Virtual Reality Exposure to a Healthy Weight Body Is a Promising Adjunct Treatment for Anorexia Nervosa

Simone C Behrens; Joachim Tesch; Philine J B Sun; Sebastian Starke; Michael J Black; Hannah Schneider; Jacopo Pruccoli; Stephan Zipfel; Katrin E Giel

doi:10.1159/000530932

Virtual Reality Exposure to a Healthy Weight Body Is a Promising Adjunct Treatment for Anorexia Nervosa

Psychother Psychosom. 2023;92(3):170-179. doi: 10.1159/000530932. Epub 2023 May 30.

Authors

Simone C Behrens^{1

2

3}, Joachim Tesch², Philine J B Sun¹, Sebastian Starke⁴, Michael J Black², Hannah Schneider¹, Jacopo Pruccoli^{1

5

6}, Stephan Zipfel^{1

3}, Katrin E Giel^{1

3}

Affiliations

¹ Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Tübingen, Germany.
² Max Planck Institute for Intelligent Systems, Tübingen, Germany.
³ Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany.
⁴ Meta Reality Labs, London, UK.
⁵ IRCCS Istituto delle Scienze Neurologiche di Bologna, Pediatric Neuropsychiatry Unit, Center for Eating Disorders, Bologna, Italy.
⁶ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

Abstract

Introduction/objective: Treatment results of anorexia nervosa (AN) are modest, with fear of weight gain being a strong predictor of treatment outcome and relapse. Here, we present a virtual reality (VR) setup for exposure to healthy weight and evaluate its potential as an adjunct treatment for AN.

Methods: In two studies, we investigate VR experience and clinical effects of VR exposure to higher weight in 20 women with high weight concern or shape concern and in 20 women with AN.

Results: In study 1, 90% of participants (18/20) reported symptoms of high arousal but verbalized low to medium levels of fear. Study 2 demonstrated that VR exposure to healthy weight induced high arousal in patients with AN and yielded a trend that four sessions of exposure improved fear of weight gain. Explorative analyses revealed three clusters of individual reactions to exposure, which need further exploration.

Conclusions: VR exposure is a well-accepted and powerful tool for evoking fear of weight gain in patients with AN. We observed a statistical trend that repeated virtual exposure to healthy weight improved fear of weight gain with large effect sizes. Further studies are needed to determine the mechanisms and differential effects.

Keywords: Anorexia nervosa; Anxiety; Cognitive-behavioral psychotherapy; Eating disorders; Psychological stress; Psychotherapy research; Virtual reality.

MeSH terms

Anorexia Nervosa* / therapy
Fear
Female
Humans
Treatment Outcome
Virtual Reality*
Weight Gain

Grants and funding

S.C.B. was funded through intramural funding from the Medical Faculty of the University of Tübingen, Grant No. 2535-0-0 and 2724-0-0. The funder had no role in the preparation of data or the manuscript.