Improving Anorexia Nervosa Treatment with Virtual Reality Body Exposure and Attentional Bias Modification: A Single Case Study

Abstract

This case study explores the potential of integrating attentional bias modification training (ABMT) with mirror exposure therapy (MET), utilizing virtual reality and eye-tracking, for a 14-year-old girl diagnosed with anorexia nervosa (AN). The ABMT-MET intervention was used alongside a standard treatment program called Home Treatment (HoT), which combines cognitive behavioral therapy with family-based therapy. Though the patient began HoT with a 3-week inpatient phase, the ABMT-MET intervention specifically took place during the subsequent Home Treatment sessions. The experimental treatment, comprising five consecutive weekly sessions, was bookended by pre- and post-assessment sessions and included a six-month follow-up. During the sessions, the patient engaged in systematic and hierarchical exposure to a virtual representation of her silhouette, with gradual adjustments made to the avatar’s body mass index (BMI) toward a healthier range. ABMT sessions, conducted before each MET session, aimed to redistribute the patient’s focus evenly across her body, successfully neutralizing her initial attentional bias toward non-weight-related body parts. The patient demonstrated consistent decreases in anxiety and fear of weight gain, effectively progressing through the BMI hierarchy in the virtual setting. Post-treatment assessments indicated significant enhancements in body dissatisfaction, drive for thinness, body-checking behaviors, and body appreciation, with these gains preserved at the six-month follow-up, although the attentional bias returned to pre-treatment levels. Though the single-case design limits definitive conclusions, these findings suggest ABMT-MET may be a promising adjunct therapy for AN, requiring further research for confirmation.