Virtual Reality Externalization (VR‐E) for Patients With Eating Disorders: A Pilot Study

<jats:title>ABSTRACT</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>Despite significant health and psychosocial impairments, many individuals with eating disorders (ED) view their disorder as an integral part of their identity. Because this “ego‐syntonicity” is associated with low treatment motivation and treatment dropouts, we investigated the acceptability, feasibility, and effects of a newly developed externalization exercise in virtual reality (VR) for EDs.</jats:p> </jats:sec> <jats:sec> <jats:title>Method</jats:title> <jats:p> <jats:italic>N</jats:italic>  = 51 inpatients with EDs (42 women, 8 men, 1 not reported; mean age = 31.9 years) imagined that an object simulated in VR (a sphere) represented their ED. They then modified the object using controller‐assisted actions (controlling distance, size, color, and cutting it up). The perceived valence, activation, and difficulty of each action as well as user experiences were recorded. Effect parameters (self‐ED overlap as a measure of relative externalization, general self‐efficacy) were recorded before and after the exercise. </jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p> Patients rated their experience predominantly positive. Self‐ED overlap decreased (Cohen's <jats:italic>d</jats:italic>  = 0.46, 95% CI [0.22, 0.69]) and self‐efficacy increased from before to after participation (Cohen's <jats:italic>d</jats:italic>  = −0.22, 95% CI [−0.43, −0.01]). The effects were comparable between anorexia nervosa and other diagnostic groups. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The results indicate the feasibility and potential efficacy of the newly developed VR procedure for externalizing EDs and provide a basis for planning controlled studies.</jats:p> </jats:sec>