Unlocking the potential of virtual reality to expand treatment frontiers for bulimia nervosa: a pilot study to explore the impact of virtual reality-enhanced cognitive-behavioral therapy

The primary objective of this study is to assess the efficacy of a Virtual Reality (VR) intervention when compared to an integrated multimodal medically managed Inpatient Program (IP) in a cohort of 24 female patients diagnosed with Bulimia Nervosa (BN). Psychological measures (i.e., EDI-2) were assessed at three points: pre-treatment, post-treatment, and at 1-month follow-up. Behavioral measures (i.e., BMI) were evaluated at 6 different time points, instead (i.e., pre-treatment, post-treatment, 3, 6, 9, and 12 months from the discharge date). The VR treatment was more effective in improving the EDI subscales EDI-DT (i.e., drive for thinness) and EDI-BU (i.e., binging-purging behaviors). In particular, patients in the VR condition showed a reduced EDI-BU score at 1-month follow-up and post-test in comparison to the pre-test, as well as a lower EDI-DT score at 1-month follow-up compared to the pre-test. Conversely, no significant changes were noted in the IP group for either subscale. Regarding the behavioral measures, the group undergoing the VR condition reported the maintenance of the BMI in the long term compared to the IP. Specifically, in the VR group BMI decreased from the pre- to post-test, and from the pre-test to the 12-month follow-up. In the IP group, BMI improved from the pre- to the post-test, and from the pre-test to the 12-month follow-up. However, a relapse pattern was observed in the IP condition during the follow-up period, with a significant BMI increase from the post-test to the 9-month follow-up, from the 3 to the 9-month follow-up, from the 6 to the 9-month follow-up, and a decrease of BMI between the 9 and the 12-month follow-up. In conclusion, these results suggest that integrating VR treatment into the care of individuals with BN could enhance both immediate and sustained treatment outcomes.