Treating Fear of Weight Gain With Virtual Reality

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Recovering from an eating disorder (ED) is challenging.

First, the strong psychological grip these illnesses can have on a person often dampens their motivation to recover. And many individuals find their ED comforting, making long-term recovery difficult.

Moreover, few effective treatment approaches are available to treat EDs.¹ Most often, individuals seeking treatment for an ED are prescribed therapy (e.g., cognitive behavioral therapy or CBT) to help them overcome disordered eating behaviors and body shape and weight concerns. Additional treatment approaches include medical stabilization (e.g., rebalancing electrolytes), nutrition plans, and/or pharmacotherapy where necessary.

Unfortunately, up to half of the individuals with an ED who use these treatment approaches will relapse within the first year following treatment.^{1, 2} This is concerning because the longer an ED persists, the harder it is to treat, and the more damage it can do to the body (e.g., heart irregularities). Finding a treatment approach that works early on, therefore, is crucial for optimizing patient health.

What Is Recovery From an Eating Disorder?

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The terms "recovery," "remission," and "relapse" are common vocabulary, but what do they mean? Unfortunately, there are no standard definitions of these terms in reference to EDs.^{1, 3, 4}

Remission most often refers to a change in common ED symptoms, though which symptoms aren't clearly defined. Typically, medical doctors rely on a change in visible symptoms (e.g., weight gain or reduced binge eating) to determine if a patient is in remission from an ED.

Less often, physicians will consider psychological symptoms (e.g., fear of weight gain) to determine if a patient is in remission from an ED. Consequently, psychological symptoms often linger after a patient is classified as fully recovered (e.g., showing no visible signs of their eating disorder). These lingering psychological symptoms make many individuals vulnerable to relapse (e.g., a return of visible ED symptoms).

Because of lingering psychological symptoms after ED recovery, it often takes multiple treatment attempts for an individual to maintain full recovery.

Fear of Weight Gain

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Lingering psychological symptoms are one reason that anorexia nervosa (AN), a type of ED involving food restriction and fear of weight gain, is so difficult to treat.

One of the biggest obstacles to treating AN is fear of weight gain.^5,6 People who experience fear of weight gain often perceive their bodies in distorted ways, making them irrationally fearful of increasing their body size.

If this psychological symptom persists during AN recovery, it can make it difficult for the individual to maintain a healthy body weight.

In vivo exposure therapy is one way to treat fear of weight gain in AN.^{5, 6, 7} During in vivo exposure therapy, an individual imagines themselves at a heavier body weight. During this visualization, they practice sitting with the negative thoughts and feelings they associate with weight gain.

While this approach can be effective in reducing negative associations with weight gain, it has its disadvantages. Individuals in treatment for AN might find it difficult to consistently imagine themselves in a heavier body. Also, engaging with these thoughts and feelings might be so distressing that patients actively avoid them.⁶

Using Virtual Reality to Treat Eating Disorders

Considering these drawbacks of in vivo exposure therapy for treating fear of weight gain, some tech-savvy researchers have figured out how to apply virtual reality (VR) to ED exposure treatment.^{6, 8, 9}

VR is a technology that creates realistic simulations in a user's environment that allow for sensory engagement. By providing a user with enough virtual realism, VR can trick our brains into interpreting information from our sensory experiences as real.

Using VR to reduce fear of weight gain during AN treatment involves slowly exposing an individual to the visual, emotional, and movement sensations of having a larger body. It does through special software that creates a realistic, body movement sensitive full body avatar.

Through the use of these full-body VR avatars, individuals are less able to avoid perceiving themselves in a larger body.

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Using VR to treat fear of weight gain has been tested in a clinical trial with 35 adolescent and adult individuals clinically diagnosed AN.⁶

During this trial, all patients participated in 5 sessions of either standard CBT treatment or CBT + VR treatment, with each session lasting up to 60 minutes.⁶ Over the course of these 5 sessions, researchers gradually manipulated each patient's avatar so that they gained a small percentage of body weight; at the conclusion of the treatment, patients' avatars reached a predetermined "ideal" BMI for that individual.

As individuals encountered their increasingly heavier bodies with each session, they were asked to verbally discuss their thoughts and feelings about how they looked and how it made them feel.⁶ Patients were asked to focus on specific body parts (e.g., thighs) to make sure that they didn't avoid looking at body areas they found uncomfortable. Also during the session, patients' anxiety levels were monitored to determine their comfort levels with their virtual bodies.

Results from this trial showed that individuals who were treated with CBT + VR had less anxiety, body dissatisfaction, and body distortion compared to individuals who only received CBT treatment.⁶ These results suggest that VR in addition to standard therapy might be an effective approach for treating fear of weight gain in AN.

Conclusions

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Nonetheless, while including VR in exposure therapy for EDs is promising, improvements are necessary.⁶ First, the software used for this procedure needs to be updated. Better participant representation (e.g., skin tone), for example, will make it easier for individuals to fully immerse themselves in the experience. The addition of virtual backgrounds (e.g., dressing rooms) to the avatars will also help personalize the experience.

Another drawback of using VR in ED treatment is that there are currently no universal protocols for its use. Therefore, clinicians will need to work together to develop effective, scientifically tested guidelines for using VR in ED treatment. An additional concern is the financial barriers to using VR for ED treatment, which will need to be considered by healthcare providers.

Finally, VR has also been demonstrated to be effective in reducing body dissatisfaction in other EDs, such as binge eating disorder, in combination with CBT.⁹ Therefore, more research is needed to determine the effectiveness of VR in treating different types of EDs.

Despite these obstacles, the use of VR in ED treatment is proving to be an exciting, innovative breath of fresh air in ED treatment approaches.