1 - (SYM 35) Through the Looking Glass: Using Virtual Reality in Cue Exposure Therapy for Eating Disorders

Enhancing outcomes for eating disorders treatment is important due to their serious nature and issues around treatment accessibility. Considering variations due to diagnosis and treatment setting, abstinence rates across studies typically do not exceed 50% post-treatment, with high rates of relapse and dropout. Integrating virtual reality (VR) technology with treatment has shown to be a promising strategy for enhancing outcomes, including reducing dropout, compared to standard treatments alone. VR technology offers several advantages within a treatment setting, such as improved ecological validity, skill acquisition, and generalization, enabling better personalized interventions. With the ability to track body movements and provide biofeedback (visual, physiological), VR can also collect objective markers of change. The U.S. has lagged significantly behind Europe when it comes to studying VR’s use in eating disorder treatment, and uptake of VR in clinical settings has been limited by the lack of effectiveness research. Historically, across disorders, implementation was limited by the cost of technology and concerns about acceptability (e.g., motion sickness was common). Over time, however, VR technology has become increasingly sophisticated and portable, resulting in improved acceptance, increased access, and reduction in costs. Market trends suggest VR may be nearly ubiquitous in American homes, much like the personal computer, within a decade. This increased access would introduce the possibility of engaging in treatment not just from the clinic but also the home. As such, our research lab has focused on implementation of VR therapy for eating disorders in real world practice settings in the U.S. Initially, we successfully translated a short (8 session) VR cue-exposure therapy (CET) intervention developed in the research-trial setting for use in a “real-world” outpatient setting for patients with bulimia nervosa and binge-eating disorder. In a small pilot with 11 participants refractory to prior evidence-based treatment, we found VR-CET was feasible and acceptable as well as had preliminary evidence of effectiveness in reducing binge eating and purging after just 8 sessions. Post-treatment OBE 7-day abstinence rate for completers was 56% and purging abstinence was 100% maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears viable and may help refractory patients. Findings, including some loss of treatment gains by follow-up, will inform future treatment development.