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Using Virtual Reality to Treat Eating Disorder

Using Virtual Reality to Treat Eating DisorderThere is sound evidence that in the general population body dysphoria and social pressure for thinness constitute risk factors for the development of Eating Disorders (ED). Persons with ED and those deeply concerned about their figure have problems with the way they represent, value, feel, and live their body. Body image (BI) disturbances are considered as precursors of disordered eating and as predictors of relapse.


Recovery from ED in terms of weight and eating pathology does not guarantee that the individual gets along with her/his physical appearance (Perpiñá et al., 2003). Hence, it seems sensible to specifically tackle BI disturbances in the general treatment of ED. However, there is scarce number of studies dealing with the utilization of a specific component for the treatment of BI, within the scope of the general treatment of eating disorders.




Body Dysphoria


is used to describe general feelings of sadness or an uncomfortable mood. It can include feeling great anxiety, irritability or restlessness.


Body Image Distortion


refers to a distorted view of the body. Those suffering tend to view themselves as being larger than they really are.


Body Image Disturbances


is a more general concept that includes dysphoria, distortions and behaviour rituals related.


Cognitive behavioural treatment


therapy that focuses on problematic behaviours and thoughts of the patient. The therapist will try to understand the relationships among a host of different variables including thoughts, behaviours, sensations and emotions.


Exposure Treatment


patients are asked to deliberately confront anxiety-provoking thoughts, situations and circumstances until their arousal levels are reduced by at least half.


Behavioural Intervention


interventions that may include assertiveness training, behavioural activation, communication and social skills training, distraction, modeling, problem solving, thought stopping, visualization, exposure, relaxation and breathing.


Cognitive Restructuring


therapy that helps patients to recognize and turn irrational thoughts into rational and more adaptive responses.



VR allows the person to model and "embody" their body imageVirtual Reality (VR) is a new tool with numerous possibilities in the assessment and treatment of BI disturbances. This technology allows the user to feel he/she is present in virtual environments, and experience them with all their impact. VR technology allows representing a 3D bodily figure in an immersive system where the person feels "to be there" as she can face her own body. In addition, this method can combine several of the BI dimensions: the body can be evaluated wholly or in parts; the body can be placed in different contexts (for instance, in the kitchen, before eating, after eating, facing attractive persons, etc.); and behavioural tests can be performed in these contexts. Moreover, VR allows the person to model and "embody" their body image; and it allows him/her to “communicate” to the therapist.


In a previous work (Perpiñá et al., 1999), the differential effectiveness of a specific VR component for the treatment of BI in ED was tested. To do so, two treatment conditions were compared: the VR condition (cognitive-behavioural treatment plus VR) and the standard BI treatment condition (cognitive-behavioural treatment plus relaxation). Therefore, this was a controlled study conducted in a clinical population, and consisted of a comparison of the efficacy of the VR component versus the "traditional" BI techniques.


The cognitive-behavioural BI treatment was based on Cash (1996) and Rosen (1997) programmes and consisted of psychoeducation, exposure, a safety behaviours intervention, cognitive restructuring, and a body self-esteem component. The VR application was developed using a PC Pentium with a medium quality Head Mounted Display (V6 from Virtual Research) and a 2D mouse. The VR component was developed through several virtual environments.


Participant's real weight vs subjective weightThe first one consisted of a food area with a virtual balance in it. In the scales appeared the participant’s real weight, and she introduced her subjective and desired weights. The balance also showed her healthy weight. The purpose was to obtain, and then discuss, several discrepancy indexes. Moreover, there were forbidden and "safe" foods. Once the participant had eaten, she had to introduce into the balance the weight she thought she had at that moment. Setting two was an exhibit room with several pictures showing different body builds. The purpose there was that the participant understood that weight is a relative concept. Setting three consisted of two mirrors. In the first mirror, the participant had to manipulate a 3D human figure by increasing or decreasing different body areas until it represented her BI. In the second mirror, the participant’s actual body appeared in a translucent 2D-image that could overlap the 3D-figure. If both figures did not fit, the participant had to correct the 3D-figure. In setting four there was a doorframe with several coloured strips in it. The objective of this area was to make the participant aware of the volume her body occupies in space. The participant was asked to pass through the door in sideways, so she had to remove the correct number of strips to open the accurate gap. Finally, in setting five, the participant had to manipulate again different body areas, but this time she was asked to model her subjective and desired bodies, and the idea that, according to her, a significant person would have of her. All these images were contrasted.


Before and after the treatment, the patients were assessed through several questionnaires regarding their eating and weight symptoms and BI disturbances. Results showed that after treatment, all patients had improved significantly. However, those patients treated with the VR component showed a significantly higher improvement.Global improvement kept progressing one year after treatment The aim of a second study (Perpiñá et al., 2004) was to examine the evolution of those results at one-year follow-up, once the whole sample had completed treatment in the VR condition. Data pointed out that the participants’ global improvement at post-treatment kept progressing one year after treatment completion. The results from both studies showed that the combination of cognitive-behavioural treatment and VR strengthens the results of the “classical” BI treatment, and the results kept improving during the year that followed the end of treatment. Improvement was not only limited to the intervention target, that is BI disturbances, but it reached variables of ED psychopathology and variables of general psychopathology.


For more information visit the
Laboratorio de Psicología y Tecnologia website
and the
Centro Clínico de Psicología Previ website


Author : Conxa Perpiñá, Ph.D.
Full Professor of Psychopathology
University of Valencia
CIBER of Fisiopatología de la Obesidad y Nutrición (CIBEROBN)
Instituto de Salud Carlos III, Spain



  • Cash, T.F. (1996). The treatment of body Image disturbances. In J.K.Thompson (Ed.), Body Image, eating disorders and obesity. Washington: American Psychological Association.

  • Perpiñá, C., Botella, C., Baños, R., Marco, J.H; Alcañiz, M. y Quero, S. (1999). Body Image and virtual reality in eating disorders: Exposure by virtual reality is more effective than the classical body image treatment? Cyberpsychology & Behavior, 2 (2), 149-159.

  • Perpiñá, C., Botella, C. y Baños, R M. (2003). Virtual Reality in Eating Disorders.  European Eating Disorders Review, 11, 261-278

  • Perpiñá, C., Marco, J.H., Botella, C., y Baños, R. (2004). Tratamiento de la imagen corporal en los trastornos alimentarios mediante tratamiento cognitivo-comportamental apoyado con realidad virtual: resultados al año de seguimiento. Psicología Conductual, 12 (3), 519-538

  • Rosen, J.C. (1997). Cognitive-behavioral body image therapy. En D.M. Garner
    y P.E. Garfinkel (Eds.), Handbook of treatment for eating disorders (2ª
    Ed.). New York: Guilford Press.

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