Bringing Virtual Reality From Clinical Trials to Clinical Practice for the Treatment of Eating Disorders: An Example Using Virtual Reality Cue Exposure Therapy

Abstract

Novel treatment options for eating disorders (EDs) are critically needed to enhance treatment outcomes and reduce the rates of treatment dropouts. On average, only 50% of individuals receiving evidence-based care remit, whereas 24% drop out before treatment completion. One particularly promising direction involves integrating virtual reality (VR) with existing evidence-based treatments (EBTs) such as cue exposure therapy (CET). Across psychiatric disorders, VR-based interventions are demonstrating at least preliminary efficacy and noninferiority to traditional treatments. Furthermore, VR technology has become increasingly portable, resulting in improved acceptance, increased access, and reductions in cost. However, more efficient research processes may be needed to uncover the potential benefits of these rapid technological advances. This viewpoint paper reviews existing empirical support for integrating VR with EBTs (with a focus on its use with EDs) and proposes key next steps to more rapidly bring this innovative technology-based intervention into real-world clinic settings, as warranted. VR-CET for EDs is used to illustrate a suggested process for developing such treatment enhancements. We recommend following a deployment-focused model of intervention development and testing to enable rapid implementation of robust, practice-ready treatments. In addition, our review highlights the need for a comprehensive clinical protocol that supports clinicians and researchers in the implementation and testing of VR-CET and identifies key missing protocol components with rationale for their inclusion. Ultimately, this work may lead to a more complete understanding of the full potential of the applications and integrations of VR into mental health care globally.

Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study

“…Further, a therapist can manipulate a larger number of stimuli (e.g., types of food) within the VR environment than in the real world. The level of customization can help patients to cope with binge cues or complex environments in a safe and controlled setting while maximizing opportunities for inhibitory learning [ 27 , 28 , 29 ]. Thus, patients may progress faster due to a perception of increased safety and control [ 28 ].…”

“…Despite the many potential benefits and efficacy research of VR-CET for binge-type eating disorders, there has been minimal adoption of this treatment in the U.S., and it has not been tested in real-world settings to our knowledge [ 29 ]. As such, the purpose of this small, uncontrolled pilot study is to examine feasibility, acceptability, and preliminary signals of effectiveness of immersive VR-CET for binge eating in a U.S. real-world eating disorders clinic.…”

A REDCap-based model for online interventional research: Parent sleep education in autism

“…Online platforms are efficient in terms of manpower, costs, and paper needs. Because study coordinators can carry out their work without dedicated clinical space for receiving participants, research conducted using online platforms can greatly increase the capacity to conduct larger studies with less personnel and physical facility requirements than traditional face-to-face research study methodology [2–4, 6, 7]. In models where the patient or family enters data directly into an electronic data capture system, coordinators are relieved of scheduling and data entry tasks that normally require significant dedicated effort [3, 8], with reduced opportunity for error.…”

Forging Stronger Bonds Through Technology: How Virtual Reality Can Instill Empathy

“…Seeing the power of VR, I have also had the opportunity to use it to provide family members of those with posttraumatic stress disorder unique insight into their loved one's pain, furthering compassion and decreasing feelings of helplessness. 4 For the past two decades, numerous researchers and clinicians have continued to develop and test environments to help destigmatize and build empathy for a wide range of mental health conditions, including autism, 2 dementia, eating disorders, 5 schizophrenia, and psychosis. 6 Another area of growth features environments that help caregivers understand the effects of physical challenges, such as the profound anemia often caused by chemotherapy.…”

“…7 Other virtual environments that have shown promise include those for addiction and smoking, 8 wheelchair navigation, aging, 9 macular degeneration, 4 and caregiver burnout. 5 Finally, VR has proven its ability to increase empathy between those of different genders, 10 races, ethnicities, 10 and economic situations, demonstrating that technology has the ability to help break down barriers between groups and forge stronger connections among us all.…”