
- Research Center in Communication Psychology, Catholic University of Milan, Milan, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council, IRIB-CNR, 98164, Messina, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy.
- Humane Technology Lab, Catholic University of Milan, Largo Gemelli 1, 20123, Milan, Italy.
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Lyall AE, Breithaupt L, Ji C, Haidar A, Kotler E, Becker KR, Plessow F, Slattery M, Thomas JJ, Holsen LM, Misra M, Eddy KT, Lawson EA. Lower region-specific gray matter volume in females with atypical anorexia nervosa and anorexia nervosa. Int J Eat Disord 2024; 57:951-966. [PMID: 38366701 PMCID: PMC11018478 DOI: 10.1002/eat.24168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Few studies have focused on brain structure in atypical anorexia nervosa (atypical AN). This study investigates differences in gray matter volume (GMV) between females with anorexia nervosa (AN) and atypical AN, and healthy controls (HC). METHOD Structural magnetic resonance imaging data were acquired for 37 AN, 23 atypical AN, and 41 HC female participants. Freesurfer was used to extract GMV, cortical thickness, and surface area for six brain lobes and associated cortical regions of interest (ROI). Primary analyses employed linear mixed-effects models to compare group differences in lobar GMV, followed by secondary analyses on ROIs within significant lobes. We also explored relationships between cortical gray matter and both body mass index (BMI) and symptom severity. RESULTS Our primary analyses revealed significant lower GMV in frontal, temporal and parietal areas (FDR < .05) in AN and atypical AN when compared to HC. Lobar GMV comparisons were non-significant between atypical AN and AN. The parietal lobe exhibited the greatest proportion of affected cortical ROIs in both AN versus HC and atypical AN versus HC. BMI, but not symptom severity, was found to be associated with cortical GMV in the parietal, frontal, temporal, and cingulate lobes. No significant differences were observed in cortical thickness or surface area. DISCUSSION We observed lower GMV in frontal, temporal, and parietal areas, when compared to HC, but no differences between AN and atypical AN. This indicates potentially overlapping structural phenotypes between these disorders and evidence of brain changes among those who are not below the clinical underweight threshold. PUBLIC SIGNIFICANCE Despite individuals with atypical anorexia nervosa presenting above the clinical weight threshold, lower cortical gray matter volume was observed in partial, temporal, and frontal cortices, compared to healthy individuals. No significant differences were found in cortical gray matter volume between anorexia nervosa and atypical anorexia nervosa. This underscores the importance of continuing to assess and target weight gain in clinical care, even for those who are presenting above the low-weight clinical criteria.
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Affiliation(s)
- Amanda E. Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Lauren Breithaupt
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Chunni Ji
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
- Division of Women’s Health, Department of Medicine, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anastasia Haidar
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
| | - Elana Kotler
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
| | - Kendra R Becker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
| | - Jennifer J. Thomas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Laura M. Holsen
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
- Division of Women’s Health, Department of Medicine, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Harvard Medical School, MA
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Kamryn T. Eddy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
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Hu Y, Pan Y, Yue L, Gao X. Self-objectification and eating disorders: the psychopathological and neural processes from psychological distortion to psychosomatic illness. PSYCHORADIOLOGY 2024; 4:kkae003. [PMID: 38666139 PMCID: PMC10946225 DOI: 10.1093/psyrad/kkae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Yinying Hu
- Department of Applied Psychology, School of Psychology, Shanghai Normal University, Shanghai, Shanghai 200234, China
| | - Yafeng Pan
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou, Zhejaing 310058, China
| | - Liming Yue
- Department of Applied Psychology, School of Psychology, Shanghai Normal University, Shanghai, Shanghai 200234, China
| | - Xiangping Gao
- Department of Applied Psychology, School of Psychology, Shanghai Normal University, Shanghai, Shanghai 200234, China
- Shanghai Institute of Early Childhood Education, Shanghai Normal University, Shanghai, Shanghai 200234, China
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Navas-León S, Tajadura-Jiménez A, Motrico E, Morales L, Borda-Mas M, Almeda N, Sánchez-Martín M. Understanding and treating body image disturbances in eating disorders through body illusion interventions: a scoping review protocol. Syst Rev 2024; 13:65. [PMID: 38351148 PMCID: PMC10863300 DOI: 10.1186/s13643-024-02458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND We plan a scoping review aimed to synthesize what is known about the use of sensory-driven body illusion (BI) interventions for understanding and treating body image disturbance (BID) in people diagnosed with clinical eating disorders (EDs) and people with subclinical ED symptomatology. Our study will provide an outline of the current literature, identify gaps within the literature, and suggest novel directions for future research. METHODS/DESIGN The scoping review process will be guided by the methodological framework of Arksey and O'Malley, subsequent recommendations by Levac et al., and the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews guidelines. The following electronic databases will be systematically searched: MEDLINE (via PubMed), Web of Science, PsycINFO, and Scopus. Furthermore, to identify additional studies, we will use a search engine such as Google Scholar, and for grey literature, we will include Proquest for Dissertations and Theses. A search strategy has been identified and agreed upon by the research team in conjunction with a research librarian. Two researchers will screen the titles and abstracts independently and then assess the full text of the selected citations for the inclusion criteria. A third reviewer will be involved in cases of disagreement. Data will be extracted, collated, and charted to summarize all the relevant methods, outcomes, and key findings in the articles. DISCUSSION A better understanding of this topic will aid in the development and refinement of current treatments aimed at treating BID in people with EDs. Implications and recommendations for research, policy, and practice in the context of the ED community will be discussed. SYSTEMATIC REVIEW REGISTRATION https://osf.io/3bcm6/?view_only=83b2e8a2445d4266909992e3dfb51929.
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Affiliation(s)
- Sergio Navas-León
- Department of Psychology, Universidad Loyola Andalucía, Avda. de Las Universidades S/N, 41704, Dos Hermanas, Seville, Spain
| | - Ana Tajadura-Jiménez
- UCL Interaction Centre, University College London, London, WC1E 6BT, UK
- DEI Interactive Systems Group, Department of Computer Science, Universidad Carlos III de Madrid, 28911, Madrid, Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Avda. de Las Universidades S/N, 41704, Dos Hermanas, Seville, Spain
| | - Luis Morales
- Department of Psychology, Universidad Loyola Andalucía, Avda. de Las Universidades S/N, 41704, Dos Hermanas, Seville, Spain
| | - Mercedes Borda-Mas
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Universidad de Sevilla, 41018, Seville, Spain
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Avda. de Las Universidades S/N, 41704, Dos Hermanas, Seville, Spain
| | - Milagrosa Sánchez-Martín
- Department of Psychology, Universidad Loyola Andalucía, Avda. de Las Universidades S/N, 41704, Dos Hermanas, Seville, Spain.
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Nisticò V, Ingrosso G, Lombardi F, Chiudinelli E, Bianchini G, Faggioli R, Bertani A, Gambini O, Demartini B. Autistic traits, sensory sensitivity and eating disturbances in a sample of young adults referring to a generalized mental health clinic. Eat Weight Disord 2024; 29:10. [PMID: 38261082 PMCID: PMC10806192 DOI: 10.1007/s40519-024-01639-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
PURPOSE The relationship between autistic traits and eating disturbances has been given considerable attention over the last decades. The rise of a dimensional approach to psychopathology has expanded the way we think about autism, acknowledging that subthreshold autistic manifestations span across the general population and are more pronounced in psychiatric patients. Here we investigated the prevalence of eating disorders and its potential relationship with autistic traits and sensory sensitivity in a group of patients who were referred for the first time to a mental health outpatient clinic, without a formal diagnosis yet. METHODS 259 young adults (between 18 and 24 years old) completed: the Eating Attitude Test (EAT-26), the Swedish Eating Assessment for Autism Spectrum Disorders (SWEAA), the Autism Quotient (AQ), the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), and the Sensory Perception Quotient-Short Form 35 item (SPQ-SF35). RESULTS 23.55% of participants scored above the cut-off at the EAT-26, suggesting that they presented a risk for eating disorders and should be assessed by a specialized clinician; associations emerged between hypersensitivity in the touch and vision domain and both the EAT-26 and the SWEAA; the presence of autistic traits was largely associated with eating disturbances. CONCLUSIONS This study underlines the significance of the eating domain as a central psychopathological feature in the distress experienced by young adults with general psychiatric symptoms and psychological suffering; it adds evidence to the association between autistic traits and eating disorders and opens to new research questions about the role of subthreshold autistic traits in general psychopathology. LEVEL OF EVIDENCE Level I: Evidence obtained from experimental studies.
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Affiliation(s)
- Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. Di Rudinì, 8, 20142, Milano, Italy.
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milano, Italy.
- Dipartimento di Psicologia, Università degli Studi di Milano-Bicocca, Milano, Italy.
| | - Gianmarco Ingrosso
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. Di Rudinì, 8, 20142, Milano, Italy
| | - Francesco Lombardi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. Di Rudinì, 8, 20142, Milano, Italy
| | - Elia Chiudinelli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. Di Rudinì, 8, 20142, Milano, Italy
| | - Giulia Bianchini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. Di Rudinì, 8, 20142, Milano, Italy
| | - Raffaella Faggioli
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Angelo Bertani
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
- Dipartimento Salute Mentale e Dipendenze, Centro Giovani "Ettore Ponti", ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. Di Rudinì, 8, 20142, Milano, Italy
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milano, Italy
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Benedetta Demartini
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milano, Italy
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
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10
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Naraindas AM, Moreno M, Cooney SM. Beyond Gender: Interoceptive Sensibility as a Key Predictor of Body Image Disturbances. Behav Sci (Basel) 2023; 14:25. [PMID: 38247677 PMCID: PMC10812832 DOI: 10.3390/bs14010025] [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: 11/23/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Body image disturbance (BID) involves negative attitudes towards shape and weight and is associated with lower levels of interoceptive sensibility (IS) (the subjective perceptions of internal bodily states). This association is considered a risk factor for developing eating disorders (EDs) and is linked to altered sensorimotor representations of the body (i.e., body schema). BIDs manifest across genders and are currently understudied in men. This study investigated gender-related differences in BID and its relationship to the body schema and IS. Data were collected from 86 men and 86 women. BID was assessed using questionnaires measuring self-objectification, state, and trait body dissatisfaction. IS was measured via the MAIA-2. The body schema was indexed via an embodied mental rotation task. Results showed that women reported higher BID than men across all scales. Gender differences in sub-components of interoceptive sensibility were found. Overall, both gender and interoceptive sensibility predicted BID. However, interoceptive sensibility exhibited its own unique association with BID beyond the influence of gender. BID, IS and gender were not significant predictors of performance in the body schema task. Therefore, while gender predicts differences in BID and interoceptive sensibility, there was no evidence of gender-related differences in body schema.
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Affiliation(s)
| | | | - Sarah M. Cooney
- School of Psychology, University College Dublin, D04 F6X4 Dublin, Ireland;
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11
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Bijsterbosch JM, Hasenack B, van Rooijen B, Sternheim LC, Boelen PA, Dijkerman HC, Keizer A. Intolerable feelings of uncertainty within the body: Associations between interoceptive awareness, intolerance of uncertainty, and body dissatisfaction. J Adolesc 2023; 95:1678-1688. [PMID: 37655512 DOI: 10.1002/jad.12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Adolescence is a period marked by important physical and social changes, which often leads to an increase of body dissatisfaction. Recent studies have shown an association between interoception and body dissatisfaction in female adolescents. One variable that may contribute to the association between interoceptive awareness and body dissatisfaction is intolerance of uncertainty (IU). This study aims to investigate multiple facets of interoceptive awareness, IU, and their relations with body dissatisfaction in adolescent girls. METHODS In a cross-sectional study, a convenience sample of 307 adolescent girls (mean age = 17.73; SD = 1.02) was recruited in the Netherlands in 2022. Three questionnaires were completed measuring interoceptive awareness, IU, and body dissatisfaction. A moderation analyses using a multiple hierarchical regression was used to investigate associations between variables. RESULTS Correlation analyses indicated that several facets of lower interoceptive awareness (Not distracting, Not worrying and Trusting) were related to higher levels of body dissatisfaction. IU only marginally moderated the relationship between several domains of interoceptive awareness (Notice, Attention regulation and Emotional awareness) and body dissatisfaction. DISCUSSION Findings suggest that experiencing bodily signals as ambiguous and uncertain may result in more complex body image issues. Within certain domains of interoceptive awareness, IU may affect the process of appraising bodily signals. Furthermore, adolescent girls who do not feel safe in their body and who find it difficult to distract their thoughts when experiencing pain or discomfort in their body may be particularly at risk for developing more complex body image disturbances and may benefit from interventions improving both interoceptive awareness and IU. Moreover, future research should focus on interoceptive awareness and IU as potential underlying mechanisms for body image issues.
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Affiliation(s)
| | - Birgit Hasenack
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Bregje van Rooijen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- ARQ Centrum'45, Diemen, The Netherlands
| | - H Chris Dijkerman
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Anouk Keizer
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
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12
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Naraindas AM, Cooney SM. Body image disturbance, interoceptive sensibility and the body schema across female adulthood: a pre-registered study. Front Psychol 2023; 14:1285216. [PMID: 38098520 PMCID: PMC10720753 DOI: 10.3389/fpsyg.2023.1285216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Body image disturbance (BID) typically involves explicit negative attitudes toward one's shape and weight and is associated with altered interoceptive sensibility (the subjective perception of internal bodily states). This association is a known risk factor for the development and maintenance of eating disorders. However, while research has centred on younger women with eating disorders, diverse facets of BID appear in women without eating disorders across adulthood. Research shows that in the general population, young women (ages 18-25) with high BID exhibit disturbances in the body schema: an implicit sensorimotor representation of the body in space which includes mental simulation of a movement such as motor imagery. Given that body image is subject to age-related influences, it is important to investigate how age-related variation in BID can influence the body schema beyond young adulthood alone. Here, we examine the relationship between BID, interoceptive sensibility and the body schema across female adulthood. Methods Cross-sectional data was collected online from 1,214 women across four age groups: Young adults (18-24), Adults (25-39), Middle-aged adults (40-59), and Older aged adults (60-75). BID was indexed by questionnaires measuring body objectification, state, and trait body dissatisfaction. Interoceptive sensibility (IS) was measured using the MAIA-2 questionnaire. The body schema was evaluated through the Own Body Transformation task: a mental rotation task which assesses the capacity to make an embodied mental transformation. Results Analyses revealed that while body objectification and trait body dissatisfaction decreased from young to older adulthood, state body dissatisfaction showed a marked increase. A negative relationship between IS and BID across all age groups was also evidenced. Finally, age, BID and orientation of the presented body were significant predictors of the time taken to make an embodied transformation. Discussion These findings highlight the consistent relationship of BID and IS across age groups beyond young adulthood and demonstrate the varying importance of different aspects of BID as individuals age. We also evidence for the first time that disruptions in body image have the potential to impact implicit sensorimotor representations of the body even in women without eating disorders across female adulthood.
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Affiliation(s)
| | - Sarah M. Cooney
- School of Psychology, University College Dublin, Dublin, Ireland
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13
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Brizzi G, Sansoni M, Di Lernia D, Frisone F, Tuena C, Riva G. The multisensory mind: a systematic review of multisensory integration processing in Anorexia and Bulimia Nervosa. J Eat Disord 2023; 11:204. [PMID: 37974266 PMCID: PMC10655389 DOI: 10.1186/s40337-023-00930-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023] Open
Abstract
Individuals with Anorexia Nervosa and Bulimia Nervosa present alterations in the way they experience their bodies. Body experience results from a multisensory integration process in which information from different sensory domains and spatial reference frames is combined into a coherent percept. Given the critical role of the body in the onset and maintenance of both Anorexia Nervosa and Bulimia Nervosa, we conducted a systematic review to examine multisensory integration abilities of individuals affected by these two conditions and investigate whether they exhibit impairments in crossmodal integration. We searched for studies evaluating crossmodal integration in individuals with a current diagnosis of Anorexia Nervosa and Bulimia Nervosa as compared to healthy individuals from both behavioral and neurobiological perspectives. A search of PubMed, PsycINFO, and Web of Sciences databases was performed to extract relevant articles. Of the 2348 studies retrieved, 911 were unique articles. After the screening, 13 articles were included. Studies revealed multisensory integration abnormalities in patients affected by Anorexia Nervosa; only one included individuals with Bulimia Nervosa and observed less severe impairments compared to healthy controls. Overall, results seemed to support the presence of multisensory deficits in Anorexia Nervosa, especially when integrating interoceptive and exteroceptive information. We proposed the Predictive Coding framework for understanding our findings and suggested future lines of investigation.
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Affiliation(s)
- Giulia Brizzi
- Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149, Milan, Italy.
| | - Maria Sansoni
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
| | - Daniele Di Lernia
- Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149, Milan, Italy
| | - Fabio Frisone
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149, Milan, Italy
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
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14
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Lernia DDI, Serino S, Tuena C, Cacciatore C, Polli N, Riva G. Mental health meets computational neuroscience: A predictive Bayesian account of the relationship between interoception and multisensory bodily illusions in anorexia nervosa. Int J Clin Health Psychol 2023; 23:100383. [PMID: 36937547 PMCID: PMC10017360 DOI: 10.1016/j.ijchp.2023.100383] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
Mental health disorders pose a significant challenge to society. The Bayesian perspective on the mind offers unique insights and tools that may help address a variety of mental health conditions. Psychopathological dysfunctions are often connected to altered predictive and active inference processes, in which cognitive and physiological pathogenic beliefs shape the clinical condition and its symptoms. However, there is a lack of general empirical models that integrate cognitive beliefs, physiological experience, and symptoms in healthy and clinical populations. In this study, we examined the relationship between altered predictive mechanisms, interoception, and pathological bodily distortions in healty individuals and in individuals suffering from anorexia nervosa (AN). AN patients (N=15) completed a Virtual Reality Full-Body Illusion along with interoceptive tasks twice: at hospital admission during an acute symptomatological phase (Time 1) and after a 12-week outpatient clinical weight-restoring rehabilitative program (Time 2). Results were compared to a healthy control group. Our findings indicated that higher levels of interoceptive metacognitive awareness were associated with a greater embodiment. However, unlike in healthy participants, AN patients' interoceptive metacognition was linked to embodiment even in multisensory mismatching (asynchronous) conditions. In addition, unlike in healthy participants, higher interoceptive metacognition in AN patients was related to prior abnormal bodily distortions during the acute symptomatology phase. Prediction errors in bodily estimates predicted posterior bodily estimate distortions after the illusion, but while this relationship was only significant in the synchronous condition in healthy participants, there was no significant difference between synchronous and asynchronous conditions in AN patients. Despite the success of the rehabilitation program in restoring some dysfunctional patterns in the AN group, prediction errors and posterior estimate distortions were present at hospital discharge. Our findings suggest that individuals with AN prioritize interoceptive metacognitive processes (i.e., confidence in their own perceived sensations rather than their actual perceptions), disregarding bottom-up bodily inputs in favour of their prior altered top-down beliefs. Moreover, even if the rehabilitative program partially mitigated these alterations, the pathological condition impaired the patients' ability to coherently update their prior erroneous expectations with real-time multisensory bottom-up bodily information, possibly locking the patients in the experience of a distorted prior top-down belief. These results suggest new therapeutic perspectives and introduce the framework of regenerative virtual therapy (RVT), which aims at utilizing technology-based somatic modification techniques to restructure the maladaptive priors underlying a pathological condition.
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Affiliation(s)
- Daniele DI Lernia
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
| | - Silvia Serino
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Chiara Cacciatore
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicoletta Polli
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
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15
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Magni G, Tuena C, Riva G. A predictive coding approach to psychedelic virtual-induced hallucinations and creative cognition in aging. Front Hum Neurosci 2023; 17:1219052. [PMID: 37484922 PMCID: PMC10359985 DOI: 10.3389/fnhum.2023.1219052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Recent research has investigated the potential of psychedelic substances in treating various neurological and psychiatric disorders. In particular, there has been a growth in studies concerning the intersection of psychedelics, Virtual Reality (VR), and Cognitive Flexibility (CF). Indeed, the use of immersive technology allows the simulation of the perceptual and cognitive effects of psychedelic substances without the potential risks associated with them. CF is strongly associated with creative cognition, a complex cognitive mechanism involved in creative thinking and associated with the prefrontal cortex and the neural networks supporting executive functions, memory, attention, and spontaneous modes of thought. The Bayesian brain approach, which is rooted in predictive coding, has emerged as a promising framework for understanding the effects of psychedelic hallucinations on cognitive functioning. Psychedelic substances may enhance creativity by inducing a state of CF, allowing for a wider range of associations and possibilities to be explored and increasing openness to experience. A decline in cognitive abilities, including creative processing and divergent thinking, is observed during the aging process. In particular, studies on Mild Cognitive Impairment (MCI) show poorer performance in executive functions, including CF. The present paper suggests that psychedelic hallucinations induced by VR may help optimize the balance between top-down expectations and bottom-up sensory information. Therefore, enhanced CF and creativity may be crucial during the aging process for maintaining cognitive functions and preventing pathological conditions.
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Affiliation(s)
- Giulia Magni
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
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16
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Raoul L, Grosbras MH. Relating different Dimensions of Bodily Experiences: Review and proposition of an integrative model relying on phenomenology, predictive brain and neuroscience of the self. Neurosci Biobehav Rev 2023; 148:105141. [PMID: 36965863 DOI: 10.1016/j.neubiorev.2023.105141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
How we mentally experience our body has been studied in a variety research domains. Each of these domains focuses in its own ways on different aspects of the body, namely the neurophysiological, perceptual, affective or social components, and proposes different conceptual taxonomies. It is therefore difficult to find one's way through this vast literature and to grasp the relationships between the different dimensions of bodily experiences. In this narrative review, we summarize the existing research directions and present their limits. We propose an integrative framework, grounded in studies on phenomenal consciousness, self-consciousness and bodily self-consciousness, that can provide a common basis for evaluating findings on different dimensions of bodily experiences. We review the putative mechanisms, relying on predictive processes, and neural substrates that support this model. We discuss how this model enables a conceptual assessment of the interrelationships between multiple dimensions of bodily experiences and potentiate interdisciplinary approaches.
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Affiliation(s)
- Lisa Raoul
- Aix Marseille Univ, CNRS, LNC, Laboratoire de Neurosciences Cognitives, Marseille, France.
| | - Marie-Hélène Grosbras
- Aix Marseille Univ, CNRS, LNC, Laboratoire de Neurosciences Cognitives, Marseille, France.
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17
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Brizzi G, Sansoni M, Riva G. The BODY-FRIEND Project: Using New Technology to Learn about How People with Anorexia Feel about Their Bodies. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:141-143. [PMID: 36730711 DOI: 10.1089/cyber.2023.29267.ceu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Giulia Brizzi
- Humane Technology Lab., Catholic University of Milan, Milan, Italy.,Applied Technology for Neuro-Psychology Lab., IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Maria Sansoni
- Humane Technology Lab., Catholic University of Milan, Milan, Italy
| | - Giuseppe Riva
- Humane Technology Lab., Catholic University of Milan, Milan, Italy.,Applied Technology for Neuro-Psychology Lab., IRCCS Istituto Auxologico Italiano, Milan, Italy
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18
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Turnbull G, Lego S, Kennedy BL, Alexi J, Li YR, Engel MM, Mann G, Bayliss DM, Farrell S, Bell J. Sizing up the crowd: Assessing spatial integration difficulties in body size judgements across eating disorder symptomatology. Front Psychol 2023; 13:1003250. [PMID: 36687820 PMCID: PMC9853910 DOI: 10.3389/fpsyg.2022.1003250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Body size judgements are frequently biased, or inaccurate, and these errors are further exaggerated for individuals with eating disorders. Within the eating disorder literature, it has been suggested that exaggerated errors in body size judgements are due to difficulties with integration. Across two experiments, we developed a novel integration task, named the Ebbinghaus Illusion for Bodies in Virtual Reality (VR), to assess whether nearby bodies influence the perceived size of a single body. VR was used to simulate the appearance of a small crowd around a central target body. Method and Results In Experiment 1 (N = 412), participants were required to judge the size of a central female target within a crowd. Experiment 1 revealed an Ebbinghaus Illusion, in which a central female appeared larger when surrounded by small distractors, but comparatively smaller when surrounded by large distractors. In other words, the findings of Experiment 1 demonstrate that surrounding crowd information is integrated when judging an individual's body size; a novel measure of spatial integration (i.e., an Ebbinghaus Illusion for Bodies in VR). In Experiment 2 (N = 96), female participants were selected based on high (n = 43) and low (n = 53) eating disorder symptomatology. We examined whether the magnitude of this illusion would differ amongst those with elevated versus low eating disorder symptomatology, in accordance with weak central coherence theory, with the high symptomatology group displaying less spatial integration relative to the low group. The results of Experiment 2 similarly found an Ebbinghaus Illusion for Bodies in VR. However, illusion magnitude did not vary across high and low symptomatology groups. Discussion Overall, these findings demonstrate that surrounding crowd information is integrated when judging individual body size; however, those with elevated eating disorder symptomatology did not show any integration deficit on this broader measure of spatial integration.
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Affiliation(s)
- Georgia Turnbull
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia,*Correspondence: Georgia Turnbull,
| | - Sophia Lego
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Briana L. Kennedy
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Joanna Alexi
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Yanqi R. Li
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Manja M. Engel
- Faculty of Social and Behavioural Sciences, Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
| | - Georgina Mann
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Donna M. Bayliss
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Simon Farrell
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
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19
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Repetto C, Riva G. The neuroscience of body memory: Recent findings and conceptual advances. EXCLI JOURNAL 2023; 22:191-206. [PMID: 36998712 PMCID: PMC10043453 DOI: 10.17179/excli2023-5877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 04/01/2023]
Abstract
The body is a very special object, as it corresponds to the physical component of the self and it is the medium through which we interact with the world. Our body awareness includes the mental representation of the body that happens to be our own, and traditionally has been defined in terms of body schema and body image. Starting from the distinction between these two types of representations, the present paper tries to reconcile the literature around body representations under the common framework of body memory. The body memory develops ontogenetically from birth and across all the life span and is directly linked to the development of the self. Therefore, our sense of self and identity is fundamentally based on multisensory knowledge accumulated in body memory, so that the sensations collected by our body, stored as implicit memory, can unfold in the future, under suitable circumstances. Indeed, these sets of bodily information had been proposed as possible key factors underpinning several mental health illnesses. Following this perspective, the Embodied Medicine approach put forward the use of advanced technologies to alter the dysfunctional body memory to enhance people's well-being. In the last sections, recent experimental pieces of evidence will be illustrated that targeted specifically bodily information for increasing health and wellbeing, by means of two strategies: interoceptive feedback and bodily illusions. See also Figure 1(Fig. 1).
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Affiliation(s)
- Claudia Repetto
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- *To whom correspondence should be addressed: Claudia Repetto, Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy; Tel: + 39 02 7234 2585, E-mail:
| | - Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
- Applied Technology for Neuropsychology Lab, Istituto Auxologico Italiano IRCCS, Milan, Italy
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20
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Cusack CE, Vanzhula IA, Levinson CA. The structure of eating disorder and somatic symptoms. J Affect Disord 2022; 319:397-406. [PMID: 36162678 DOI: 10.1016/j.jad.2022.09.106] [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] [Received: 03/10/2022] [Revised: 05/18/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
Individuals with eating disorders (EDs) often present with somatic concerns in treatment, such as bloating, fullness, and feeling tight clothes on skin. However, most research generally focuses on general interoception (e.g., heartbeat) rather than sensations relevant to EDs (e.g., sensations related to the gastrointestinal system or body movement). In the current study (N = 181), we used network analysis to model the structure of ED symptoms and somatic concerns among individuals with anorexia nervosa, bulimia nervosa, and other specified feeding and eating disorder. Results showed that heightened sensitivity to somatic concerns had the highest strength centrality within a symptom network comprising ED and somatic symptoms. Exploratory graph analysis identified four symptom dimensions: cognitive-affective ED symptoms, behavioral ED symptoms, general interoception, and ED-specific proprioception. Findings suggest that heightened sensitivity to somatic concerns may maintain ED symptoms and mutually reinforce other somatic concerns. Implications concerning assessment and treatment of EDs are discussed.
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Affiliation(s)
- Claire E Cusack
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | - Irina A Vanzhula
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America.
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21
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Kitajima T, Otani R, Inoue T, Matsushima N, Matsubara N, Sakuta R. Sensory processing in children and adolescents shortly after the onset of anorexia nervosa: a pilot study. Biopsychosoc Med 2022; 16:27. [PMID: 36510231 PMCID: PMC9743604 DOI: 10.1186/s13030-022-00256-z] [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] [Received: 02/01/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Alterations in sensory processing, such as vision, taste, and interoceptive sensation, have been reported in adult anorexia nervosa (AN). Whether these symptoms are traits, states, or "scars" due to chronic starvation has not been fully established. Based on the hypothesis that alterations in sensory processing also occur in adolescent AN in the early stages of the disease, the present study was conducted using both self-administered and parent-administered sensory processing questionnaires. METHODS Children and adolescents with anorexia nervosa treated at a single tertiary eating disorder treatment center in Japan (AN group) and female junior high school students attending a public junior high school in Saitama Prefecture, Japan (healthy control group: HC group) were included in the study. The Sensory Profile (SP) and Adult/Adolescent Sensory Profile (AASP) were administered to the participants and their caregivers. In addition, we collected demographic data and administered the Children's Eating Attitude Test and Autism-Spectrum Quotient Children's version. RESULTS Seventeen children and adolescents were enrolled in the AN group, and 63 were enrolled in the HC group. There was no statistically significant difference between the AN and HC groups in the quadrant scores of the AASP. In the SP, the Sensory Avoiding score and the Emotional/Social response score were higher in the AN group than in the HC group. CONCLUSION From the parents' point of view, the patient avoids unexpected sensory stimuli, but the patients are unaware of their own avoiding behavior in the early stages of the disease. The results suggest that sensory sensitivity in AN may be a "scar" symptom due to chronic starvation and a state symptom. Longitudinal studies from shortly after the onset with larger sample sizes are needed to gain insight into the dynamic relation between sensory processing and eating disorder pathology.
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Affiliation(s)
- Tasuku Kitajima
- grid.416093.9Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Ryoko Otani
- grid.416093.9Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Takeshi Inoue
- grid.416093.9Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Naho Matsushima
- grid.416093.9Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Naoki Matsubara
- grid.416093.9Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Ryoichi Sakuta
- grid.416093.9Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
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22
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Malighetti C, Sansoni M, Gaudio S, Matamala-Gomez M, Di Lernia D, Serino S, Riva G. From Virtual Reality to Regenerative Virtual Therapy: Some Insights from a Systematic Review Exploring Inner Body Perception in Anorexia and Bulimia Nervosa. J Clin Med 2022; 11:jcm11237134. [PMID: 36498708 PMCID: PMC9737310 DOI: 10.3390/jcm11237134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
Despite advances in our understanding of the behavioral and molecular factors that underlie the onset and maintenance of Eating Disorders (EDs), it is still necessary to optimize treatment strategies and establish their efficacy. In this context, over the past 25 years, Virtual Reality (VR) has provided creative treatments for a variety of ED symptoms, including body dissatisfaction, craving, and negative emotions. Recently, different researchers suggested that EDs may reflect a broader impairment in multisensory body integration, and a particular VR technique-VR body swapping-has been used to repair it, but with limited clinical results. In this paper, we use the results of a systematic review employing PRISMA guidelines that explore inner body perception in EDs (21 studies included), with the ultimate goal to analyze the features of multisensory impairment associated with this clinical condition and provide possible solutions. Deficits in interoception, proprioception, and vestibular signals were observed across Anorexia and Bulimia Nervosa, suggesting that: (a) alteration of inner body perception might be a crucial feature of EDs, even if further research is needed and; (b) VR, to be effective with these patients, has to simulate/modify both the external and the internal body. Following this outcome, we introduce a new therapeutic approach-Regenerative Virtual Therapy-that integrates VR with different technologies and clinical strategies to regenerate a faulty bodily experience by stimulating the multisensory brain mechanisms and promoting self-regenerative processes within the brain itself.
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Affiliation(s)
- Clelia Malighetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Maria Sansoni
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
- Correspondence: ; Tel.: +39-02-72-343-863
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Husargatan 3, 75237 Uppsala, Sweden
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy
| | - Marta Matamala-Gomez
- Department of Psychology, Mind and Behavior Technological Center, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
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23
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24
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Riva G, Wiederhold BK. What the Metaverse Is (Really) and Why We Need to Know About It. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2022; 25:355-359. [PMID: 35696299 DOI: 10.1089/cyber.2022.0124] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Major technology companies are investing significant sums of money in the creation of the metaverse whose main feature will be the fusion between the virtual world and the physical world. To allow this possibility is one of the less obvious features of the metaverse: the metaverse works like our minds. This ability makes the metaverse a significantly different technology from its predecessors. If television and social media are persuasive technologies, because of their ability to influence people's attitudes and behaviors, the metaverse is instead a transformative technology, capable of modifying what people think reality is. To achieve this goal, the technologies of the metaverse hack different key cognitive mechanisms: the experience of being in a place and in a body, the processes of brain-to-brain attunement and synchrony, and the ability of experiencing and inducing emotions. Clearly, these possibilities define totally new scenarios with positive and negative outcomes. Educating ourselves as to its promise, and the challenges it may present, is a necessity. This requires a "humane," integrated, and multidisciplinary approach, with stakeholders at the supranational level joining in the conversation.
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Affiliation(s)
- Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology, Lab. Istituto Auxologico Italiano, Milan, Italy
| | - Brenda K Wiederhold
- Virtual Reality Medical Center, Scripps Memorial Hospital, La Jolla, California, USA.,Interactive Media Institute, San Diego, California, USA
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25
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Magrini M, Curzio O, Tampucci M, Donzelli G, Cori L, Imiotti MC, Maestro S, Moroni D. Anorexia Nervosa, Body Image Perception and Virtual Reality Therapeutic Applications: State of the Art and Operational Proposal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052533. [PMID: 35270226 PMCID: PMC8909096 DOI: 10.3390/ijerph19052533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Massimo Magrini
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
| | - Olivia Curzio
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
- Correspondence:
| | - Marco Tampucci
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
| | - Gabriele Donzelli
- Department of Health Science, University of Florence, 50134 Florence, Italy;
| | - Liliana Cori
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
| | - Maria Cristina Imiotti
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
| | - Sandra Maestro
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Calambrone, Italy;
| | - Davide Moroni
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
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26
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Turnbull G, Alexi J, Mann G, Li Y, Engel M, Bayliss DM, Farrell S, Bell J. EXPRESS: The Influence of Three-Dimensional Cues on Body Size Judgements. Q J Exp Psychol (Hove) 2022; 75:2318-2331. [PMID: 35034530 DOI: 10.1177/17470218221076850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Georgia Turnbull
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Joanna Alexi
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Georgina Mann
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Yanqi Li
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Manja Engel
- Utrecht University, Faculty of Social and Behavioural Sciences, Experimental Psychology/Helmholtz Institute. Heidelberglaan 1, 3584 CS Utrecht, Netherlands 8125
| | - Donna M Bayliss
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Simon Farrell
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Jason Bell
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
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27
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Scarpina F, Bastoni I, Villa V, Mendolicchio L, Castelnuovo G, Mauro L, Sedda A. Self-perception in anorexia nervosa: When the body becomes an object. Neuropsychologia 2022; 166:108158. [PMID: 35033502 DOI: 10.1016/j.neuropsychologia.2022.108158] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Women with anorexia nervosa (AN) act as if they have a larger body, as evidenced in obstacle avoidance tasks, where an allocentric perspective is adopted. This alteration emerges not only when they perform, but also when they imagine movements. However, no previous study has investigated own body centered tasks. As such, in this study we aim at documenting if women with AN show an altered behaviour also when the task requires a first-person perspective. METHOD We explored the performance of eleven woman affected by AN compared to eighteen matched controls, in two motor imagery tasks based on a self-frame of reference, the Hand Laterality Task and the Mental Motor Chronometry Task. Moreover, two control tasks relative to visual imagery were administered. RESULTS In the Hand Laterality Task, affected participants did not adopt a motor strategy to judge hands laterality (i.e. no biomechanical constraints effect). Crucially, they also showed an altered behavior in the control task. Similarly, they did not show the expected isochrony in the Mental Motor Chronometry Task, when actions pertained the left (but not the right) hand, in absence of any difference in the control task. CONCLUSIONS Our findings reveal altered imagery processes in AN. Specifically, affected participants adopt a third-person, rather than a first-person perspective, even when the task requires to imagine their own body in an internal frame of reference. In other words, participants with AN objectify body stimuli. Different mechanisms (i.e., checking behaviour; mirror self-reflection; altered multisensory integration) can explain such an altered imagery in AN.
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Affiliation(s)
- Federica Scarpina
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Italy; I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy.
| | - Ilaria Bastoni
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo (VCO), Italy; I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Valentina Villa
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo (VCO), Italy; I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Leonardo Mendolicchio
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Gianluca Castelnuovo
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo (VCO), Italy; Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Leonardo Mauro
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Italy; I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Anna Sedda
- Psychology Department, School of Social Sciences, Heriot-Watt University, Edinburgh, UK; Centre for Applied Behavioural Sciences, School of Social Sciences, Heriot-Watt University, UK
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28
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Riva G. Virtual Reality in Clinical Psychology. COMPREHENSIVE CLINICAL PSYCHOLOGY 2022. [PMCID: PMC7500920 DOI: 10.1016/b978-0-12-818697-8.00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Riva G, Serino S, Di Lernia D, Pagnini F. Regenerative Virtual Therapy: The Use of Multisensory Technologies and Mindful Attention for Updating the Altered Representations of the Bodily Self. Front Syst Neurosci 2021; 15:749268. [PMID: 34803617 PMCID: PMC8595209 DOI: 10.3389/fnsys.2021.749268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022] Open
Abstract
The term “regenerative medicine” (RM) indicates an emerging trend in biomedical sciences that aims at replacing, engineering, or regenerating human cells, tissues, or organs to restore or establish normal function. So far, the focus of RM has been the physical body. Neuroscience, however, is now suggesting that mental disorders can be broadly characterized by a dysfunction in the way the brain computes and integrates the representations of the inner and outer body across time [bodily self-consciousness (BSC)]. In this perspective, we proposed a new kind of clinical intervention, i.e., “Regenerative Virtual Therapy” (RVT), which integrates knowledge from different disciplines, from neuroscience to computational psychiatry, to regenerate a distorted or faulty BSC. The main goal of RVT was to use technology-based somatic modification techniques to restructure the maladaptive bodily representations behind a pathological condition. Specifically, starting from a Bayesian model of our BSC (i.e., body matrix), we suggested the use of mindful attention, cognitive reappraisal, and brain stimulation techniques merged with high-rewarding and novel synthetic multisensory bodily experience (i.e., a virtual reality full-body illusion in sync with a low predictabIlity interoceptive modulation) to rewrite a faulty experience of the body and to regenerate the wellbeing of an individual. The use of RVT will also offer an unprecedented experimental overview of the dynamics of our bodily representations, allowing the reverse-engineering of their functioning for hacking them using advanced technologies.
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Affiliation(s)
- Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Silvia Serino
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Daniele Di Lernia
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Harvard University, Cambridge, MA, United States
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30
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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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31
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Beckmann N, Baumann P, Herpertz S, Trojan J, Diers M. How the unconscious mind controls body movements: Body schema distortion in anorexia nervosa. Int J Eat Disord 2021; 54:578-586. [PMID: 33345338 DOI: 10.1002/eat.23451] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Besides all visible somatic manifestations, distorted body representation is a key symptom for anorexia nervosa (AN). Body representation can be divided into a conscious component, body image, and an unconscious action-related one, body schema. As behavioral studies already explored the impact of a distorted body image in AN, we aimed to explore whether distortion also extends into unconscious body schema. This study is the first with an unbiased measurement of the body schema in a homogeneous sample of AN patients. METHOD Twenty-three patients diagnosed with AN and 23 healthy controls (HC) walked through a door like aperture varying in width. Door width was based on participants shoulder width and ranged from an aperture-to-shoulder-ratio of (A/S) 0.9 to 1.45. Shoulder rotation was measured as indication of perceived body width. To measure the unconscious body schema, we used a cover story pretending to investigate the influence of change of position on retention memory. RESULTS We found a significantly higher critical A/S for AN than HC, which indicates that AN patients rotate their shoulders for relatively larger door widths than HC, thus unconsciously estimating their body size to be larger than in reality. Additionally, we found a correlation between negative body attribution and overestimation of bodily dimensions. DISCUSSION As stated by the "allocentric-lock"-hypothesis, AN patients might be locked to a stored representation of their body that cannot be updated and remains at pre-AN conditions. We suggest future AN-therapy to counter body schema alterations by combining cognitive behavioral therapy and virtual reality therapy.
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Affiliation(s)
- Nina Beckmann
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Patricia Baumann
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jörg Trojan
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin Diers
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
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32
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Artoni P, Chierici ML, Arnone F, Cigarini C, De Bernardis E, Galeazzi GM, Minneci DG, Scita F, Turrini G, De Bernardis M, Pingani L. Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case-control efficacy study. Eat Weight Disord 2021; 26:499-514. [PMID: 32124409 DOI: 10.1007/s40519-020-00875-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder. OBJECTIVE We looked for an additional treatment effect on a protocol for ED inpatients to evaluate the efficacy of BPT. We performed the study through statistical analysis of admission and discharge scores. METHODS We conducted a case-control study in a hospital ward specialized in eating disorders. Two groups were identified: the control group (TAU; N = 91) and the experimental group (TAU + BPT; N = 91). The experimental group performed BTP activities in addition to the treatment at usual. All patients in both groups had an eating disorder diagnosis (AN, BN, BED and EDNOS/OSFED). Sampling occurred on a time basis and not by randomization. Moreover, all patients admitted in the ED hospital ward in the time frame considered (from end-2009 to mid-2017) were included in the study. BPT activities were introduced in mid-2013 and three psychometric instruments upon entry and discharge were used: Symptom Check List-90 (SCL-90) to measure the general psychopathological state; the Eating Disorder Inventory-3 (EDI-3) to estimate the incidence of personality traits strongly correlated to eating disorders; the body uneasiness test (BUT) to measure the body uneasiness. We performed a pre/post analysis for both groups; we studied the additional effect of the treatment through deltas analysis of the three questionnaires (Δ = assessment at discharge - assessment at the entrance). Data were analyzed using the Student T and the Wilcoxon rank-sum test. RESULTS The pre/post analysis showed statistically significant improvement in both conditions (TAU and TAU + BPT) in the general psychopathological state (SCL-90) and in the incidence of personality traits (EDI-3). Improvements in body uneasiness (BUT) were observed only in the experimental group (TAU + BPT). Furthermore, the analysis of the deltas shows more significant improvements in TAU + BPT compared to TAU in all the variables considered. CONCLUSION We found an additional effect of the BPT on TAU. The usual ED protocol added with BPT activities showed significantly better clinical results. We have interpreted these results in light of recent developments in the neuroscientific field of body image. LEVEL OF EVIDENCE Level II: controlled trial without randomization.
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Affiliation(s)
- P Artoni
- Maria Luigia Hospital, Monticelli Terme, Italy.
| | | | - F Arnone
- Maria Luigia Hospital, Monticelli Terme, Italy
| | - C Cigarini
- Maria Luigia Hospital, Monticelli Terme, Italy
| | | | - G M Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - D G Minneci
- Maria Luigia Hospital, Monticelli Terme, Italy
| | - F Scita
- Maria Luigia Hospital, Monticelli Terme, Italy
| | - G Turrini
- Maria Luigia Hospital, Monticelli Terme, Italy
| | | | - L Pingani
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
- Department of Health Professions, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Mental Health, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Parsons TD, Gaggioli A, Riva G. Extended Reality for the Clinical, Affective, and Social Neurosciences. Brain Sci 2020; 10:E922. [PMID: 33265932 PMCID: PMC7761460 DOI: 10.3390/brainsci10120922] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/26/2020] [Indexed: 12/15/2022] Open
Abstract
Brain science research often involves the use of low-dimensional tools and stimuli that lack several of the potentially valuable features of everyday activities and interactions. Although this research has provided important information about cognitive, affective, and social processes for both clinical and nonclinical populations, there is growing interest in high-dimensional simulations that extend reality. These high-dimensional simulations involve dynamic stimuli presented serially or concurrently to permit the assessment and training of perceivers' integrative processes over time. Moreover, high-dimensional simulation platforms can contextually restrain interpretations of cues about a target's internal states. Extended reality environments extend assessment and training platforms that balance experimental control with emotionally engaging background narratives aimed at extending the affective experience and social interactions. Herein, we highlight the promise of extended reality platforms for greater ecological validity in the clinical, affective, and social neurosciences.
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Affiliation(s)
- Thomas D. Parsons
- iCenter for Affective Neurotechnologies (iCAN), Denton, TX 76203, USA
- Computational Neuropsychology and Simulation (CNS) Laboratory, University of North Texas, Denton, TX 76203, USA
- College of Information, University of North Texas, Denton, TX 76203, USA
| | - Andrea Gaggioli
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (A.G.); (G.R.)
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (A.G.); (G.R.)
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, 20145 Milan, Italy
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Weineck F, Hauke G, Lindemann H, Lachenmeir K, Schnebel A, Karačić M, Meule A, Voderholzer U, Pollatos O. Using bodily postures in the treatment of anorexia nervosa: Effects of power posing on interoception and affective states. EUROPEAN EATING DISORDERS REVIEW 2020; 29:216-231. [PMID: 33252788 DOI: 10.1002/erv.2813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Power posing involves the adoption of an expansive bodily posture. This study examined whether power posing could benefit individuals with anorexia nervosa (AN) and women with normal weight in regards to interoceptive ability and affective states. METHOD Participants included 50 inpatients and outpatients with AN as well as 51 normal-weight women. Interoceptive accuracy (IAcc), measured by the heartbeat tracking task and interoceptive sensibility (IS), measured by confidence ratings, were assessed at baseline, after a single power posing session and after 1 week of daily training. Also, the short-term effects of power posing on subjective feelings of dominance, pleasantness, and arousal were investigated. RESULTS Both groups increased in their IAcc after one power posing session. Also, there was a significant main effect of time on feelings of dominance and pleasantness in the short-term. Women with AN displayed lower levels of IS, dominance, and pleasantness as well as higher levels of arousal than women without AN. DISCUSSION These findings suggest that power posing has the potential to increase IAcc, subjective feelings of power and pleasant affect in the short-term. Further research should investigate which mechanisms foster the effectiveness of this intervention to tailor it to the needs of women with AN.
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Affiliation(s)
- Felicitas Weineck
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Gernot Hauke
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Hanna Lindemann
- Department of Physical Medicine and Rehabilitation, Ludwig Maximilian University, Munich, Germany
| | - Karin Lachenmeir
- Treatment Center for Eating Disorders (TCE), Dritter Orden Hospital, Munich, Germany
| | | | | | - Adrian Meule
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Ulrich Voderholzer
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Freiburg, Freiburg, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
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Lander R, Heled E, Gur E. Executive functioning and spatial processing in anorexia nervosa: an experimental study and its significance for the allocentric lock theory. Eat Weight Disord 2020; 25:1039-1047. [PMID: 31209765 DOI: 10.1007/s40519-019-00728-2] [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: 02/22/2019] [Accepted: 06/04/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The allocentric lock theory (ALT) suggests that people with eating disorders have difficulties in multisensory integration in two reference frames-egocentric and allocentric, whereby the egocentric, but not allocentric, is impaired. This leads to a distorted body image that contributes to the development and maintenance of the disorder. The current study aimed to explore a facet of the ALT, namely, the visuo-spatial aspect, and its relation to cognitive flexibility in patients with anorexia nervosa (AN). METHODS Fifty-five participants took part in the study: 20 AN patients and 35 controls, matched by age and education. The object perspective taking test (OPTT) and the mental rotation test (MRT), tapping egocentric and allocentric representations, respectively, and a set-shifting task were administered. The brief symptom inventory was used to measure overall levels of distress. RESULTS AN patients showed higher level of distress. They performed poorer on the OPTT and set-shifting task but not on the MRT. The OPTT and MRT were correlated for controls but not for AN patients, while the set-shifting task and body mass index were associated with the OPTT but not with the MRT for the AN patients. CONCLUSIONS The findings support the ALT by demonstrating impaired visual egocentric representations and intact allocentric visual functions in AN patients, with cognitive flexibility associated only with the egocentric frame. Therefore, egocentric frame impairment in AN patients may be influenced by visual perception and cognitive flexibility deficiency. LEVEL OF EVIDENCE Level III: case-control analytic study.
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Affiliation(s)
- Ravid Lander
- Department of Psychology, Ariel University, Ariel, Israel
| | - Eyal Heled
- Department of Psychology, Ariel University, Ariel, Israel. .,Neurological Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel.
| | - Eitan Gur
- Department of Eaing Disorders, Sheba Medical Center, Ramat Gan, Israel
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Increased anticipatory brain response to pleasant touch in women remitted from bulimia nervosa. Transl Psychiatry 2020; 10:236. [PMID: 32669557 PMCID: PMC7363900 DOI: 10.1038/s41398-020-00916-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 01/24/2023] Open
Abstract
Bulimia nervosa (BN) is characterized by affective instability and dysregulated behaviors (binge eating, fasting, self-induced vomiting) that disrupt bodily homeostasis. Mechanisms underlying dysregulation in BN are unclear, although altered reward responsivity, anticipatory processing of environmental cues, and interoception (detection and integration of body-state signals to regulate behavior) have been implicated in BN pathophysiology. We aimed to determine whether BN is associated with ineffectively predicting body state or integrating predicted experience with actual experience by examining neural response to anticipation and experience of affective touch, a pleasant interoceptive stimulus that acts on sensory and emotional systems to guide behavior. During fMRI, we administered soft strokes to the palm and forearm in women remitted from BN (RBN; N = 23) and control women (CW; N = 25). A Group (RBN/CW) × Condition (anticipation/touch) interaction was found in the right dorsal caudate; both CW and RBN had increased activation during touch compared with anticipation, with RBN demonstrating marginally greater anticipatory response than CW. For RBN, those individuals who showed greater anticipatory response in the dorsal caudate also reported higher levels of harm avoidance. RBN individuals relative to CW showed greater activation in left putamen and insula during the anticipation but not when experiencing an affective touch. This increase during anticipation rather than the actual experience of the affective touch is consistent with a top-down preparatory process which is associated with harm avoidance and is similar to what has been observed in anxious individuals. This aberrant signal integration could disrupt feedback processing, serving to maintain disordered behavior.
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Frewen P, Schroeter ML, Riva G, Cipresso P, Fairfield B, Padulo C, Kemp AH, Palaniyappan L, Owolabi M, Kusi-Mensah K, Polyakova M, Fehertoi N, D’Andrea W, Lowe L, Northoff G. Neuroimaging the consciousness of self: Review, and conceptual-methodological framework. Neurosci Biobehav Rev 2020; 112:164-212. [DOI: 10.1016/j.neubiorev.2020.01.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
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Kinnaird E, Dandil Y, Li Z, Smith K, Pimblett C, Agbalaya R, Stewart C, Tchanturia K. Pragmatic Sensory Screening in Anorexia Nervosa and Associations with Autistic Traits. J Clin Med 2020; 9:E1182. [PMID: 32326069 PMCID: PMC7230430 DOI: 10.3390/jcm9041182] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Research suggests that people with anorexia nervosa (AN) experience subjective hypersensitivity to external sensations that may require consideration in treatment. These difficulties may be particularly pronounced in people with AN and high autistic traits. The purpose of this pilot study was to explore the use of a brief screening tool to assess sensory sensitivity in individuals receiving treatment for AN, and to assess if self-rated sensitivity in AN is related to autistic traits. METHODS 47 individuals receiving treatment for AN completed a brief sensory screening tool and self-rated their autistic traits. Individuals were also asked to give qualitative feedback on the screening tool. RESULTS People with AN and high autistic traits rated themselves as more hypersensitive compared to people with AN and low autistic traits. Feedback surrounding the use of the screener was positive. CONCLUSIONS The results of this study suggest that the use of this screener may be beneficial in eating disorder settings to help adjust and calibrate treatment to personal needs, although further research and psychometric evaluation around the clinical use of the screener is required. The finding that people with AN and high autistic traits may experience elevated hypersensitivity also warrants further exploration in future research.
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Affiliation(s)
- Emma Kinnaird
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
| | - Yasemin Dandil
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
| | - Zhuo Li
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
| | - Katherine Smith
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
| | - Caroline Pimblett
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
| | - Rafiu Agbalaya
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
| | - Catherine Stewart
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Kate Tchanturia
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
- Department of Psychology, Illia State University, Tbilisi 0162, Georgia
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Alexi J, Dommisse K, Cleary D, Palermo R, Kloth N, Bell J. An Assessment of Computer-Generated Stimuli for Use in Studies of Body Size Estimation and Bias. Front Psychol 2019; 10:2390. [PMID: 31695661 PMCID: PMC6817789 DOI: 10.3389/fpsyg.2019.02390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/07/2019] [Indexed: 12/20/2022] Open
Abstract
Inaccurate body size judgments are associated with body image disturbances, a clinical feature of many eating disorders. Accordingly, body-related stimuli have become increasingly important in the study of estimation inaccuracies and body image disturbances. Technological advancements in the last decade have led to an increased use of computer-generated (CG) body stimuli in body image research. However, recent face perception research has suggested that CG face stimuli are not recognized as readily and may not fully tap facial processing mechanisms. The current study assessed the effectiveness of using CG stimuli in an established body size estimation task (the “bodyline” task). Specifically, we examined whether employing CG body stimuli alters body size judgments and associated estimation biases. One hundred and six 17- to 25-year-old females completed the CG bodyline task, which involved estimating the size of full-length CG body stimuli along a visual analogue scale. Our results show that perception of body size for CG stimuli was non-linear. Participants struggled to discriminate between extreme bodies sizes and overestimated the size change between near to average bodies. Furthermore, one of our measured size estimation biases was larger for CG stimuli. Our collective findings suggest using caution when employing CG stimuli in experimental research on body perception.
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Affiliation(s)
- Joanna Alexi
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Kendra Dommisse
- School of Psychological Science, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Dominique Cleary
- School of Psychological Science, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Romina Palermo
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Nadine Kloth
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
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Lutz AP, Schulz A, Voderholzer U, Koch S, van Dyck Z, Vögele C. Enhanced cortical processing of cardio-afferent signals in anorexia nervosa. Clin Neurophysiol 2019; 130:1620-1627. [DOI: 10.1016/j.clinph.2019.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/14/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022]
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Alexi J, Palermo R, Rieger E, Bell J. Evidence for a perceptual mechanism relating body size misperception and eating disorder symptoms. Eat Weight Disord 2019; 24:615-621. [PMID: 30758775 DOI: 10.1007/s40519-019-00653-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/04/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE There are known and serious health risks associated with extreme body weights, including the development of eating disorders. Body size misperceptions are particularly evident in individuals with eating disorders, compared to healthy controls. The present research investigated whether serial dependence, a recently discovered bias in body size judgement, is associated with eating disorder symptomatology. We additionally examined whether this bias operates on holistic body representations or whether it works by distorting specific visual features. METHODS A correlational analysis was used to examine the association between serial dependence and eating disorder symptomatology. We used a within-subjects experimental design to investigate the holistic nature of this misperception. Participants were 63 young women, who judged the size of upright and inverted female body images using a visual analogue scale and then completed the Eating Disorder Examination-Questionnaire (EDE-Q) to assess eating disorder symptoms. RESULTS Our findings provide the first evidence of an association between serial dependence and eating disorder symptoms, with significant and positive correlations between body size misperception owing to serial dependence and EDE-Q scores, when controlling for Body Mass Index. Furthermore, we reveal that serial dependence is consistent with distortion of local visual features. CONCLUSIONS Findings are discussed in relation to the broader theories of central coherence, cognitive inflexibility, and multisensory integration difficulties, and as providing a candidate mechanism for body size misperception in an eating disorder population. LEVEL OF EVIDENCE Level 1, experimental study.
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Affiliation(s)
- Joanna Alexi
- School of Psychological Science, University of Western Australia, Crawley, WA, 6009, Australia. .,Australian Research Council, Centre of Excellence in Cognition and its Disorders, University of Western Australia, Crawley, WA, 6009, Australia.
| | - Romina Palermo
- School of Psychological Science, University of Western Australia, Crawley, WA, 6009, Australia.,Australian Research Council, Centre of Excellence in Cognition and its Disorders, University of Western Australia, Crawley, WA, 6009, Australia
| | - Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, ACT, 0200, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Crawley, WA, 6009, Australia.,Australian Research Council, Centre of Excellence in Cognition and its Disorders, University of Western Australia, Crawley, WA, 6009, Australia
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Yokokura M, Terada T, Bunai T, Nakaizumi K, Kato Y, Yoshikawa E, Futatsubashi M, Suzuki K, Yamasue H, Ouchi Y. Alterations in serotonin transporter and body image-related cognition in anorexia nervosa. NEUROIMAGE-CLINICAL 2019; 23:101928. [PMID: 31491815 PMCID: PMC6627582 DOI: 10.1016/j.nicl.2019.101928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/17/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023]
Abstract
The serotonin system has been implicated in the pathophysiology of anorexia nervosa (AN). A recent report proposed that body image distortion (BID), a core symptom of AN, may relate to abnormalities of the serotonin system, especially the serotonin transporter (5HTT). Positron emission tomography (PET) studies of underweight patients with active AN reported alterations in serotonin receptors, but not 5HTT. Here, we aimed to disclose the clinicopathophysiology of AN by focusing on 5HTT and cognitive functions, including BID, in groups with active AN. Twenty-two underweight female patients with AN (12 restricting-type AN (ANR); 10 binge-eating/purging-type AN (ANBP)) and 20 age-matched healthy female subjects underwent PET with a 5HTT radioligand [11C]DASB. The binding potential (BPND) of [11C]DASB was estimated semiquantitatively, and clinical data from Raven's colored progressive matrices for general intelligence, the Stroop test for focused attention, the Iowa gambling task for decision making and a dot-probe task designed for BID were compared with the levels of BPND in different groups. [11C]DASB BPND was significantly decreased in the medial parietal cortex in patients with AN and in the dorsal raphe in patients with ANR compared with healthy subjects (p < .05 corrected). Patients with ANR showed a significantly negative correlation between [11C]DASB BPND in the dorsal raphe and performance on the dot-probe task (p < .05 corrected). While reduced 5HTT in the medial parietal cortex (the somatosensory association area) is pathophysiologically important in AN in general, additional 5HTT reduction in the dorsal raphe as seen in ANR is implicated for the clinicopathophysiological relevance. 5HTT decreased in the parietal cortex in patients with AN. 5HTT decreased in the parietal cortex in patients with ANBP. 5HTT decreased in the parietal cortex and the dorsal raphe in patients with ANR. Patients with AN were poor at responding to the test for body image distortion (BID). 5HTT in the dorsal raphe was associated with cognitive performance of BID.
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Affiliation(s)
- Masamichi Yokokura
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuhiro Terada
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyasu Bunai
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kyoko Nakaizumi
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuhiko Kato
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Etsuji Yoshikawa
- Central Research Laboratory, Hamamatsu Photonics K.K., Hamamatsu, Japan
| | - Masami Futatsubashi
- Hamamatsu PET Imaging Center, Hamamatsu Medical Photonics Foundation, Hamamatsu, Japan
| | - Katsuaki Suzuki
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hidenori Yamasue
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuomi Ouchi
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Rubo M, Gamer M. Visuo-tactile congruency influences the body schema during full body ownership illusion. Conscious Cogn 2019; 73:102758. [PMID: 31176847 PMCID: PMC6694184 DOI: 10.1016/j.concog.2019.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 12/21/2022]
Abstract
Visuo-tactile congruency influences the body schema, but not the body image. Movement behavior may provide a window into the unconscious body schema. We present novel methods to distort avatars and Euclidean space in virtual reality.
Previous research showed that full body ownership illusions in virtual reality (VR) can be robustly induced by providing congruent visual stimulation, and that congruent tactile experiences provide a dispensable extension to an already established phenomenon. Here we show that visuo-tactile congruency indeed does not add to already high measures for body ownership on explicit measures, but does modulate movement behavior when walking in the laboratory. Specifically, participants who took ownership over a more corpulent virtual body with intact visuo-tactile congruency increased safety distances towards the laboratory’s walls compared to participants who experienced the same illusion with deteriorated visuo-tactile congruency. This effect is in line with the body schema more readily adapting to a more corpulent body after receiving congruent tactile information. We conclude that the action-oriented, unconscious body schema relies more heavily on tactile information compared to more explicit aspects of body ownership.
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Affiliation(s)
- Marius Rubo
- Marcusstr. 9-11, D-97080 Wuerzburg, Germany.
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Gledhill LJ, George HR, Tovée MJ. Perceptual Not Attitudinal Factors Predict the Accuracy of Estimating Other Women's Bodies in Both Women With Anorexia Nervosa and Controls. Front Psychol 2019; 10:997. [PMID: 31143143 PMCID: PMC6520613 DOI: 10.3389/fpsyg.2019.00997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/15/2019] [Indexed: 12/17/2022] Open
Abstract
Disturbance in how one's body shape and size is experienced, usually including over-estimation of one's own body size, is a core feature of the diagnostic criteria of anorexia nervosa (AN). Is this over-estimation specific to women with AN's judgments of their own body? Or is it just a general feature of their judgments about all bodies? If the latter, it would be consistent with a general error in the perception of body size potentially linked to the use of a different set of visual cues for judging body size. If the former, then this suggests that the over-estimation of own body size has a strong attitudinal component and may be part of the psycho-pathology of their condition. To test this hypothesis, 20 women with AN and 80 control observers estimated the body size of 46 women. The results show a strong effect of perceptual factors in estimating body size for both controls and women with AN. This result is consistent with size over-estimation of own body in AN having a strong attitudinal basis and being a core feature of the psycho-pathology of the condition.
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Affiliation(s)
- Lucinda J. Gledhill
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Hannah R. George
- Deaf Children, Young People and Family Service (National Deaf CAMHS), York, United Kingdom
| | - Martin J. Tovée
- School of Psychology, University of Lincoln, Lincoln, United Kingdom
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Oldershaw A, Startup H, Lavender T. Anorexia Nervosa and a Lost Emotional Self: A Psychological Formulation of the Development, Maintenance, and Treatment of Anorexia Nervosa. Front Psychol 2019; 10:219. [PMID: 30886593 PMCID: PMC6410927 DOI: 10.3389/fpsyg.2019.00219] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022] Open
Abstract
In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a 'lost sense of emotional self.' We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of 'emotional self.' Further, we discuss how, once established, AN becomes 'self-perpetuating' and the 'lost sense of emotional self' relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an 'emotional self' which can be flexibly and adaptively used to direct an individual's needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.
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Affiliation(s)
- Anna Oldershaw
- Salmons Centre for Applied Psychology, Canterbury Christ Church University, Canterbury, United Kingdom
- Kent and Medway All Age Eating Disorder Service, North East London NHS Foundation Trust, London, United Kingdom
| | - Helen Startup
- Sussex Eating Disorders Service and Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Tony Lavender
- Salmons Centre for Applied Psychology, Canterbury Christ Church University, Canterbury, United Kingdom
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Di Lernia D, Serino S, Polli N, Cacciatore C, Persani L, Riva G. Interoceptive Axes Dissociation in Anorexia Nervosa: A Single Case Study With Follow Up Post-recovery Assessment. Front Psychol 2019; 9:2488. [PMID: 30705649 PMCID: PMC6345152 DOI: 10.3389/fpsyg.2018.02488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/22/2018] [Indexed: 12/28/2022] Open
Abstract
Anorexia nervosa (AN) is a disorder characterized by alterations in body perception. Recent literature suggested that AN can also impair the processing of stimuli from inside the body (i.e., interoceptive) however, very few studies performed a complete interoceptive assessment exploring the evolution of the interoceptive dimensions before and after the subject’s recovery. To address this gap in knowledge, this study presented the case of Diana, a 25 years old woman affected by AN. At hospital admission, Diana performed a complete interoceptive assessment for accuracy (IAc), metacognitive awareness (IAw), sensibility (IAs), and interoceptive buffer saturation (IBs) – a new index that behaviourally evaluated the amount of interoceptive processing. Measures were repeated at the end of an outpatients rehabilitative hospital program, after Diana’s recovery. Results were confronted with a control (N = 4) of healthy female subjects. Analyses indicated severe deficits in accuracy, buffer saturation, and sensibility compared to control group. Conversely, metacognitive awareness was pathologically enhanced. After the rehabilitative hospital program, Diana’s clinical condition was largely improved and this reflected back on the interoceptive patterns that appeared restored, with no difference in interoceptive accuracy and metacognition compared to the control group. In conclusion, results indicated a very specific dissociation between interoceptive axes in AN with pervasive deficits in perception and processing that were accompanied by a pathologically enhanced confidence in the wrong perceptions. This case study reported an interesting and unique clinical pattern with a severe dissociation between interoceptive perceptions that nonetheless appeared restored after the subject’s recovery, highlighting the role of interoceptive assessment in the clinical evolution of AN.
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Affiliation(s)
- Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicoletta Polli
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Chiara Cacciatore
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico, Milan, Italy
| | - Luca Persani
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Corno G, Serino S, Cipresso P, Baños RM, Riva G. Assessing the Relationship Between Attitudinal and Perceptual Component of Body Image Disturbance Using Virtual Reality. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 21:679-686. [PMID: 30421995 DOI: 10.1089/cyber.2018.0340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Body image disturbance (BID) affects quality of life even in the absence of clinically diagnosable eating pathology, and numerous studies have shown its crucial role in the emergence and maintenance of eating disorders. This study aimed at exploring attitudinal and perceptual components of BID using a novel virtual reality (VR)-based paradigm. A community sample of women (N = 27) recreated in VR their perceived body in both an allocentric (third-person view) and egocentric (first-person view) perspective. Specifically, women were able to choose between a wide range of three-dimensional bodies spanning body mass index 12.5-42.5 kg/m2. Attitudinal indexes of BID (body dissatisfaction, body uneasiness, and body image avoidance) were assessed through questionnaires. Attitudinal components predicted the perceptual BID only in the allocentric perspective. Specifically, overestimation was predicted by body image avoidance, while underestimation was predicted by body uneasiness. Furthermore, a common predictor of underestimation and overestimation was body dissatisfaction. In line with the allocentric lock hypothesis, the current results seem to confirm the presence of two different mechanisms underlying BID: one related to real-time perception-driven inputs (egocentric frame) and one related to abstract knowledge, beliefs, and attitudes related to a person's body (allocentric frame). These findings contribute to a better understanding of the nature and mechanisms underlying BID and provide additional evidence about the suitability of using VR for exploring and assessing body image-related components and disturbances.
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Affiliation(s)
- Giulia Corno
- 1 Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano , Milan, Italy
| | - Silvia Serino
- 1 Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano , Milan, Italy .,2 Department of Psychology, Università Cattolica del Sacro Cuore , Milan, Italy
| | - Pietro Cipresso
- 1 Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano , Milan, Italy .,2 Department of Psychology, Università Cattolica del Sacro Cuore , Milan, Italy
| | - Rosa M Baños
- 3 Departamento Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de Valencia , Valencia, Spain .,4 CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health , Madrid, Spain
| | - Giuseppe Riva
- 1 Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano , Milan, Italy .,2 Department of Psychology, Università Cattolica del Sacro Cuore , Milan, Italy
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Serino S, Polli N, Riva G. From avatars to body swapping: The use of virtual reality for assessing and treating body-size distortion in individuals with anorexia. J Clin Psychol 2018; 75:313-322. [PMID: 30552669 PMCID: PMC6590458 DOI: 10.1002/jclp.22724] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the last 30 years, virtual reality (VR) has offered innovative solutions for assessing and treating body representation disturbances in anorexia nervosa (AN). The most recent and innovative trend is the exploitation of the so-called VR-based body swapping illusion. The aim of this case study was to report the use of this VR protocol within a multidisciplinary treatment of AN. A patient with a Diagnostic and Statistical Manual-5 diagnosis of AN underwent an intensive multidisciplinary outpatient treatment. Three sessions of a VR-based body swapping illusion (i.e., the experimental induction of being the owner of a virtual body as a result of a visuotactile stimulation) were delivered within the treatment protocol (i.e., beginning of the treatment; end of one cycle of the treatment; 1 year of follow-up). We report the results obtained, discussing how the VR full body illusion was both able to effectively monitor changes of multisensory bodily integration and to act as a driver for these changes.
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Affiliation(s)
- Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Istituto Auxologico Italiano IRCCS, Applied Technology for Neuro-Psychology Lab, Milan, Italy
| | - Nicoletta Polli
- Istituto Auxologico Italiano, IRCCS, Division of Endocrinology and Metabolism, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Istituto Auxologico Italiano IRCCS, Applied Technology for Neuro-Psychology Lab, Milan, Italy
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Riva G, Wiederhold BK, Mantovani F. Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 22:82-96. [PMID: 30183347 PMCID: PMC6354552 DOI: 10.1089/cyber.2017.29099.gri] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Is virtual reality (VR) already a reality in behavioral health? To answer this question, a meta-review was conducted to assess the meta-analyses and systematic and narrative reviews published in this field in the last twenty-two months. Twenty-five different articles demonstrated the clinical potential of this technology in both the diagnosis and the treatment of mental health disorders: VR compares favorably to existing treatments in anxiety disorders, eating and weight disorders, and pain management, with long-term effects that generalize to the real world. But why is VR so effective? Here, the following answer is suggested: VR shares with the brain the same basic mechanism: embodied simulations. According to neuroscience, to regulate and control the body in the world effectively, the brain creates an embodied simulation of the body in the world used to represent and predict actions, concepts, and emotions. VR works in a similar way: the VR experience tries to predict the sensory consequences of an individual's movements, providing to him/her the same scene he/she will see in the real world. To achieve this, the VR system, like the brain, maintains a model (simulation) of the body and the space around it. If the presence in the body is the outcome of different embodied simulations, concepts are embodied simulations, and VR is an embodied technology, this suggests a new clinical approach discussed in this article: the possibility of altering the experience of the body and facilitating cognitive modeling/change by designing targeted virtual environments able to simulate both the external and the internal world/body.
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Affiliation(s)
- Giuseppe Riva
- 1 Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy.,2 Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Brenda K Wiederhold
- 3 Virtual Reality Medical Center, La Jolla, California.,4 Virtual Reality Medical Institute, Brussels, Belgium
| | - Fabrizia Mantovani
- 5 Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milan, Italy
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