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

Abstract

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

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

“…Figure 2 shows a flowchart overview of the identification. See Supplementary S2 [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] for a list of the selected papers.…”

“…A total of four papers on VR-CET or a variation were included in the review. VR-CET has been successful in reducing binge and purge episodes [ 5 , 9 , 10 ] over repeated exposures in most experiments [ 5 , 9 , 10 , 11 ]. One study in the selected VR-CET papers had only a single session of treatment [ 11 ], but their sample size was the largest at n = 193; it was also the only study that had a control group (n = 135).…”

“…Each article was based on the VR-CET intervention in which the patient selected and rated a certain number of craved food products that caused an increase in anxiety and craving levels [ 5 , 9 , 10 , 11 ]. The number of products fluctuated from 10 [ 11 ] to 30 [ 5 , 9 , 10 ], and exposure time also fluctuated from 20 [ 5 ] to 45 [ 10 ] seconds per image of food.…”

“…However, it should be noted that VR-based therapies often mix multiple components in their protocols. Of the many applications of VR in the treatment of EDs, VR-CET has empirical support at present [ 5 , 9 , 10 , 11 ]. Additionally, CET has proven its efficacy in treating patients with bulimia nervosa and binge eating disorder who are resistant to standard treatment [ 12 ].…”

New developments in cognitive-behavioural therapy for eating disorders (CBT-ED)

“…Another promising direction is the use of virtual reality methods, which become more viable as technological costs fall. For example, Nameth et al [ 50 ] have shown that virtual reality can be used to deliver cue exposure among patients who binge. Similarly, Porras-Garcia et al [ 51 ▪ ] have demonstrated that virtual reality body exposure has positive effects on body image.…”