Virtual Reality–Enhanced Cognitive–Behavioral Therapy for Morbid Obesity: A Randomized Controlled Study with 1 Year Follow-Up

Abstract

It is well known that obesity has a multifactorial etiology, including biological, environmental, and psychological causes. For this reason, obesity treatment requires a more integrated approach than the standard behavioral treatment based on dietary and physical activity only. To test the long-term efficacy of an enhanced cognitive-behavioral therapy (CBT) of obesity, including a virtual reality (VR) module aimed at both unlocking the negative memory of the body and to modify its behavioral and emotional correlates, 163 female morbidly obese inpatients (body mass index >40) were randomly assigned to three conditions: a standard behavioral inpatient program (SBP), SBP plus standard CBT, and SBP plus VR-enhanced CBT. Patients' weight, eating behavior, and body dissatisfaction were measured at the start and upon completion of the inpatient program. Weight was assessed also at 1 year follow-up. All measures improved significantly at discharge from the inpatient program, and no significant difference was found among the conditions. However, odds ratios showed that patients in the VR condition had a greater probability of maintaining or improving weight loss at 1 year follow-up than SBP patients had (48% vs. 11%, p = 0.004) and, to a lesser extent, than CBT patients had (48% vs. 29%, p = 0.08). Indeed, only the VR-enhanced CBT was effective in further improving weight loss at 1 year follow-up. On the contrary, participants who received only the inpatient program regained back, on average, most of the weight they had lost. Findings support the hypothesis that a VR module addressing the locked negative memory of the body may enhance the long-term efficacy of standard CBT.

A case series to investigate food‐related fear learning and extinction using in vivo food exposure in anorexia nervosa: A clinical application of the inhibitory learning framework

“…In eating disorders, virtual cue exposure to target urge to binge and anxiety associated with binge cues has been successfully used in the treatment of patients with binge eating (bulimia nervosa or binge eating disorders) who did not respond to standard CBT (Ferrer‐García et al, ). Furthermore, the use of virtual reality to “update” negative body representations stored in memory has been shown to improve the efficacy of CBT at one year in obese patients with binge eating disorder (Cesa et al, ; Manzoni et al, ).…”

Virtual Reality–Based Biofeedback and Guided Meditation in Rheumatology: A Pilot Study

“…Possible modalities for this reduction in pain may be due to a reduction in pain‐related brain activity in the insula and thalamus, ie, how the brain processes pain and produces analgesia . Technology involving the use of visual biofeedback has been shown to improve quality of life, pain level, and physical function in patients with RA and SLE . Additionally, all participants reported that they would participate in a similar study again if given the opportunity.…”

“…VR represents an important advance in biofeedback technologies by providing immersive and realistic multisensory experiences that can help alleviate symptomology by allowing patients to learn stress reduction and pain management skills . Previously, VR has been studied in a range of disease states, including obesity , anxiety disorders , acute pain management , oncology , and neurorehabilitation . Concurrent improvements in software and hardware design, as well as associated cost reductions, have made VR promising for more widespread accessibility in health care .…”

The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study

“…Cognitive Behavioral Therapy involving VR exposure is effective for treating more severe psychological disorders such as Post-Traumatic Stress Disorder (Rothbaum et al, 2001; Difede and Hoffman, 2002; Freedman et al, 2010; Rizzo et al, 2010; Difede et al, 2014). VR has also been used to treat eating disorders (Manzoni et al, 2016; Wiederhold et al, 2016) and may help treat delusions (Freeman et al, 2016), self-criticism (Falconer et al, 2014); and patients with chronic pain (Botella et al, 2013; Garcia-Palacios et al, 2015). To our knowledge; no studies have tested VR as an intervention to facilitate mindfulness skills training for DBT®, nor are there any studies using VR to treat BPD, an unusually severe mental disorder.…”