For many people with anorexia nervosa – commonly known simply as anorexia – it is precisely the most important treatment goal that poses the greatest hurdle: gaining weight. The fear of doing so shapes everyday life for those affected and ranks among the strongest predictors of how a therapy will progress and whether a relapse will occur. A research team in Tübingen is targeting exactly this point – with a virtual reality in which patients can experience a healthy, normal-weight body as their own.
The application was developed by scientists from the Department of Psychosomatic Medicine and Psychotherapy at Tübingen University Hospital together with the Max Planck Institute for Intelligent Systems. Early in the course of treatment, those affected are meant to try out what it might feel like to have a healthy body weight – seen both from a first-person perspective and in a virtual mirror. The approach draws on behavioural therapy: much as in the treatment of phobias, patients are gently confronted with what frightens them.
One distinctive feature is the displayed body itself. Instead of the often unnatural-looking figures from video games, the team uses a digital body model from Michael J. Black's research group at the Max Planck Institute, based on thousands of body scans. This makes it possible to generate biometrically plausible bodies and to tailor their height and weight individually to each person. The setup is also portable and ready to use within ten minutes – unlike the often room-filling VR installations.
First results from a pilot study
The initial findings appeared in the journal "Psychotherapy and Psychosomatics". The team led by psychotherapist Simone Behrens tested the method in two studies: first with 20 women who had pronounced weight or shape concerns, and then with 20 patients with diagnosed anorexia, who each went through four half-hour sessions.
The patients' reactions varied widely. Almost half reported high tension that quickly subsided; about a third were relaxed at first but felt increasing discomfort the more they engaged with it; some did not find the sight distressing at all. Across the four sessions, a statistical trend emerged among the anorexia patients that repeated confrontation reduces the fear of weight gain – with large effect sizes. Notably, almost all participants described the virtual experience as very helpful for their personal recovery.
For now, these remain research prototypes; their benefit and financing must be examined further before the technology could be used more widely in clinics. As a next step, the group wants to understand more precisely what actually works during virtual body exposure. Given that around 460,000 people in Germany have a diagnosed eating disorder – more than half of them under 18 – Behrens sees great potential for technical aids in psychotherapy.