Virtual Reality Lab - Universitat de Barcelona

Abstract: Anorexia nervosa (AN) patients exhibit attentional bias (AB) related to the body, which is the tendency to pay greater attention to weight-related body areas compared to non-weight-related ones. This phenomenon has been linked to elevated levels of body dissatisfaction (BD) and may potentially reduce the effectiveness of body exposure therapy. The purpose of this pilot study is to assess the efficacy of a single session of a new body- related AB modification task (ABMT) that combines virtual reality with eye tracking in patients with AN. The goals of the ABMT are to reduce body-related AB by balancing attention between weight and non-weight-related body areas and to reduce BD levels. Twenty-three adolescent patients with AN were embodied in a virtual avatar and immersed in a virtual environment where they completed the ABMT. Body-related AB measures and BD levels were assessed before and after the training. A paired samples t-test showed statistically significant differences between pre-assessment and post-assessment; the complete fixation time on weight-related body parts was reduced and BD levels decreased. The initial evidence of the efficacy of this ABMT has important clinical implications, since AB and BD are considered risk factors for developing and maintaining eating disorder symptomatology among patients with AN.

Authors: by Mariarca Ascione, Marta Carulla-Roig, Helena Miquel-Nabau, Bruno Porras-Garcia, Franck-Alexandre Meschberger-Annweiler, Eduardo Serrano-Troncoso, Marta Ferrer-Garcia, Manuel Moreno-Sánchez and Jose Gutierrez-Maldonado

Journal: Journal of Clinical Medicine

Year: 2023

Abstract: Attentional bias modification training (ABMT) is an effective technique for reducing the dysfunctional body-related attentional bias (AB) that may be responsible for reducing the effectiveness of mirror exposure therapy (MET), which has been proposed as an effective treatment for anorexia nervosa (AN). This multiple-case study provides evidence of the usefulness of incorporating ABMT into virtual reality (VR) and eye-tracking (ET)-based MET to improve its efficacy in the treatment of four female adolescents with AN. Over five exposure sessions, patients were immersed in a virtual environment and were embodied in a real-size body virtual avatar reflected in a mirror that gradually increased body mass index (BMI) until reaching a healthy BMI in the last session. In every session, the participants completed the ABMT followed by the MET. This augmentation of MET using VR-ET-based ABMT achieved promising results for targeting AN symptomatology by reducing body dissatisfaction, drive for thinness, weight-related body parts anxiety, body checking behaviors, fear of gaining weight, and anxiety, and increasing body appreciation. Two patients who did not show a reduction in fear of gaining weight during the sessions also showed high anxiety levels, which could have affected its reduction. To advance this preliminary study and evaluate the effectiveness of incorporating ABMT into MET, a controlled clinical trial will be conducted.

Authors: Mariarca Ascione, Marta Carulla-Roig, Helena Miquel-Nabau, Franck-Alexandre Meschberger-Annweiler, Eduardo Serrano-Troncoso, Marta Ferrer-Garcia and José Gutiérrez-Maldonado

Journal: Annual Review of Cyberherapy and Telemedicine 2023 (pp. 33-39)

Year: 2023

Abstract: This case study explores the potential of integrating attentional bias modification training (ABMT) with mirror exposure therapy (MET), utilizing virtual reality and eye-tracking, for a 14-yearold girl diagnosed with anorexia nervosa (AN). The ABMT-MET intervention was used alongside a standard treatment program called Home Treatment (HoT), which combines cognitive behavioral therapy with family-based therapy. Though the patient began HoT with a 3-week inpatient phase, the ABMT-MET intervention specifically took place during the subsequent Home Treatment sessions. The experimental treatment, comprising five consecutive weekly sessions, was bookended by preand post-assessment sessions and included a six-month follow-up. During the sessions, the patient engaged in systematic and hierarchical exposure to a virtual representation of her silhouette, with gradual adjustments made to the avatar’s body mass index (BMI) toward a healthier range. ABMT sessions, conducted before each MET session, aimed to redistribute the patient’s focus evenly across her body, successfully neutralizing her initial attentional bias toward non-weight-related body parts. The patient demonstrated consistent decreases in anxiety and fear of weight gain, effectively progressing through the BMI hierarchy in the virtual setting. Post-treatment assessments indicated significant enhancements in body dissatisfaction, drive for thinness, body-checking behaviors, and body appreciation, with these gains preserved at the six-month follow-up, although the attentional bias returned to pre-treatment levels. Though the single-case design limits definitive conclusions, these findings suggest ABMT-MET may be a promising adjunct therapy for AN, requiring further research for confirmation.

Authors: Mariarca Ascione, Eduardo Serrano-Troncoso, Marta Carulla-Roig, Anna Blasco Martínez, Fernando Guerrero Álvarez, Franck-Alexandre Meschberger-Annweiler, Bruno Porras-Garcia, Marta Ferrer-Garcia and José Gutierrez-Maldonado

Journal: Applied Sciences

Year: 2024

Abstract: pending publication, coming soon.

Authors: Mariarca Ascione, Eduardo Serrano-Troncoso, Marta Carulla-Roig, María Teresa Mendoza-Medialdea, Franck-Alexandre Meschberger- Annweiler, Anna Blasco Martínez, Fernando Guerrero Álvarez, Marta Ferrer-Garcia, Manuel Moreno-Sánchez, Bruno Porras-Garcia, and José Gutierrez-Maldonado

Abstract: pending publication, coming soon.

Authors: Mariarca Ascione, Klaske A. Glashouwer, Franck-Alexandre Meschberger-Annweiler, Teresa Mendoza-Medialdea, Bruno Porras-Garcia, Marta Ferrer-Garcia and José Gutierrez-Maldonado