A virtual reality study of cognitive biases in body dysmorphic disorder

Previous research shows that individuals with body dysmorphic disorder (BDD) misinterpret ambiguous social information in a negative and threatening manner. These erroneous threat appraisals are thought to maintain disorder symptomatology and psychosocial impairment by reinforcing individuals' distorted self-image and ideas of social undesirability. Thus, maladaptive interpretation biases represent an important treatment target for this population; however, existing bias assessments and modification protocols are limited by the hypothetical and distal nature of scenarios and do not capture momentary experiential threat processes. The current study tested virtual reality (VR) technology as a novel, in vivo means of eliciting, identifying, and measuring threat interpretation biases in a clinical sample to better understand the fear/threat structure activated during social interactions in BDD. Findings indicated that, relative to nonpsychiatric controls (N = 25), individuals with BDD (N = 25) evidenced greater in vivo threat interpretation biases and discomfort ratings (distress, fear, perceived threat, urge to check, urge to avoid) in response to interpersonal scenarios presented via VR. This pattern of findings was also observed for established dispositional interpretation bias measures. Study findings enhance our understanding of disorder maintenance and offer more nuanced treatment targets. This study represents a critical first step in the long-term goal of harnessing VR gaming technology to supercharge existing treatment approaches for this debilitating illness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).