Virtual Reality Externalization (VR-E) for Patients With Eating Disorders: A Pilot Study

Despite significant health and psychosocial impairments, many individuals with eating disorders (ED) view their disorder as an integral part of their identity. Because this "ego-syntonicity" is associated with low treatment motivation and treatment dropouts, we investigated the acceptability, feasibility, and effects of a newly developed externalization exercise in virtual reality (VR) for EDs.

N = 51 inpatients with EDs (42 women, 8 men, 1 not reported; mean age = 31.9 years) imagined that an object simulated in VR (a sphere) represented their ED. They then modified the object using controller-assisted actions (controlling distance, size, color, and cutting it up). The perceived valence, activation, and difficulty of each action as well as user experiences were recorded. Effect parameters (self-ED overlap as a measure of relative externalization, general self-efficacy) were recorded before and after the exercise.

Patients rated their experience predominantly positive. Self-ED overlap decreased (Cohen's d = 0.46, 95% CI [0.22, 0.69]) and self-efficacy increased from before to after participation (Cohen's d = -0.22, 95% CI [-0.43, -0.01]). The effects were comparable between anorexia nervosa and other diagnostic groups.

The results indicate the feasibility and potential efficacy of the newly developed VR procedure for externalizing EDs and provide a basis for planning controlled studies.