Researchers used an online body image assessment to screen through 130 young adult women for at-risk individuals. Fourteen women met the requirements for the study, since they did not have an eating disorder but were considered at high risk for developing one. Those 14 individuals, as well as the therapists, sat in separate rooms and wore headsets. To begin, the clients were asked to create avatars of themselves with their measurements, which aided them in seeing an accurate picture of how they look. This virtual option also enabled the therapist to use exposure therapy to help the client become more accepting of themselves. For one exercise, the avatar gradually wore fewer articles of clothing until it was only wearing underwear. During the exercises, the therapist was able to counsel the client through their thoughts and feelings. The results of the study pointed to a possible step towards helping individuals who are diagnosed with eating disorders.
What Does Exposure Therapy Treat?
Exposure therapy is a way for individuals with PTSD, phobias such as fear of spiders and flying, and other anxiety disorders to safely face what is plaguing them and be supported through it. This support also looks like working through the emotions that come up and techniques for grounding or relaxation. That is why this practice is important for eating disorder recovery. One hallmark of having an eating disorder is an anxiety-inducing preoccupation with appearance and weight gain. Mirror exposure therapy can help to tackle the negative emotions that surface when facing one’s own body. Alexa Pinsker, LPC, is an art therapist and counselor, and she explains that treating eating disorders requires a holistic approach, one that caters to the mental state, behavior modification, and nutrition. She says, “Therapeutic models such as art therapy and mindfulness therapy are helpful, as they emphasize process and self-acceptance.” Art therapy is one of the tools employed by her treatment center, helping clients through perfectionism, which can impact someone’s self-acceptance. “Art therapy is about expression and not having one’s art look good or be perfect. This was very helpful in understanding the relationship of perfectionism, body image, and self worth.” One way this is addressed is by having clients draw without an eraser, which encourages them to accept their mistakes.
Fixing Body Image Distortions is Key in Eating Disorder Recovery
According to Jeana Cost, MS, LPC, NCC, the vice president of ACUTE Center for Eating Disorders, “Body image distortions in those who have eating disorders often play a role in their desire to lose weight and fear of gaining said weight. It can cause ‘body checking’ behaviors where the individual is obsessed with measuring certain parts of their body. It can cause extreme dieting and/or exercise behaviors if they believe that will change the appearance of the area.” This virtual reality option may be effective for helping those with eating disorders, but it must be used in addition to other forms of therapy that are proven to treat them. In other words, simply putting on a VR headset to look at an avatar won’t be enough to see benefits—a mental health professional needs to be there to guide and support the individual. Cost explains that these distortions can stand alone without an eating disorder. On their own, they can be symptoms of body dysmorphic disorder (BDD). “This represents a torturous situation where individuals are either preoccupied with an imagined defect in their appearance, or they become obsessively concerned about a slight physical anomaly.” Not only could these distortions lead to or exacerbate symptoms of a patient’s eating disorder or BDD, but it can be a hindrance in other aspects. “The preoccupation and stress that sufferers develop affect not only their emotional state [but also] their relationships, ability to work, and engagement in social activities,” says Cost. Cost explains that battling the distortions is difficult. “Providers and support systems are often up against the individual’s skewed perception of what is ‘true.’ They often have such a deep belief that they look a certain way, and it is difficult to convince them otherwise, even when it is so far off from reality. For instance, a woman weighing 85 lbs believing that she has excess fat all over her body.” Going through exposure therapy may help, but it is not a guarantee that a patient will recover. Pinsker suggests, “A huge part of shifting body image is working on self-acceptance through understanding our own habitual thoughts and patterns, and the relationships between our thoughts, feelings, and behaviors by trying new ways of thinking to shift our perspectives.” She recommends CBT (cognitive behavioral therapy), DBT (dialectical behavior therapy) or ACT (acceptance and commitment therapy), which research shows are effective in treating eating disorders and body image issues. The therapists in the study used ACT techniques alongside exposure therapy, which may be why virtual reality exposure while guided by a therapist was so effective. Cost emphasizes that the chosen therapist should specialize in treating distortions. “This isn’t something that your regular physician or therapist is likely trained in. It is also imperative that the provider gain the trust of the individual they are treating so that they have a safe foundation to start challenging some of their distortions.” Even if the therapist is remote, like in the case of multi-user virtual reality (MUVR) therapy, which the study says can be an add-on to the above forms of therapy. No matter what method is used, Pinsker says, “it is important to remember that the recovery process is not linear. You can get better then have a setback and start over. The important part of the work is understanding this and recognizing that each moment gives us the opportunity to make a choice and try again without judgment."
