Eye-Tracking and Virtual Reality-based Attentional Bias Modification Training to Improve Mirror Exposure Therapy: preliminary findings from a multiple case study with Anorexia Nervosa patients

Attentional bias modification training (ABMT) is an effective technique for reducing the dysfunctional body-related attentional bias (AB) that may be responsible for reducing the effectiveness of mirror exposure therapy (MET), which has been proposed as an effective treatment for anorexia nervosa ( AN). This multiple-case study provides evidence of the usefulness of incorporating ABMT into virtual reality ( VR) and eye-tracking (ET)-based MET to improve its efficacy in the treatment of four female adolescents with AN. Over five exposure sessions, patients were immersed in a virtual environment and were embodied in a real-size body virtual avatar reflected in a mirror that gradually increased body mass index (BMI) until reaching a healthy BMI in the last session. In every session, the participants completed the ABMT followed by the MET. This augmentation of MET using VRET-based ABMT achieved promising results for targeting AN symptomatology by reducing body dissatisfaction, drive for thinness, weight-related body parts anxiety, body checking behaviors, fear of gaining weight, and anxiety, and increasing body appreciation. Two patients who did not show a reduction in fear of gaining weight during the sessions also showed high anxiety levels, which could have affected its reduction. To advance this preliminary study and evaluate the effectiveness of incorporating ABMT into MET, a controlled clinical trial will be conducted.