VR (and presence) that teaches inhibitory control may be helpful in treating binge eating disorder

[A new study by Drexel University researchers explores the potentially valuable application of presence-evoking technology in treating inhibitory control deficits such as those in binge-eating disorder. The study is described in this story from PsyPost. The journal article by the researchers includes this:

“Delivering ICT through virtual reality (VR) confers many important advantages over traditional ICTs. First, the more realistic imagery of VR better approximates encountering palatable foods in the natural environment. In samples of individuals with eating disorders (EDs), exposure to 3D images, compared to 2D images, induce greater desires to consume the food (Perpiñá et al., 2013). Additionally exposure to real food and VR food stimuli produce equivalently high arousal (Gorini, Griez, Petrova, & Riva, 2010). Secondly, a VR ICT can be designed to facilitate inhibition of realistic motor movements (e.g., reaching and grabbing), which may increase the potential for transfer to eating behavior. Thirdly, VR induces a “sense of presence”, i.e., a feeling of being immersed (Krijn et al., 2004), which is likely to result in greater adherence with trainings in the long term.” (Introduction)


[Image: Figure 1 from the Manasse et al. article. Screenshots of the trainings: Virtual hands and fruit, and virtual hands and cake.]

Virtual reality that teaches inhibitory control may be helpful in treating binge eating disorder

By Beth Ellwood
April 13, 2021

In an experiment published in the journal Appetite, a virtual reality training was found to reduce loss of control eating among participants with a history of binge eating.

Binge eating disorder (BED) is characterized by episodes of eating large amounts of food while experiencing a loss of control. While cognitive behavioral therapy is the most popular treatment for binge eating, evidence suggests that a substantial number of patients maintain their symptoms following treatment.

Researchers Stephanie M. Manasse and her team suggest that current treatments appear to be unsuccessful in targeting the loss of control associated with binge eating. The researchers suggest that this is because it is difficult to transfer treatment gains to real-world eating behavior. Manasse and her colleagues propose that an immersive virtual reality (VR) training centered around inhibitory control may be particularly powerful in changing patients’ behavior.

The researchers recruited 14 adults who reported experiencing loss of control eating at least once a week during the past three months. The subjects were an average age of 46. Over two weeks, the participants completed a daily VR inhibitory control training. The subjects completed the first session in the lab and 13 additional training sessions at home.

The training followed something called a Go/No Go paradigm. Throughout a series of trials, subjects were shown realistic 3D models of either a binge food item (e.g., pizza, fries), a fruit or a vegetable, or a neutral item (e.g., bowl, fork). The binge food items were paired with a “no go” cue, fruits and vegetables were paired with a “go” cue, and neutral items were paired with a “no go” cue half of the time and a “go” cue the other half of the time.

All items were presented on a plate and appeared to be sitting on a table, and subjects were given controllers that allowed them to “grab” the objects. Participants were instructed to grab “go” items and bring them towards their mouths as fast as they can but were instructed to refrain from responding to “no go” objects.

Through clinical interviews conducted at baseline, post-intervention, and at a two-week follow-up, the researchers assessed changes in participants’ loss of control eating behavior. The researchers found that subjects showed reduced binge eating behavior throughout the training and that bingeing episodes continued to drop during the two-week follow-up period.

Importantly, subjects rated most aspects of the training favorably, with many indicating that it was easy to use and that they looked forward to their daily training. Participation was high, with subjects missing an average of only one training per week.

The findings were consistent with the robust evidence that Go/No Go paradigms reduce food intake in laboratory settings. “Although its specific mechanisms remain unclear,” Manasse and her team comment, “existing accounts theorize that GNG inhibitory control training paradigms create automatic “stop” associations with the target being trained (e.g., binge foods) rather than facilitating “top-down” inhibitory control, thereby targeting the “impulsive” rather than “reflective pathway of decision-making.”

The study was the first to show that a VR training that teaches inhibitory control can reduce loss of control eating behavior outside the lab. The findings suggest that such a training may be an effective addition to treatment for binge eating disorder. The authors suggest that future research should assess the effectiveness of a training period that is longer than two weeks, to assess the ideal dose of training.

The study, “Using virtual reality to train inhibitory control and reduce binge eating: A proof-of-concept study”, was authored by Stephanie M. Manasse, Elizabeth W. Lampe, Adrienne S. Juarascio, Jichen Zhu, and Evan M. Forman.


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