Laboratori de Realitat Virtual de la Universitat de Barcelona

Abstract: Mirror exposure therapies (METs) have been shown to be effective in reducing body image disturbances through the habituation process. Virtual reality (VR) combined with eye-tracking techniques can provide innovative solutions to some of METs’ limitations reported with patients with anorexia nervosa (AN), especially the negative influence of body-related attentional bias (AB). This pilot study aimed to assess the preliminary efficacy of a new VR-based AB modification task (ABMT) among healthy women and the procedure’s user experience. AB levels towards weight- and non-weight-related body parts, using complete fixation time (CFT) and number of fixations (NF), were assessed throughout the ABMT procedure (300 trials). The user experience was evaluated at the end of the procedure. The results showed that VR-based ABMT was effective in reducing AB significantly after 150 trials for both CFT- and NF-based measures, although 225 trials were necessary to get the same result for women with an NF initially more oriented towards weight-related body parts. Overall, the software received a “C-rating” on a scale from “A” (most usable) to “F” (least usable). These results provide evidence of the opportunity to use a VR-based ABMT procedure to reduce AB and improve existing treatments for AN.

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Bruno Porras-Garcia, Marta Ferrer-Garcia, Manuel Moreno-Sanchez, Helena Miquel-Nabau, Eduardo Serrano-Troncoso, Marta Carulla-Roig and José Gutiérrez-Maldonado

Revista: Journal of Clinical Medicine

Any: 2023

Abstract: Body dissatisfaction, fear of gaining weight (FGW) and body anxiety have been extensively studied as some of the strongest risk and maintenance factors of anorexia nervosa (AN) symptomatology. Recently, a new theoretical model introduced self-disgust as a factor that can lead to avoidance behaviors when patients with AN face their body. This can make them vulnerable to relapse. In addition, body-related attentional bias (AB) (e.g., selective attention to weight-related body areas) can limit the efficacy of body exposure therapies. This study aims to investigate the possible predictors of AB, to better understand the underlying mechanisms that contribute to the maintenance of AN symptomatology. A total of 116 college students from the University of Barcelona participated in the study, using a combination of virtual reality and eye-tracking techniques to provide an objective and reliable assessment of AB in a highly realistic environment. Stepwise multiple linear regression analyses were performed to identify possible predictors of AB among body mass index, FGW, body anxiety, body dissatisfaction and self-disgust. The results shows that both body dissatisfaction and self-disgust are significant predictors of AB. While an increase in body dissatisfaction predicted a greater AB towards weight-related body areas (positive regression coefficients: BBody_dissatisfaction→AB > 0, p < .001), the opposite occurred with self-disgust (negative regression coefficients: BSelf_disgust→AB < 0, p < .02). Such results provide initial evidence that self-disgust, which is a more intense negative feeling than body dissatisfaction, leads to gaze avoidance towards weight-related body areas, which are considered disgust elicitors.

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Julia Prieto-Perpiña, Chiara Verdasco, Marta Ferrer-Garcia and José Gutiérrez-Maldonado

Revista: Annual Review of Cyberherapy and Telemedicine 2023 (pp. 76-82)

Any: 2023

Abstract: Background: Body dissatisfaction (BD) has been consistently linked to adverse consequences on mental health and overall well-being, and is recognized as a significant contributing factor in the initiation and persistence of eating disorders (EDs). Empirical evidence has demonstrated that an elevated body mass index (BMI) and media influence and pressure about a thin ideal heighten the risk of subsequent BD. Moreover, suggestibility, a propensity to accept and act upon messages without critical evaluation, has been shown to be positively associated with greater susceptibility to the influence of sociocultural messages that endorse the thin ideal. This study aimed to assess whether suggestibility moderates the association between BMI and BD in women. Methods: A total of 117 women completed assessments using the Eating Disorder Inventory-3 (EDI-3) BD subscale and the Suggestibility Inventory, which encompasses a general suggestibility index and a subscale that evaluates susceptibility to influence by others. We conducted moderation analyses employing the PROCESS macro, with BMI as the central predictor, BD as the outcome variable, and suggestibility and its subscale as moderators. Results: The findings revealed statistically significant positive moderating interactions for both the general suggestibility index and susceptibility to influence by others. Specifically, women who exhibited high levels of suggestibility and susceptibility to influence by others demonstrated a more pronounced increase in BD as their BMI increased. Conclusions: These outcomes are in line with the sociocultural model of EDs, suggesting that greater susceptibility to external influences amplifies the impact of societal pressures to conform to thin ideals.

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Bruno Porras-Garcia, Maria-Teresa Mendoza-Medialdea, Marta Ferrer-Garcia and Jose Gutierrez-Maldonado

Revista: Journal of Clinical Medicine

Any: 2024

Abstract: The application of advanced embodied technologies, particularly virtual reality (VR), has been suggested as a means to induce the full-body illusion (FBI). This technology is employed to modify different facets of bodily self-consciousness, which involves the sense of inhabiting a physical form, and is influenced by cognitive inputs, affective factors like body dissatisfaction, individual personality traits and suggestibility. Specifically, VR-based Mirror Exposure Therapies are used for the treatment of anorexia nervosa (AN). This study aims to investigate whether the “Big Five” personality dimensions, suggestibility, body dissatisfaction and/or body mass index can act as predictors for FBI, either directly or acting as a mediator, in young women of similar gender and age as most patients with AN. The FBI of 156 healthy young women immersed in VR environment was induced through visuomotor and visuo-tactile stimulations, and then assessed using the Avatar Embodiment Questionnaire, comprising four dimensions: Appearance, Ownership, Response, and Multi-Sensory. Data analysis encompassed multiple linear regressions and SPSS PROCESS macro’s mediation model. The findings revealed that the “Big Five” personality dimensions did not directly predict FBI in healthy young women, but Openness to experience, Agreeableness, and Neuroticism exerted an indirect influence on some FBI components through the mediation of suggestibility.

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Bruno Porras-Garcia, Maria-Teresa Mendoza-Medialdea, Julia Prieto- Perpiña, Adela Fuste-Escolano, Jose Ruiz-Rodriguez, Marta Ferrer-Garcia, and Jose Gutierrez-Maldonado

Revista: Virtual Reality (Springer)

Any: 2024

Abstract: Male adolescents with anorexia nervosa (AN) remain markedly underrepresented in clinical and technological research, limiting understanding of the gender-specific mechanisms that may shape how they interact with virtual environments. The primary objective of this study was to evaluate the feasibility and acceptability of an integrated virtual reality (VR)-based mirror exposure therapy and eye-tracking-driven attentional bias (AB) modification training protocol—previously tested in a female-based randomized controlled trial—in two male adolescents with AN. Both participants received concurrent multidisciplinary care, with one case featuring comorbid muscle dysmorphia. Feasibility was assessed via protocol adherence and technical stability. Acceptability was measured using the System Usability Scale (SUS). Secondary exploratory measures included eye-tracking AB and clinical questionnaire outcomes (body dissatisfaction, drive for thinness, body anxiety, body appreciation) at pretreatment, posttreatment, and 3-month follow-up. Feasibility indicators were consistently positive: Both participants completed all sessions, reported high perceived usability (SUS > 80), and no technical incidents occurred. Exploratory clinical observations suggested improvements in body dissatisfaction, weight-related anxiety, and body appreciation, with effects maintained at the 3-month follow-up. Eye-tracking data revealed divergent attentional profiles: the patient with a typical AN presentation showed heightened attention to weight-related body areas, whereas the patient with muscle dysmorphia displayed a more complex pattern oriented toward muscular regions. Given the concurrent multidisciplinary treatment, clinical improvements cannot be attributed solely to the VR intervention; however, these cases show that the protocol is a viable and well-tolerated tool that warrants further investigation in a randomized controlled trial with AN male adolescents.

Autors: Franck-Alexandre Meschberger-Annweiler, Marta Carulla-Roig, Mariarca Ascione, Bruno Porras-Garcia, Eduardo Serrano-Troncoso, Marta Ferrer-Garcia and José Gutierrez-Maldonado

Revista: Cyberpsychology, Behavior, and Social Networking

Any: 2026

Abstract: Virtual reality (VR)-based mirror exposure therapies (VR-MET) are widely used for the treatment of anorexia nervosa (AN). However, their effectiveness may depend on how much patients perceive a virtual body as their own, a phenomenon known as the full-body illusion (FBI). This study examined FBI levels and their clinical correlates in adolescents with AN, a key developmental period in the disorder. Forty-nine female adolescents with AN were immersed in a VR environment and embodied in avatars reflecting their own body shape and weight through visuomotor and visuo-tactile stimulation. FBI was assessed using both unidimensional measures and a multidimensional embodiment questionnaire. Correlation analyses and multiple linear regressions were conducted to explore associations between FBI components and AN-related variables, including body mass index, body dissatisfaction, body anxiety, state anxiety, and fear of gaining weight. Results showed significant negative correlations between body anxiety and fear of gaining weight and FBI, particularly its unidimensional and ownership components, with fear of gaining weight explaining 28.1% of FBI variance. Consistent with the Allocentric Lock hypothesis, these findings suggest that adolescents with AN may rely more strongly on stored, distorted body representations than on immediate multisensory evidence (sight, touch, proprioception), creating a cognitive barrier to virtual ownership and potentially limiting VR-MET effectiveness during adolescence. Future research should incorporate more diverse samples—including different ages and genders—to further clarify the clinical role of embodiment processes in VR-based interventions.

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Bruno Porras-Garcia, Maria-Teresa Mendoza-Medialdea, Eduardo Serrano-Troncoso, Marta Carulla-Roig, Marta Ferrer-Garcia, and Jose Gutierrez-Maldonado

Revista: Cyberpsychology, Behavior, and Social Networking

Any: 2026

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Marta Carulla-Roig, Helena Miquel-Nabau, Eduardo Serrano-Troncoso, Marta Ferrer-Garcia and Jose Gutierrez-Maldonado

Congrés: VR Mental Health Conference 2023

Lloc i dates: Groningen, 9-10 de novembre del 2023

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Maria-Teresa Mendoza-Medialdea, Marta Ferrer-Garcia and Jose Gutierrez-Maldonado

Congrés: VR Mental Health Conference 2023

Lloc i dates: Groningen, 9-10 de novembre del 2023

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Julia Prieto-Perpiña, Chiara Verdesca, Marta Ferrer-Garcia and José Gutierrez-Maldonado

Congrés: 26th Annual Cyberpsychology, Cybertherapy and Social Networking Conference (cypsy26)

Lloc i dates: Paris, 11-13 de juliol de 2023

Autors: Franck-Alexandre Meschberger-Annweiler, Mariarca Ascione, Bruno Porras-Garcial, Helena Miquel, Erik Exposito, Eduardo Serrano-Troncoso, Marta Carulla-Roig, Marta Ferrer-Garcia, Jose Gutierrez-Maldonado

Congrés: European Congress of Psychiatry - EPA 2023

Lloc i dates: Paris, 25-28 de març de 2023

Autors: Meschberger-Annweiler, Franck-Alexandre; Ascione, Mariarca; Miquel, Helena; Porras-Garcia, Bruno; Exposito, Erik; Serrano-Troncosa, Eduardo; Carulla-Roig, Marta; Ferrer-Garcia, Marta; Gutierrez-Maldonado, Jose

Congrés: International Multi-Brain Congress

Lloc i dates: Barcelona, 9-10 de novembre de 2022

Autors: Franck-Alexandre Meschberger-Annweiler, Bruno Porras-Garcia, Mariarca Ascione, Helena Miquel, Eduardo Serrano-Troncoso, Marta Carulla-Roig, Marta Ferrer-Garcia and Jose Gutierrez-Maldonado

Congrés: International Congress of Eating Disorders (ICED) 2022

Lloc i dates: Virtual event, 9-10 de juny de 2022