Eating disorders affect a person’s physical and psychological functioning differently than any other mental health disorder. Once thought to be a problem of the wealthy, eating disorders are now known to impact various cultures, socioeconomic statuses, ages, and genders, and can be found worldwide.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) characterizes people with eating disorders as having “pathological eating habits and a tendency to overestimate their weight and body shape.” Eating disorders are not to be taken lightly: patients with an eating disorder faces a high risk of medical and psychological effects, along with the possibility of death if their condition becomes severe enough.
Eating disorders are also more common than you might think. In fact, a 2007 survey by Hudson, et al., noted that about 1.5% of American women (0.5% of men) experience bulimia nervosa, about 0.9% of women (0.3% of men) have been diagnosed with anorexia nervosa, and roughly 3.5% of women (2% of men) struggle with binge eating disorder.
Until recently, eating disorders have been treated mainly through cognitive behavioral therapy (CBT). New advances in the emerging field of virtual reality therapy (VRT), however, are being combined with traditional therapy and show promise for more effective treatment.
Virtual reality therapy is a high tech approach to helping people learn effective ways to cope with the fearful situations they dread. During VRT, you wear a virtual reality headset that looks similar to the type you’d use when playing video games. The therapist plays a simulation program that displays avatars in a variety of anxiety-provoking settings, such as in a restaurant or a store dressing room for those with an eating disorder. These settings are low stress to begin with, then stress levels are increased as you become more desensitized to the worrisome scenario.
You use a virtual “body” during VRT. Although this avatar isn’t really “you”, studies show that people feel a close enough association to the avatar that they emotionally respond as if they were in the actual setting. In this way, they can address their eating disorder and work through their body-image issues in a safe, controlled environment. The psychologist listens in during the session to coach, help with relaxation techniques and provide coping skills. They also can control the environment and either stop the program or lower the stress level if you become too upset.
Virtual reality exposure therapy gives people an experience that is just real enough to trigger an emotional response to their eating disorder, but is it effective?
In 2017, DeCarvalho, et. al., did a systematic review of several studies that used virtual reality therapy for binge eating and bulimia nervosa (BN) treatment. One of the studies they analyzed was done by Perpina, et. al., and focused on treatment with a combination of VRT and cognitive behavioral therapy (CBT) versus treatment with CBT alone. The study found that the “VR treatment group showed more BI [body image] improvement than CBT and greater improvement in the behavior clinical measures. At post-treatment, the VR group improved on body attitudes, frequency of negative automatic thoughts on BI, body satisfaction, discomfort caused by body-related situations and BN symptoms (measured by Bulimic Investigatory Test; BITE). These results were maintained or continued to improve (body attitudes, frequency of negative automatic thoughts on BI) at one-year follow-up.” All participants improved in the eating disorders measures and it was also maintained at follow-up.
In a different study, a body-swapping illusion was used in conjunction with virtual reality. Women with body image anxiety were asked to estimate their own body size before participating in two different body-swapping scenarios. In both illusions, the women were shown a virtual image of themselves with skinny stomachs.
The theory was that it may be possible to modify a person’s allocentric memory (a type of spatial memory in which the person mentally manipulates objects from a stationary point of view) for the positive. Indeed, after going through the virtual scenarios, the women in the study reported a decreased estimated body measurement and assessed their body size more accurately than before participating in the illusion.
Eating disorders impact a person’s biological and psychological functioning in ways unlike other mental health disorders. If you are struggling, we can help through both traditional and virtual reality therapies. Talk to the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida today. For more information, contact us or call us today at 561-496-1094.
Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 01;61(3):348–58. doi: 10.1016/j.biopsych.2006.03.040. http://europepmc.org/abstract/MED/16815322. [PMC free article] [PubMed] [Cross Ref]
De Carvalho, M. R., Dias, T. R. de S., Duchesne, M., Nardi, A. E., & Appolinario, J. C. (2017). Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review. Behavioral Sciences, 7(3), 43. http://doi.org/10.3390/bs7030043
Humans are social creatures. We bond with friends, engage with coworkers, and pair up in relationships. In many ways, we need interaction with other people but, for individuals with social anxiety disorder, being in a social setting can be a huge source of stress and anxiety. This is where virtual reality therapy can help.
The standard treatment for social anxiety is cognitive behavioral therapy (CBT) and in-vivo exposure therapy. This combination physically exposes a person to social situations in small doses, allowing them to gradually desensitize their fear and build up their tolerance. The individual also participates in role playing to learn and practice social skills for even more confidence.
But, being physically present in an anxiety-inducing setting can be difficult, not to mention time consuming when you have to travel to a location. With virtual reality exposure therapy (VRET), however, people with social anxiety can work behind the scenes to challenge their fears in a safe, realistic environment, and in a way that gives them control.
Social Anxiety Disorder is the persistent, sometimes overwhelming anxiety or chronic fear of being in everyday social situations. People who suffer from the disorder feel that they are constantly being watched and judged by those around them. In a social setting, they worry continuously that they will do something to embarrass themselves. While these people are aware they might be making more out of a situation than it really calls for, they can’t help stressing about it anyway.
Social Anxiety can be present in just one area of a person’s life (for example, they may fear giving a speech in front of their team at work) or it may be so encompassing that a person with the disorder finds it extremely traumatic to go to school or work, or perhaps even to the bank or the grocery store.
VR Therapy is a high-tech method that helps people learn effective ways to cope with the anxiety-laden situations they dread. During a VRET session, the person wears a virtual reality headset similar to the kind used in video games or to watch movies on the phone. A simulation program plays and one or more avatars are displayed. The person engages with these avatars in a variety of common social situations in order to become better prepared for interactions in real-life situations.
The programs start at a low threshold of anxiety stimulus and are gradually increased as the person builds their coping skills. A therapist listens in to the session, providing coaching and feedback. Relaxation and stress management techniques are often also used and sometimes medications can provide a benefit.
Virtual reality exposure therapy allows you to feel as if you are in a setting, but the therapist can stop the program if you become truly upset. Even if a person knows the virtual reality program isn’t real, what they experience is enough to trigger an emotional response to their phobia. By working through their reactions, nearly 83 percent of people who have tried virtual reality therapy have managed to put their fears behind them.
In a 2013 study, participants who had been diagnosed with social anxiety disorder took part in a randomized trial that compared virtual reality therapy with in-vivo exposure therapy. The group was assigned to present a speech in front of their peers.
Before doing so, some participants went through eight sessions of VRET, some went through eight sessions of in-vivo exposure therapy, while some were waitlisted and had to give the speech without either type of therapy. After completion of active treatment, both therapy groups showed significant improvement and reduced anxiety levels over the waitlisted group. Furthermore, at the 12-month review, both groups continued to maintain this improvement.
Although more studies will be done in the future, the findings from this one show that there were no significant differences between the physical and virtual treatments. VR therapy is just as effective in treating social anxiety as traditional therapy, but with the benefit of being in an office setting rather than in the actual, emotionally-charged environment.
The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida is a regional center for the National Social Anxiety Center. Our certified therapists provide compassionate care and have specialized training in social anxiety treatment and virtual reality therapy. For more information, contact us or call us today at 561-496-1094.
What would you think if you had a phobia about something (example: a fear of flying) and you could overcome your fear just by sitting in your therapist’s office and watching a movie? We think you’d sign up for that! Okay, it’s not entirely that simple (although it almost is), but virtual reality therapy for phobias is now giving patients a high-tech, cutting-edge solution for helping them get past their fears so they can live a better life.
Many types of phobias can be overcome or greatly reduced when the sufferer goes through cognitive behavioral therapy. In this type of therapy, a patient learns to recognize the thoughts causing the negative feelings surrounding their fears. Once these thoughts are identified, the patient learns how to replace those undesirable beliefs with more positive ones.
In-vivo exposure therapy goes hand in hand with cognitive behavioral therapy. With in-vivo exposure, the patient experiences what they fear in a controlled way and in small doses. By taking small steps, they can confront and gradually conquer their phobia.
Virtual reality exposure therapy combines the best of cognitive behavior therapy and in-vivo exposure. It allows people to work through their fears in a realistic environment without actually leaving the comfort and safety of their therapist’s office.
In the case of the fear of flying phobia mentioned above, a patient comes to our office, sits in a comfortable chair, and puts on a pair of virtual reality therapy goggles. In conjunction with coaching from their therapist, they view a simulation of the inside of an airplane’s passenger compartment and can look around to see all aspects of the interior.
The patient not only sees the plane, they also hear the same sounds they would experience if they were really on a flight, such as the flight attendant’s announcement or the rumble of airplane engines. Additionally, our virtual reality therapy chair vibrates with the motion of the plane “taking off” or “flying” to provide an even more convincing simulation.
Even if a person knows the virtual reality program isn’t completely realistic, there is enough realism in it to trigger their emotional responses to their phobia. And, by working through these reactions, in some types of phobias or traumas, nearly 83 percent of people who have tried virtual reality therapy have managed to put their fears behind them.
Some of the benefits of virtual reality therapy include:
Studies show this treatment has a powerful real-life impact and a great track record, over time. Virtual reality therapy has been successful in treating both children and adults for PTSD (post-traumatic stress disorder), social anxiety, panic disorder, anxiety disorder, OCD (obsessive compulsive disorder), and phobias. It is also a very effective tool for treating children who suffer from phobias such as school phobia or sleep fears.
Virtual Reality Therapy is coming to our practice very soon. For more information or to find out when it becomes available, contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida or call us today at 561-496-1094.