Extended Reality (XR) umfasst verschiedene immersive Technologien, die die Wahrnehmung mit virtuellen Elementen erweitern. Die bisherige Forschung hat sich insbesondere auf die mit Virtual Reality unterstützte Expositionstherapie fokussiert, aktuell gibt es jedoch dynamische Entwicklungen sowohl inhaltlicher als auch struktureller Art. Diese narrative Übersichtsarbeit beschreibt von Mitgliedern des Netzwerks „Extended Reality für die Psychotherapie“ genannte inhaltliche und technische sowie strukturelle Entwicklungen in der Erforschung von XR-Anwendungen für die Psychotherapie. Genannt wurden der Einsatz von Mixed-Reality-Technologien und künstlicher Intelligenz und die Entwicklung und Erprobung kreativer therapeutischer Konzepte jenseits des klassischen Expositionsparadigmas. Außerdem werden als strukturelle Entwicklungen die Etablierung standardisierter Prozesse, die Professionalisierung der Entwicklung, Barrieren bei der Implementierung in die Versorgungspraxis und regulatorische Aspekte skizziert. Die befragten Expert:innen weisen auf technische Weiterentwicklungen und innovative Konzepte hin, die in der aktuellen Psychotherapie so nicht umsetzbar wären. Angesichts der komplexen Technologie, die gleichzeitig multiplen regulatorischen Anforderungen entsprechen muss, bedarf es breit angelegter interdisziplinärer Forschung.

BACKGROUND:Extended reality (XR) encompasses various immersive technologies that enhance perception with virtual elements. Previous research has focused in particular on virtual reality-assisted exposure therapy but there are currently dynamic developments in terms of both content and structure of XR research for psychotherapy. METHODS:This narrative review describes content-related, technical and structural developments in the research of XR applications for psychotherapy, as identified by members of the Extended Reality for Psychotherapy network. RESULTS:The use of mixed reality technologies and artificial intelligence was mentioned as well as the development and testing of creative therapeutic concepts beyond the classical exposure paradigm. In addition, structural developments, such as the establishment of standardized processes, the professionalization of development, barriers to implementation in healthcare practice and regulatory aspects are outlined. DISCUSSION:The experts point to technical advances and emerging innovative concepts that would not be feasible in the current psychotherapy. Given the complex technology, which must simultaneously meet multiple regulatory requirements, broad-based interdisciplinary research is needed.

Bulimia Nervosa (BN) and Binge Eating Disorder (BED) have considerable symptom overlap, and prior studies observed similiarities in respect to patient's body image. However, weight-based stereotypes have so far not been considered together with other facets of body image. This study investigated body image, body size estimation accuracy and weight-based stereotypes in a German-Italian sample of 22 patients with BN, 22 patients with BED and 44 weight-matched controls who had no eating disorder. Patients with BN and BED reported significantly more negative body image than controls and were not differently accurate in estimating their body size than the controls. However, patients with BN showed stronger weight-based stereotypes compared to patients with BED and controls, suggesting that these patients hold stronger stereotypes and apply weight-based stereotypes to lower weight excessively. Observations from this study suggest that clinical treatment of body image disturbance in patients with BN and BED should address negative body image and weight-based stereotypes in a differentiated way.

BackgroundNegative body image and adverse body self-evaluation represent key psychological constructs within the realm of weight bias (WB), potentially intertwined with the negative self-evaluation characteristic of depressive symptomatology. Although WB encapsulates an implicit form of self-critical assessment, its exploration among people with mood disorders (MD) has been under-investigated. Our primary goal is to comprehensively assess both explicit and implicit WB, seeking to reveal specific dimensions that could interconnect with the symptoms of MDs.MethodsA cohort comprising 25 MD patients and 35 demographically matched healthy peers (with 83% female representation) participated in a series of tasks designed to evaluate the congruence between various computer-generated body representations and a spectrum of descriptive adjectives. Our analysis delved into multiple facets of body image evaluation, scrutinizing the associations between different body sizes and emotionally charged adjectives (e.g., active, apple-shaped, attractive).ResultsNo discernible differences emerged concerning body dissatisfaction or the correspondence of different body sizes with varying adjectives. Interestingly, MD patients exhibited a markedly higher tendency to overestimate their body weight (p = 0.011). Explicit WB did not show significant variance between the two groups, but MD participants demonstrated a notable implicit WB within a specific weight rating task for BMI between 18.5 and 25 kg/m2 (p = 0.012).ConclusionsDespite the striking similarities in the assessment of participants’ body weight, our investigation revealed an implicit WB among individuals grappling with MD. This bias potentially assumes a role in fostering self-directed negative evaluations, shedding light on a previously unexplored facet of the interplay between WB and mood disorders.

INTRODUCTION/OBJECTIVE:Treatment results of anorexia nervosa (AN) are modest, with fear of weight gain being a strong predictor of treatment outcome and relapse. Here, we present a virtual reality (VR) setup for exposure to healthy weight and evaluate its potential as an adjunct treatment for AN.METHODS:In two studies, we investigate VR experience and clinical effects of VR exposure to higher weight in 20 women with high weight concern or shape concern and in 20 women with AN.RESULTS:In study 1, 90% of participants (18/20) reported symptoms of high arousal but verbalized low to medium levels of fear. Study 2 demonstrated that VR exposure to healthy weight induced high arousal in patients with AN and yielded a trend that four sessions of exposure improved fear of weight gain. Explorative analyses revealed three clusters of individual reactions to exposure, which need further exploration.CONCLUSIONS:VR exposure is a well-accepted and powerful tool for evoking fear of weight gain in patients with AN. We observed a statistical trend that repeated virtual exposure to healthy weight improved fear of weight gain with large effect sizes. Further studies are needed to determine the mechanisms and differential effects.

Background: Weight gain in the context of inpatient treatment for anorexia nervosa typically leads to an update of two core symptoms: fear of weight gain and high importance of a low body weight for self-esteem. Objective: To assess the use of a biometric figure rating scale for monitoring of the fear of gaining weight and the body image during inpatient treatment of anorexia nervosa, the dynamic developments in actually perceived and ideal body weight as indicators of fear of weight gain and body image were exploratively examined in a case series. Material and methods: A biometric figure rating scale optimized for underweight to normal weight is used. On this scale 13 inpatients diagnosed with typical anorexia nervosa marked the 2 bodies that most closely matched the patients' actual body and ideal body after the weekly weighing appointments. The data were compared with the weight gain trajectories. Results: A total of 128 weighing appointments were evaluated. Generally, answers were differentiated and varied over time in three typical patterns: (1) constant dissatisfaction with the body weight and accurate estimation with little weight change, (2) constant dissatisfaction with the body weight and accurate estimation with constant gain, (3) changing dissatisfaction with the body weight and accuracy, which jumped depending on the weight trajectory. Conclusion: The observations support the validity of figure rating scales for monitoring of cognition and affect with respect to one's own body weight in the inpatient treatment of anorexia nervosa. The interpretation of the scales should only be done in individual cases with the addition of further information.

To reduce the number of sedentary people, an improved understanding of effects of exercise in this specific group is needed. The present project investigates the impact of regular aerobic exercise uptake on body image, and how this effect is associated with differences in interoceptive abilities and affective response to exercise. Participants were 29 sedentary adults who underwent a 12-week aerobic physical activity intervention comprised of 30–36 sessions. Body image was improved with large effect sizes. Correlations were observed between affective response to physical activity and body image improvement, but not with interoceptive abilities. Explorative mediation models suggest a neglectable role of a priori interoceptive abilities. Instead, body image improvement was achieved when positive valence was assigned to interoceptive cues experienced during exercise.

Immersive virtual reality technology (VR) still waits for its wide dissemination in research and psychotherapy of eating and weight disorders. Given the comparably high efforts in producing a VR setup, we outline that the technology's breakthrough needs tailored exploitation of specific features of VR and user-centered design of setups. In this paper, we introduce VR hardware and review the specific properties of immersive VR versus real-world setups providing examples how they improved existing setups. We then summarize current approaches to make VR a tool for psychotherapy of eating and weight disorders and introduce user-centered design of VR environments as a solution to support their further development. Overall, we argue that exploitation of the specific properties of VR can substantially improve existing approaches for research and therapy of eating and weight disorders. To produce more than pilot setups, iterative development of VR setups within a user-centered design approach is needed.

Zusammenfassung Hintergrund Die Gewichtszunahme im Rahmen der stationären Behandlung von Anorexia nervosa führt typischerweise zu einer Aktualisierung von zwei Kernsymptomen: Angst vor Gewichtszunahme und hohem Stellenwert eines niedrig gewichtigen Körpers für den Selbstwert. Ziel der Arbeit Um den Nutzen einer biometrischen Figure-rating-Skala (FRS) für das Monitoring der Angst vor einer Gewichtszunahme und dem Körperbild während einer stationären Behandlung von Anorexia nervosa abschätzen zu können, wurden in einer Fallserie explorativ dynamische Entwicklungen in aktuell empfundenem und idealem Körpergewicht untersucht. Material und Methoden Es wird eine auf Unter- bis Normalgewicht optimierte biometrische FRS eingesetzt. Auf dieser Skala markierten 13 stationär behandelte Patientinnen mit der Diagnose einer typischen Anorexia nervosa wöchentlich nach dem Wiegetermin die beiden Körper, die dem aktuellen und dem idealen Körper der Patientinnen am ehesten entsprechen. Die Angaben wurden mit dem Gewichtsverlauf verglichen. Ergebnisse Insgesamt wurden 128 Wiegetermine ausgewertet. Es zeigten sich differenzierte, im Verlauf variierende Antworten, die drei typische Muster aufwiesen: (1) konstante Unzufriedenheit mit dem Körpergewicht und akkurate Einschätzung bei wenig Gewichtsveränderung, (2) konstante Unzufriedenheit mit dem Körpergewicht und akkurate Einschätzung bei konstanter Zunahme, (3) wechselnde Unzufriedenheit mit dem Körpergewicht und Genauigkeit, die abhängig vom Gewichtsverlauf springen. Diskussion Die Beobachtungen stützen die Sinnhaftigkeit von FRS für das Monitoring von Kognitionen und Affekten im Hinblick auf das eigene Körpergewicht in der stationären Behandlung von Anorexia nervosa. Die Interpretation der Skalen sollte im Einzelfall nur unter Hinzunahme weiterer Informationen erfolgen.

Data for the paper ''Alertness training increases visual processing speed in healthy older adults', by Melanie D. Penning, Adriana L. Ruiz-Rizzo, Petra Redel, Hermann J. Müller, Tiina Salminen, Tilo Strobach, Simone Behrens, Torsten Schubert, Christian Sorg, and Kathrin Finke.

In this study, we investigated whether alertness training in healthy older adults increases visual processing speed (VPS) and whether functional connectivity in the cingulo-opercular network predicts training gain. Using the theory of visual attention, we derived quantitative estimates of VPS before and after training. In Study 1, 75 healthy older adults participated in alertness training, active-control training, or no training ( n = 25 each). A significant Group × Session interaction indicated an increase in VPS in the alertness-training group but not in the control group, despite VPS not differing significantly between groups before training. In Study 2, 29 healthy older adults underwent resting-state functional MRI and then participated in alertness training. Pretraining functional connectivity in the cingulo-opercular network correlated with the individual training-induced change in VPS. In conclusion, results indicate that alertness training improves visual processing in older adults and that functional connectivity in the cingulo-opercular network provides a neural marker for predicting individual training gain.

Recent studies have suggested that people's intent and ability to act also can influence their perception of their bodies' peripersonal space. Vice versa one could assume that the inability to reach toward and grasp an object might have an impact on the subject's perception of reaching distance. Here we tested this prediction by investigating body size and action capability perception of neurological patients suffering from arm paresis after stroke, comparing 32 right-brain-damaged patients (13 with left-sided arm paresis without additional spatial neglect, 10 with left-sided arm paresis and additional spatial neglect, 9 patients had neither arm paresis nor neglect) and 27 healthy controls. Nineteen of the group of right hemisphere stroke patients could be re-examined about five months after initial injury. Arm length was estimated in three different methodological approaches: explicit visual, explicit tactile/proprioceptive, and implicit reaching. Results fulfilled the working hypothesis. Patients with an arm paresis indeed perceived their bodies differently. We found a transient overestimation of the length of the contralesional, paretic arm after stroke. Body size and action capability perception for the extremities thus indeed seem to be tightly linked in humans.