External Eating as a Predictor of Cue-reactivity to Food-related Virtual Environments

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 caf\ue9). 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

VR-based cue-exposure therapy (VR-CET) versus VR-CET plus pharmacotherapy in the treatment of bulimic-type eating disorders

Treatment guidelines recommend antidepressant medication for bulimic-type eating disorders either as an alternative to or in combination with cognitive behavioural therapy (CBT). This study compared the efficacy of two second-line treatments of patients with bulimic-type eating disorders resistant to CBT: virtual reality-based cue-exposure therapy (VR-CET) alone or VR-CET in combination with pharmacotherapy. Results showed that bingeing episodes, bulimic symptomatology (the bulimia EDI-3 score) and food cravings (FCQ-T/S) were significantly reduced after both interventions. However, no significant differences were found between the combined intervention and VR-CET alone. Improvements from the treatments continued at the 6-month follow-up. Our results support the use of VR-CET as an effective treatment of bulimic-type eating disorders, reducing bulimic symptoms and food cravings. The addition of antidepressants to VR-CET does not provide any additional benefit

Using virtual reality for cue-exposure therapy in a case of bulimia nervosa

This case study describes the use of a virtual reality-based cue-exposure therapy (VR-CET) for a patient diagnosed with bulimia nervosa (BN) who was resistant to standard cognitive behavioral therapy (CBT). After six VR-CE booster sessions, both anxiety and food craving dropped significantly. No binging and purging episodes were reported at the end of the treatment. Patient\u2019s mood and confidence to change were also improved. Finally, both eating symptoms and food craving were reduced at the end of the VR-CET. These results support the use of VR-CE as an effective component for the treatment of BN to reduce bulimia symptoms, body dissatisfaction and craving, especially in patients resistant to conventional treatments

A Randomized Trial of Virtual Reality-Based Cue Exposure Second-Level Therapy and Cognitive Behavior Second-Level Therapy for Bulimia Nervosa and Binge-Eating Disorder: Outcome at Six-Month Followup

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; \u3c7 2 = 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

A Randomised Controlled Comparison of Second-Level Treatment Approaches for Treatment-Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy

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 \ua9 2017 John Wiley & Sons, Ltd and Eating Disorders Association

Development of a VR application for binge eating treatment: Identification of contexts and cues related to bingeing behavior in Spanish Italian patients

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

Identifying specific cues and contexts related to bingeing behavior for the development of effective virtual environments

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

Wytyczne ESC dotycz\u105ce post\u119powania w stabilnej chorobie wie\u144cowej w 2013 roku

N/

2013 ESC clinical practice guidelines on diagnosis and treatment of stable ischemic heart disease (Review) [Gu\ueda de Pr\ue1ctica Cl\uednica de la ESC 2013 sobre diagn\uf3stico y tratamiento de la cardiopat\ueda isqu\ue9mica estable]

No abstract availabl