Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review

Several lines of evidence suggest that Virtual Reality (VR) has a potential utility in eating disorders. The objective of this study is to review the literature on the use of VR in bulimia nervosa (BN) and binge eating disorder (BED). Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting systematic reviews, we performed a PubMed, Web of Knowledge and SCOPUS search to identify studies employing VR in the assessment and treatment of BN and BED. The following search terms were used: “virtual reality”, “eating disorders”, “binge eating”, and “bulimia nervosa”. From the 420 articles identified, 19 were selected, nine investigated VR in assessment and 10 were treatment studies (one case-report, two non-controlled and six randomized controlled trials). The studies using VR in BN and BED are at an early stage. However, considering the available evidence, the use of VR in the assessment of those conditions showed some promise in identifying: (1) how those patients experienced their body image; and (2) environments or specific kinds of foods that may trigger binge–purging cycle. Some studies using VR-based environments associated to cognitive behavioral techniques showed their potential utility in improving motivation for change, self-esteem, body image disturbances and in reducing binge eating and purging behavior.

[1]  C. Perpiñá,et al.  Similarities and differences between eating disorders and obese patients in a virtual environment for normalizing eating patterns. , 2016, Comprehensive psychiatry.

[2]  M. Ferrer-García,et al.  The Validity of Virtual Environments for Eliciting Emotional Responses in Patients With Eating Disorders and in Controls , 2009, Behavior modification.

[3]  T. Vos,et al.  Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 , 2013, The Lancet.

[4]  U. Schmidt,et al.  Treatment of eating disorders can not remain 'brainless': the case for brain-directed treatments. , 2013, European eating disorders review : the journal of the Eating Disorders Association.

[5]  G. Riva,et al.  Virtual Reality Based Treatments in Eating Disorders and Obesity: A Review , 2013, Journal of Contemporary Psychotherapy.

[6]  Mark B. Powers,et al.  Virtual reality exposure therapy for anxiety disorders: A meta-analysis. , 2008, Journal of anxiety disorders.

[7]  C. Faravelli,et al.  Cognitive-Behavioural Therapy for Bulimia nervosa and Binge Eating Disorder , 2000, Psychotherapy and Psychosomatics.

[8]  José Gutiérrez-Maldonado,et al.  Body Image in Eating Disorders: The Influence of Exposure to Virtual-Reality Environments , 2010, Cyberpsychology Behav. Soc. Netw..

[9]  E. Stice Interactive and Mediational Etiologic Models of Eating Disorder Onset: Evidence from Prospective Studies. , 2016, Annual review of clinical psychology.

[10]  M. Ferrer-García,et al.  The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: a review of the literature. , 2012, Body image.

[11]  Concepción Perpiñá,et al.  Body Image and Virtual Reality in Eating Disorders: Is Exposure to Virtual Reality More Effective than the Classical Body Image Treatment? , 1999, Cyberpsychology Behav. Soc. Netw..

[12]  Iain C. Campbell,et al.  Exposure therapy in eating disorders revisited , 2013, Neuroscience & Biobehavioral Reviews.

[13]  José Gutiérrez-Maldonado,et al.  Virtual Reality Exposure in Patients with Eating Disorders: Influence of Symptom Severity and Presence , 2011, Annual Review of Cybertherapy and Telemedicine.

[14]  Giuseppe Riva,et al.  Trait and State Craving as Indicators of Validity of VR-based Software for Binge Eating Treatment. , 2015, Studies in health technology and informatics.

[15]  Samantha J. Brooks,et al.  A debate on current eating disorder diagnoses in light of neurobiological findings: is it time for a spectrum model? , 2012, BMC Psychiatry.

[16]  Alan D. Lopez,et al.  The Global Burden of Disease Study , 2003 .

[17]  K Audenaert,et al.  Personality-related characteristics in restricting versus binging and purging eating disordered patients. , 2004, Comprehensive psychiatry.

[18]  S. Vocks,et al.  Body image disturbance in binge eating disorder: a review. , 2011, European eating disorders review : the journal of the Eating Disorders Association.

[19]  G. Riva,et al.  Assessment of the emotional responses produced by exposure to real food, virtual food and photographs of food in patients affected by eating disorders , 2010, Annals of general psychiatry.

[20]  C. Fairburn,et al.  Overcoming binge eating. , 1995 .

[21]  G. Riva,et al.  Virtual Reality for Enhancing the Cognitive Behavioral Treatment of Obesity With Binge Eating Disorder: Randomized Controlled Study With One-Year Follow-up , 2013, Journal of medical Internet research.

[22]  Rosa María Baños Rivera,et al.  Tratamiento de la imagen corporal en los trastornos alimentarios mediante tratamiento cognitivo-comportamental apoyado con realidad virtual: resultados al año de seguimiento , 2004 .

[23]  G. Riva Human Neuroscience Hypothesis and Theory Article out of My Real Body: Cognitive Neuroscience Meets Eating Disorders , 2022 .

[24]  Giuseppe Riva,et al.  Six-Month Follow-Up of In-Patient Experiential Cognitive Therapy for Binge Eating Disorders , 2003, Cyberpsychology Behav. Soc. Netw..

[25]  D. Levac,et al.  When is virtual reality "therapy"? , 2013, Archives of physical medicine and rehabilitation.

[26]  Brenda K. Wiederhold,et al.  Virtual Reality in the Assessment and Treatment of Weight-Related Disorders , 2016, Cyberpsychology Behav. Soc. Netw..

[27]  Giuseppe Riva,et al.  The use of VR in the treatment of Eating Disorders , 2004, Cybertherapy.

[28]  M. Devlin,et al.  Cognitive behavioral therapy for bulimia nervosa. , 2013, Psychotherapy.

[29]  M. Kempton,et al.  Virtual reality in the psychological treatment for mental health problems: An systematic review of recent evidence , 2016, Psychiatry Research.

[30]  Giuseppe Riva,et al.  The neuropsychology of self-objectification , 2015 .

[31]  C. Larson,et al.  The possible influence of impulsivity and dietary restraint on associations between serotonin genes and binge eating. , 2009, Journal of psychiatric research.

[32]  José Gutiérrez-Maldonado,et al.  Assessment of Emotional Reactivity Produced by Exposure to Virtual Environments in Patients with Eating Disorders , 2006, Cyberpsychology Behav. Soc. Netw..

[33]  C. Fairburn,et al.  Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. , 1993 .

[34]  Antonio Egidio Nardi,et al.  Virtual reality as a mechanism for exposure therapy , 2010, The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry.

[35]  H. Friederich,et al.  Inhibitory Control in Bulimic-Type Eating Disorders: A Systematic Review and Meta-Analysis , 2013, PloS one.

[36]  Michael D. Robinson,et al.  Differentiating bingeing/purging and restrictive eating disorder subtypes: The roles of temperament, effortful control and cognitive control , 2010 .

[37]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[38]  T. Wade,et al.  A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions? , 2016, Clinical psychology review.

[39]  Robin J. Lewis,et al.  Assessing the roles of impulsivity, food-related cognitions, BMI, and demographics in the dual pathway model of binge eating among men and women. , 2015, Eating behaviors.

[40]  C. Faravelli,et al.  Cognitive-behavioural therapy for bulimia nervosa and binge eating disorder. A review. , 2000, Psychotherapy and psychosomatics.

[41]  Ran Tao,et al.  Cognitive-Behavioral Therapy. , 2008, Advances in experimental medicine and biology.

[42]  E. Stice,et al.  Negative affect and neural response to palatable food intake in bulimia nervosa , 2012, Appetite.

[43]  Rosa María Baños,et al.  The Third Pole of the Sense of Presence: Comparing Virtual and Imagery Spaces , 2005, PsychNology J..

[44]  Cristina Botella,et al.  Effectiveness of cognitive behavioral therapy supported by virtual reality in the treatment of body image in eating disorders: One year follow-up , 2013, Psychiatry Research.

[45]  V. Feigin,et al.  The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010 , 2015, PloS one.

[46]  C. Perpiñá,et al.  Normalizing the eating pattern with virtual reality for bulimia nervosa: a case report , 2015 .

[47]  M J Griffin,et al.  Virtual reality environments for psycho-neuro-physiological assessment and rehabilitation. , 1997, Studies in health technology and informatics.

[48]  A. Rizzo,et al.  The application of virtual reality technology in rehabilitation. , 2001 .

[49]  Andrea Gaggioli,et al.  Virtual Reality-Enhanced Cognitive-Behavioral Therapy for Morbid Obesity: A Randomized Controlled Study with 1 Year Follow-Up , 2016, Cyberpsychology Behav. Soc. Netw..

[50]  M. Slater,et al.  Virtual reality in the assessment, understanding, and treatment of mental health disorders , 2017, Psychological Medicine.

[51]  H. Hoek,et al.  Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates , 2012, Current Psychiatry Reports.

[52]  D. Moher,et al.  Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation. , 2001, JAMA.

[53]  Giuseppe Riva,et al.  Virtual Reality Environment for Body Image Modification: A Multidimensional Therapy for the Treatment of Body Image in Obesity and Related Pathologies , 2000, Cyberpsychology Behav. Soc. Netw..

[54]  Giuseppe Riva,et al.  Virtual reality-based experiential cognitive treatment of obesity and binge-eating disorders , 2000 .

[55]  T. F. Cash,et al.  Cognitive-behavioral treatment of women's body-image dissatisfaction. , 1987, Journal of consulting and clinical psychology.

[56]  Giuseppe Riva,et al.  Virtual-reality-based multidimensional therapy for the treatment of body image disturbances in binge eating disorders: a preliminary controlled study , 2002, IEEE Transactions on Information Technology in Biomedicine.

[57]  R. Baños,et al.  Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change , 2016, Front. Psychiatry.

[58]  Giuseppe Riva,et al.  External Eating as a Predictor of Cue-reactivity to Food-related Virtual Environments. , 2015, Studies in health technology and informatics.

[59]  C. Perpiñá,et al.  Clinical validation of a virtual environment for normalizing eating patterns in eating disorders. , 2013, Comprehensive psychiatry.

[60]  Concepción Perpiñá,et al.  Clinically Significant Virtual Environments for the Treatment of Panic Disorder and Agoraphobia , 2004, Cyberpsychology Behav. Soc. Netw..