RESUMEN
PURPOSE: Virtual reality (VR) technologies have been proposed as a new tool able to improve on in vivo exposure in patients with eating disorders. This study assessed the validity of a VR-based software for cue exposure therapy (CET) in people with bulimia nervosa (BN) and binge eating disorder (BED). METHODS: Fifty eight outpatients (33 BN and 25 BED) and 135 healthy participants were exposed to 10 craved virtual foods and a neutral cue in four experimental virtual environments (kitchen, dining room, bedroom, and cafeteria). After exposure to each VR scenario, food craving and anxiety were assessed. The frequency/severity of episodes of uncontrollable overeating was also assessed and body mass index was measured prior to the exposure. RESULTS: In both groups, craving and anxiety responses when exposed to the food-related virtual environments were significantly higher than in the neutral-cue virtual environment. However, craving and anxiety levels were higher in the clinical group. Furthermore, cue-elicited anxiety was better at discriminating between clinical and healthy groups than cue-elicited craving. CONCLUSIONS: This study provides evidence of the ability of food-related VR environments to provoke food craving and anxiety responses in BN and BED patients and highlights the need to consider both responses during treatment. The results support the use of VR-CET in the treatment of eating disorder patients characterized by binge-eating and people with high bulimic symptoms.
Asunto(s)
Ansiedad/psicología , Trastorno por Atracón/psicología , Bulimia Nerviosa/psicología , Ansia/fisiología , Terapia de Exposición Mediante Realidad Virtual , Adolescente , Adulto , Señales (Psicología) , Conducta Alimentaria/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Programas Informáticos , Adulto JovenRESUMEN
This article reviews the 6-month followup data of a randomized, multicenter, parallel-group study conducted at five clinical sites in three European cities, which compared two second-level treatments for bulimia nervosa (BN) and binge eating disorder (BED): virtual reality-based cue exposure therapy (VR-CET) versus additional cognitive behavioral therapy (A-CBT). Post-treatment outcomes of this study were previously published and details of its design can be found at clinicaltrials.gov (identifier: NCT02237300). This article focuses on the evolution of symptoms assessed after 6 months of followup in a subgroup of 58 patients from the original study. In this study 64 patients with eating disorders (EDs) (35 with BN and 29 with BED), who still showed active episodes of binge eating by the end of a structured CBT program (first-level treatment), were randomly assigned to one of two second-level treatments (A-CBT or VR-CET). Frequency of binge and purge episodes, and attitudinal features of binge-related EDs (bulimia, drive for thinness, and body dissatisfaction) were assessed before starting the second-level treatment (n = 64), at the end (n = 64), and at 6-month followup (n = 58). Mixed between-within subject analyses of variance were used to compare outcomes of both second-level treatments over time. Although both treatment conditions showed statistically significant improvements at the end and after 6-month followup, obtained reductions were greater after VR-CET, regarding binge and purge episodes, as well as the decrease of self-reported tendency to engage in overeating episodes. Accordingly, abstinence from binge episodes were higher in VR-CET than A-CBT at followup (70 percent vs. 26 percent, respectively; χ2 = 11.711, p = 0.001). These results provide further support for the use of VR-CET as an effective second-level intervention for BN and BED treatment-resistant patients.
Asunto(s)
Trastorno por Atracón/terapia , Bulimia Nerviosa/terapia , Terapia Cognitivo-Conductual , Terapia de Exposición Mediante Realidad Virtual , Estudios de Seguimiento , HumanosRESUMEN
A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Asunto(s)
Trastorno por Atracón/terapia , Bulimia Nerviosa/terapia , Terapia Cognitivo-Conductual/métodos , Señales (Psicología) , Terapia de Exposición Mediante Realidad Virtual , Adulto , Ansiedad/psicología , Trastorno por Atracón/psicología , Bulimia Nerviosa/psicología , Ansia , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
Eating behavior style (emotional, restrictive, or external) has been proposed as an explanation for the differences in response to food-related cues between people who overeat and those who do not, and has been also considered a target for the treatment of eating disorders (EDs) characterized by lack of control over eating and weight-related (overweight/obesity) conditions. The aim of this study was to analyze the relationship between eating behavior style and psychophysiological responses (self-reported food craving and anxiety) to food-related virtual reality (VR) environments in outpatients with bulimia nervosa (BN) and binge eating disorder (BED) and to compare them with healthy participants. Fifty-eight outpatients and 135 healthy participants were exposed to palatable foods in four experimental everyday real-life VR environments (kitchen, dining room, bedroom and café). During exposure, cue-elicited food craving and anxiety were assessed. Participants also completed standardized instruments for the study purposes. ED patients reported significantly higher levels of craving and anxiety when exposed to the virtual food than healthy controls. Eating behavior styles showed strong associations with cue-elicited food craving and anxiety. In the healthy group, external eating was the only predictor of cue-elicited craving and anxiety. In participants with BN and BED, external and emotional eating were the best predictors of cue-elicited craving and anxiety, respectively.
Asunto(s)
Ansiedad/etiología , Bulimia Nerviosa/fisiopatología , Bulimia/fisiopatología , Ansia , Conducta Alimentaria , Preferencias Alimentarias , Modelos Psicológicos , Adolescente , Adulto , Ansiedad/psicología , Índice de Masa Corporal , Bulimia/psicología , Bulimia Nerviosa/psicología , Estudios Transversales , Señales (Psicología) , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Conducta Alimentaria/psicología , Femenino , Preferencias Alimentarias/psicología , Humanos , Masculino , Persona de Mediana Edad , Obesidad/etiología , Obesidad/prevención & control , Obesidad/psicología , Autoinforme , Delgadez/etiología , Delgadez/psicología , Realidad Virtual , Adulto JovenRESUMEN
The objective of this study was to assess the association between external eating style and food craving experienced during exposure to food cues in virtual reality (VR) environments in both clinical and non-clinical samples. According to the externality theory, people with external eating experience higher reactivity when exposed to food cues, which in turn increases the probability of overeating. Forty patients with eating disorders (23 with bulimia nervosa and 17 with binge eating disorder) and 78 undergraduate students were exposed to 10 different food cues in four VR environments (kitchen, dining room, bedroom, and café). After 30 seconds of exposure to each VR environment, food craving was assessed using a visual analog scale. External, emotional and restrictive eating styles were also assessed using the DEBQ. The results showed a strong association between external eating and cue-elicited food craving. After controlling for the presence of eating disorder diagnosis, external eating was the best predictor of reported food craving. The results lend support to the externality theory but highlight the need for further research in specific patterns of functioning in patients with bulimia nervosa and binge eating disorder.
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Ansia , Señales (Psicología) , Conducta Alimentaria/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Realidad Virtual , Adulto , Trastorno por Atracón/diagnóstico , Trastorno por Atracón/psicología , Bulimia Nerviosa/diagnóstico , Bulimia Nerviosa/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Femenino , Humanos , Hiperfagia/psicología , Masculino , Adulto JovenRESUMEN
The aim of this study was to establish whether virtual reality (VR) exposure to food cues is able to produce craving levels consistent with state-craving and trait-craving as assessed by the Spanish and Italian versions of the State and Trait Food Craving Questionnaires (FCQ-T/S). The results were compared in 40 patients with eating disorders (17 with binge eating disorder, 23 with bulimia nervosa) and 78 healthy control subjects without eating disorders. Controls and patients with higher levels of trait-craving and state-craving both showed a greater desire to eat during VR exposure. Results also showed that trait and state craving assessed by FCQ-T/S were able to predict the total mean craving experienced during exposure to the VR software in both clinical and control samples. These findings present preliminary evidence about the validity of a new virtual reality-based application for cue-exposure treatment in patients with eating disorders.
Asunto(s)
Trastorno por Atracón/psicología , Trastorno por Atracón/terapia , Carácter , Ansia , Terapia Implosiva/métodos , Programas Informáticos , Terapia Asistida por Computador/métodos , Realidad Virtual , Adolescente , Adulto , Estudios de Casos y Controles , Señales (Psicología) , Femenino , Alimentos , Humanos , Masculino , Persona de Mediana Edad , Estadística como Asunto , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Binge eating behavior constitutes a central feature of both bulimia nervosa (BN) and binge eating disorder (BED). Cue exposure therapy (CET) has been proposed as an effective intervention. OBJECTIVE: To determine which situations and specific cues trigger higher levels of binge craving and to use the results in the development of virtual reality scenarios in which CET could be applied with BN and BED patients. METHOD: Participants were 101 outpatients, 50 with BED and 51 with BN, according to DSM-5 criteria, and 63 healthy undergraduate students who completed a self-administered questionnaire to assess binge craving. RESULTS: The likelihood of binge craving in the clinical group was greater when alone at home, during the afternoon/early evening and in the late evening/at night, at weekends, and at dinner time or between meals. Higher levels of craving were produced in the kitchen, bedroom, dining room, and bakery situations. With regard to the specific cues reported, the presence of and access to high calorie food and snacks was the most commonly reported cue. Although some gender differences regarding triggering factors were obtained, no statistical differences were observed between ED subtypes. BN and BED patients showed significantly higher levels of binge craving than controls in all the contexts except when feeling positive affect; in this situation, levels of craving were low in both groups. CONCLUSIONS: This information regarding trigger contexts and specific cues can be used to create valid and reliable virtual environments for CET. Indeed, the data from this study may serve to develop a wide range of situations with different levels of binge craving, in which the therapeutic aim is to extinguish conditioned responses and facilitate the generalization of craving extinction.
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Trastorno por Atracón/psicología , Bulimia Nerviosa/psicología , Bulimia/psicología , Señales (Psicología) , Ambiente , Conducta Alimentaria , Alimentos , Adolescente , Adulto , Conducta Adictiva/psicología , Conducta Adictiva/terapia , Trastorno por Atracón/terapia , Bulimia/terapia , Bulimia Nerviosa/terapia , Simulación por Computador , Ansia , Emociones , Extinción Psicológica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Interfaz Usuario-Computador , Adulto JovenRESUMEN
This paper gives a broad definition of the characteristics and incidence for schizophrenia, and introduces the various deficits in social skills and social function faced by patients with this disorder. The role of Social Skills Training (SST), which can be used to improve some of these deficiencies in social skills, social function, cognition and competence, including the history and efficacy of such training, is addressed. An outline is given of the Brief Cognitive-Behavioural SST for schizophrenia patients, designed by our clinical research group (University of Barcelona and General Hospital of Igualada, Spain), along with the parameters of the study, risk factors for certain patients and results. We then indicate future directions focusing on the sue of virtual reality as a modern technology to enhance treatment and highlighting potential areas for further study
Este artículo proporciona una definición amplia sobre las características y la incidencia de la esquizofrenia y presenta los distintos déficit en habilidades sociales y en funcionamiento social que sufren los pacientes con este trastorno. Se aborda el papel del entrenamiento en habilidades sociales (EHS), que puede utilizarse para mejorar algunas de estas deficiencias en habilidades sociales, en el funcionamiento social, en las cogniciones y en la competencia, incluyendo la historia y la eficacia de dicho entrenamiento. Se expone un esquema del "EHS cognitivo conductual breve" para pacientes con esquizofrenia desarrollado por nuestro grupo clínico de investigación (Universidad de Barcelona y Hospital General de Igualada, España), junto con los parámetros del estudio, los factores de riesgo para ciertos pacientes y los resultados. Finalmente, presentamos las perspectivas futuras, centrándonos en el uso de la realidad virtual como una tecnología moderna para mejorar el tratamiento y resaltar áreas potenciales para estudios futuros
Asunto(s)
Humanos , Masculino , Femenino , Habilidades Sociales , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Cognición/fisiología , Competencia Mental/psicología , Conducta Social , Psicología Social/instrumentación , Psicología Social/organización & administración , Terapia Cognitivo-Conductual/métodosRESUMEN
The objective of this study was to identify frequent situations and specific cues that produce the craving to binge in Spanish and Italian samples of patients with eating disorders (ED). There were two main aims: to assess transcultural differences in the contexts and cues that elicit food craving; and to develop valid, reliable VR environments for effective cue-exposure therapy (CET) for patients from both countries. Twenty-six Spanish and 75 Italian ED patients completed an ad hoc questionnaire to assess contexts and cues that trigger the craving to binge. No differences between groups were found. All patients reported experiencing higher levels of craving in the afternoon/early evening and in the late evening/night, between meals, when alone, and more frequently at the end of the week. Being in the dining room, the kitchen, the bedroom, the bakery and the supermarket were the specific situations that produced the highest levels of craving to binge. We used the questionnaire results to develop a virtual reality application for CET.
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Bulimia/psicología , Bulimia/terapia , Instrucción por Computador/métodos , Ansia , Comparación Transcultural , Educación del Paciente como Asunto/métodos , Realidad Virtual , Adulto , Características Culturales , Femenino , Humanos , Italia , Masculino , España , Encuestas y CuestionariosRESUMEN
BACKGROUND AND OBJECTIVES: Social skills training (SST) intervention has shown its efficacy to improve social dysfunction in patients with psychosis; however the implementation of new skills into patients' everyday functioning is difficult to achieve. In this study, we report results from the application of a virtual reality (VR) integrated program as an adjunct technique to a brief social skills intervention for patients with schizophrenia. It was predicted that the intervention would improve social cognition and performance of patients as well as generalisation of the learned responses into patient's daily life. METHODS: Twelve patients with schizophrenia or schizoaffective disorder completed the study. They attended sixteen individual one-hour sessions, and outcome assessments were conducted at pre-treatment, post-treatment and four-month follow-up. RESULTS: The results of a series of repeated measures ANOVA revealed significant improvement in negative symptoms, psychopathology, social anxiety and discomfort, avoidance and social functioning. Objective scores obtained through the use of the VR program showed a pattern of learning in emotion perception, assertive behaviours and time spent in a conversation. Most of these gains were maintained at four-month follow-up. LIMITATIONS: The reported results are based on a small, uncontrolled pilot study. Although there was an independent rater for the self-reported and informant questionnaires, assessments were not blinded. CONCLUSIONS: The results showed that the intervention may be effective for improving social dysfunction. The use of the VR program contributed to the generalisation of new skills into the patient's everyday functioning.
Asunto(s)
Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Trastorno de la Conducta Social/etiología , Trastorno de la Conducta Social/rehabilitación , Terapia de Exposición Mediante Realidad Virtual/métodos , Actividades Cotidianas , Adolescente , Adulto , Análisis de Varianza , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Autoinforme , Resultado del Tratamiento , Adulto JovenRESUMEN
Patients with psychosis exhibit a wide range of cognitive deficits which are associated with poor functioning and poor outcomes in psychosocial interventions. Recently, virtual reality (VR) has been demonstrated to be a useful tool for treatment and rehabilitation of these patients. We have developed and applied an integrated VR programme to improve social skills in people with schizophrenia: the Soskitrain. The aim of the present study is to evaluate the relationship between patients' cognitive deficits, their sense of presence and their ratings of the programme's acceptability. Twelve clinically stabilized outpatients with a well-established diagnosis of schizophrenia or schizoaffective disorder underwent neuropsychological assessment prior to treatment, while after the intervention they completed a questionnaire about their sense of presence and the acceptability of the VR programme. Post-treatment results revealed a high sense of presence among patients, as well as good verisimilitude and high acceptance of the virtual environments. In addition, there were significant negative correlations between sense of presence and deficits in both delayed verbal learning and processing speed. The paper discusses the implications of cognitive impairment for the experience and acceptance of VR when treating psychotic patients.
Asunto(s)
Trastornos del Conocimiento/terapia , Trastornos Psicóticos/terapia , Esquizofrenia/terapia , Terapia Asistida por Computador/métodos , Terapia de Exposición Mediante Realidad Virtual/métodos , Adulto , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Femenino , Humanos , Masculino , Aceptación de la Atención de Salud , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Resultado del TratamientoRESUMEN
Achieving social functioning and achieving social competence are two main objectives of psychosocial interventions for people suffering from schizophrenia. The present preliminary study presents a novel approach of social skills training (SST) based on the proposals of Kopelowicz et al. (Kopelowicz, A., Liberman, R. P., and Zarate, R., 2006. Schizophr. Bull. 32 (1): S12-23) that link the treatment to seven specific target behaviours: social perception, social information processing, responding and sending skills, affiliative skills, interactional skills, and behaviour governed by social norms. Thirty-one stabilised outpatients were randomly assigned to one of two groups, SST (n=13) or treatment-as-usual (n=18) (TAU; case management, medication adherence, psychotherapy, leisure engagement, and family support) and were assessed at baseline in cognitive performance, clinical symptomatology, social cognition, and psychosocial functioning. These outcomes were evaluated across post-treatment and at the 6-month follow-up appointment. SST subjects showed improvements in psychopathology, social discomfort, social cognition (self-regulation statements during interactions), social withdrawal, interpersonal communication, and quality of life compared with the TAU group. At the 6-month follow-up, results were maintained for negative symptoms, social discomfort, and some functioning outcomes. Neuropsychological variables were also examined, as mediators of benefit from skills training. Results support the efficacy of the brief SST for outpatients with schizophrenia and show the need to implement empirically supported interventions in mental health services to enhance patients' social functioning and quality of life.