Virtual reality against anorexia: the UB shows how to change body perception with avatars

The patient (or, in this case, the editor of La Vanguardia) puts on the virtual reality glasses, adjusts the sensors on her feet and hands, and grabs a kind of laser pointer. The first thing she sees is an avatar that resembles her, that has her measurements and that has been put on pants and a shirt of the same color as the ones she is wearing. It is about promoting what is called embodiment, identifying with one’s own avatar. He is not fully aware, but eye tracking technology measures, with a precision of 90 movements per second, what his eyes are fixing on: if they go to the belly, or to the thighs, or are alarmed by the width of those hips, they are yours and they are not yours.

The experiment, which takes place in the Faculty of Psychology of the Mundet Campus of the UB, shows how a study being carried out by two doctoral students, the Italian Marie Ascione and the French-German Frank Meschberger, who each received grants to continue refining the application, operates. of virtual reality systems in different therapies, a field in which the UB has been working for years, with virtual simulations that are applied in many centers to treat phobias such as fear of flying, addictions and alcoholism.

“It is about gradually exposing patients to what generates their phobia, a treatment of choice and exposure based on classical conditioning that has been worked on in Psychology since Pavlov,” explains José Gutiérrez Maldonado, who leads the research group that seeks to apply virtual reality and new technologies to clinical psychology. “For example -he continues- a person with a phobia of heights would go up higher and higher floors, but doing this with a psychotherapist individually with a patient for 15 or 20 sessions has an unaffordable cost in public services and almost in private ones” .

The use of virtual reality, which has been applied since the 1990s, helps facilitate this type of therapy. In addition, for about five years, the price of glasses and equipment, which many companies in the video game sector sell, have dropped radically. “Before they cost 50,000, now for 500 you have ones that are much better,” Gutiérrez Maldonado clarifies.

Several recent studies that have been carried out applying virtual reality to Eating Disorders (TCA) have already given good results, such as one that was tested in Bellvitge and Sant Joan de Déu that sought to reduce craving, the desire to consume food concrete or binge eating, of patients with bulimia. In that of anorexia, which is now being carried out with the ACT unit of Sant Joan de Deu, it introduces ocular monitoring as the main novelty.

Of a total of 75 day hospital patients, 25 do their usual treatment without introducing virtual reality, another 25 (they are all women, since there are not enough men to provide statistically reliable data, in anorexia nervosa, nine out of ten patients they are still women) do undergo the process of exposure to their avatar, using it as if it were an improved version of the therapies that confront the patient with her image in the mirror, and the remaining 25 try the exposure treatment plus what is called “attentional bias reduction training.” In other words, since the program details to the millimeter which parts of the body the patients have been looking at and which they have avoided looking at, the therapists who accompany all the sessions can guide the patients.

“We have more obsessive patients who focus on some parts of the body and others who are more avoidant. There is that phobic fear and then they focus on the face, arms or parts that do not cause them discomfort. And in this case, exposure therapy is not as effective”, explains Marta Ferrer Garcia, psychologist and researcher in the UB group. Just as this type of treatment is done in the analog world using a mirror, the idea is to apply the data to make it more effective. “It is about patients getting used to seeing themselves and describing themselves in a more neutral way, not so negative.”

Over the course of five one-hour sessions, the patient’s avatar gains weight until, ideally, it remains at one that corresponds to a Healthy Body Mass Index, and which is marked by the nutritionists of Sant Joan de Deu. The change is progressive and gradual and no more kilos are added to the avatar until anxiety levels drop below 50% in a marker that the patient herself points to with her pointer.

“The main reaction,” says Ascione, “is not to like each other. They are very perfectionists and they know that this is not their weight”. It also happens that when they see the avatar that weighs more than them, they believe that it is actually smaller than their own body, because they suffer body distortion. “In her head, her body is huge,” explains the doctoral student. There are patients who cannot see their avatar reach their ideal weight and others who not only reach it in virtual reality but also gain the same weight in real life, in parallel time. This is considered, of course, the ideal result of combination therapy.

“Eye tracking works well for us because it allows us to sequence where the patients look at each moment. That gives us a lot of information, it lets us know if they are benefiting from the therapy. The way we look at each other is very important. People without EDs have a more homogeneous look”, adds Eduardo Serrano, psychologist and coordinator of the Sant Joan de Deu ED Unit, a large team made up of psychiatrists, psychologists, nurses, social educators, social workers, teachers and experts in nutrition.

The ED Unit is just beginning to emerge from its post-pandemic collapse, when admissions and diagnoses for eating disorders increased. “The mental health of the population was greatly compromised, and especially that of adolescents. It was clearly seen in the prevalence of eating disorders due to a sum of factors. The harshness of the confinement, the extreme use of social networks that increased aesthetic pressure…”. More patients arrived (many more), and more young people arrived.

In fact, the virtual reality study is being carried out with adolescents between the ages of 12 and 17, and the idea is to start another trial period with much younger girls starting in September. From the UB they speak of a range from eight to 12, although in the hospital they clarify that eight-year-old patients are not common. “Since the pandemic, prepubertal cases have increased and the objective is to study this age group. Before it was very rare for girls of eleven and twelve to enter. Now it does not seem strange to us ”, confirms Marta Carulla, a psychiatrist at the Unit.

Virtual reality treatments can be even more effective for young patients, who are used to using them to play video games. What they will do is modify the software to make it more attractive to such small female users. “It’s all about improving gamification,” says Frank Meschberger. “We are going to add colors and sounds to make it more playful and attractive.”