Anorexia NervosaAN-VR-ABMTNCT04786951
Virtual Reality-Based Attention Bias Modification Training for Adolescents With Anorexia Nervosa
A study testing Attentional Bias Modification Training and VR-based body exposure in people with Anorexia Nervosa, run by University of Barcelona at 1 site in Spain.
Trial summary
Anorexia Nervosa (AN) is considered one of the most severe subtypes of eating disorders (EDs), characterized by significant medical complications, high mortality rates, and high comorbidity with other disorders, such as anxiety disorders. Read more about this study
- Who is it for?
- Ages 12 to 17 years, women only
- Conditions the study is for
- Anorexia Nervosa
- What is being tested?
- Attentional Bias Modification Training and VR-based body exposure
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 75 participants
- Where
- 1 siteSpain
- Study dates
- 21 Dec 2021to 29 Feb 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 12 to 17 years
- Women only
- No healthy volunteers
- Child
Who may be able to join
- Female adolescents aged 12-17 years.
- Primary diagnosis of anorexia nervosa according to DSM-5 criteria.
- Body weight below the expected range for height, age, and sex.
- Ability to understand and communicate in Spanish.
Who cannot join
- Presence of severe mental disorders other than anorexia nervosa.
- Significant cognitive impairment that would interfere with participation.
- Visual or auditory deficits that could interfere with VR-based body exposure therapy.
- Epilepsy.
- Pregnancy.
- Cardiac arrhythmia.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: AN-VR-ABM: Attentional Bias Modification and Body Exposure Using Virtual Reality and Eye-Tracking to Enhance Treatment for Adolescents With Anorexia Nervosa
Anorexia Nervosa (AN) is considered one of the most severe subtypes of eating disorders (EDs), characterized by significant medical complications, high mortality rates, and high comorbidity with other disorders, such as anxiety disorders. Similarly to what occurs in anxiety disorders, several studies have suggested the presence of dysfunctional body-related attentional bias (AB) in patients with EDs, and specifically in patients with AN. Individuals with AN tend to focus their attention on their body in a dysfunctional manner, engaging in body-checking behaviors and excessively scrutinizing their general appearance and weight-related body parts. This body-related AB has been associated with higher levels of body dissatisfaction, which represents one of the most important risk factors for the development and maintenance of EDs.
Moreover, body-related AB may contribute to reducing the effectiveness of body exposure-based treatments used in patients with AN. For this reason, it is necessary to develop new treatment techniques by incorporating specific components aimed at reducing body-related AB. It has been proposed that attentional bias modification techniques could be integrated into body exposure therapy as an effective approach to reduce body-related AB, body dissatisfaction, and body anxiety.
Read more
To date, our research group has been the first to use a combination of virtual reality (VR) and eye-tracking (ET) technologies to assess the presence of body-related AB in non-clinical samples. In order to improve treatments for AN, the present project aims to develop a novel attentional bias modification procedure using ET and VR technologies. In addition, this project seeks to integrate this AB modification procedure into a body exposure-based treatment designed to reduce the fear of weight gain experienced by patients with AN.
Finally, the project aims to evaluate whether combining two distinct components-body exposure-based therapy and attentional bias modification training-results in a more effective intervention. It is expected that the inclusion of a VR-based body exposure procedure in standard AN treatment, enhanced through the illusion of ownership over a virtual body, will lead to improved treatment outcomes. Furthermore, it is anticipated that the addition of attentional bias modification training to the body exposure-based procedure will further enhance treatment effectiveness.
Read the detailed description
Attentional bias (AB) refers to the tendency to allocate greater attention to certain types of stimuli or information (e.g., disorder-relevant information) over other types of information. Adolescent patients with Anorexia Nervosa (AN) have been shown to focus more on self-perceived unattractive body parts than on other body parts. Dysfunctional body-related AB is thought to maintain body image disturbances commonly reported by adolescents with AN by selectively processing body-related information that is consistent with dysfunctional cognitive schemas (e.g., "I am getting a fatter belly"), while schema-inconsistent information (e.g., "I am getting thinner") receives less attention and is often visually neglected.
Dysfunctional body-related AB may also contribute to the reduced effectiveness of body exposure-based treatments for adolescents with AN. Therefore, there is a need to develop novel treatment approaches by incorporating specific components aimed at reducing body-related AB in this population. In a previous project conducted by our group, preliminary evidence supported the effectiveness of body-related AB modification in adolescent patients with AN following a virtual reality (VR)-based mirror exposure intervention. A key factor underlying these results may lie in the structure of the procedure, in which patients were required to sequentially focus on different parts of a virtual body (from head to feet) and verbally express their thoughts and emotions related to each body area.
Building on these findings, the present project aims to further advance this line of research by integrating attentional bias modification techniques into body exposure therapy as an effective approach to reducing body-related AB, body dissatisfaction, and body anxiety in adolescents with AN. To date, our research group has been among the first to combine virtual reality (VR) and eye-tracking (ET) technologies to assess body-related AB in both clinical and non-clinical samples. Specifically, this project seeks to determine whether the addition of attentional bias modification training to body exposure-based therapy results in a more effective intervention for adolescents diagnosed with AN.
It is hypothesized that incorporating AB modification training into the body exposure-based procedure (experimental group) will lead to greater treatment efficacy compared with treatment as usual (control group). Specifically, adolescents in the experimental group are expected to show a significant increase in body mass index (BMI) and a significant reduction in core AN symptomatology (e.g., fear of weight gain, body image disturbances), as well as a reduction in body-related AB, from pre- to post-treatment, compared with the control group. These improvements are also expected to be maintained at the six-month follow-up.
The project will be conducted at the Eating Disorders Units of Hospital Sant Joan de Déu (Barcelona, Spain), which specializes in the treatment of adolescents with eating disorders.
Adolescent patients with AN will be exposed to an immersive virtual environment using a VR head-mounted display (HTC Pro Eye) equipped with integrated eye-tracking. In addition to the two controllers typically provided with the HTC Pro Eye system, three additional body trackers will be used to enable full-body motion tracking. The virtual environment will consist of a room featuring a large mirror positioned on the front wall, approximately 1.5 m in front of the participant, and large enough to reflect the entire body. A young female avatar wearing a basic white T-shirt, blue jeans, and black trainers will be created for the intervention.
Regarding the treatment protocol, all sessions will last approximately one hour and will be conducted once per week. Each session will begin with the induction of the full-body illusion (FBI) and the assessment of visual analogue scales (VASs). Body exposure will initially involve a virtual body with the same BMI as the adolescent patient. The attentional bias modification training will be based on an adaptation of the AB induction procedure proposed by Smeets, Jansen, and Roefs (2011). The training will involve the visual selection of geometric figures (e.g., squares, rectangles, circles) that approximately correspond to specific body parts, with each figure presented in different colors. Participants will be required to detect and identify figures appearing on different parts of the avatar's body. In 50% of the trials, discrimination will be based on shape, while in the remaining 50% it will be based on color. Throughout the training, figures will appear on weight-related body parts in 45% of the trials and on non-weight-related body parts in another 45% of the trials. In the remaining 10% of trials, figures will appear on one of three neutral stimuli positioned next to the avatar.
Raw eye-tracking data will be processed using Ogama (Open Gaze and Mouse Analyzer) software to obtain quantitative measures of visual attention. Weight-related and non-weight-related areas of interest (AOIs) will be defined a priori. Weight-related AOIs will be determined based on the weight-related body items of the PASTAS questionnaire and mapped onto a frontal-view image of a female avatar. These weight-related AOIs will include the legs, thighs, buttocks, hips, abdomen, and waist. All remaining body parts (head, neck, chest, shoulders, arms, and feet) will be classified as non-weight-related AOIs. Selective visual attention will be assessed using total fixation duration and the number of fixations within each AOI.
- Conditions
- Anorexia Nervosa
- Being tested
- Attentional Bias Modification Training, VR-based body exposure, Usual Care for Eating Disorders
- Keywords
- Attentional bias, Virtual Reality, Body exposure procedure, Attentional bias modification training
- Medical subject headings
- Anorexia Nervosa
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Attentional Bias Modification TrainingBehavioural
Combine usual treatment with an additional five VR-based body-exposure therapy sessions and five sessions of Attentional Bias Modification Training.
VR-based body exposureBehavioural
Combine the usual treatment with an additional five VR-based body-exposure therapy sessions
Usual Care for Eating DisordersBehavioural
Participants were recruited from the day-patient and home-treatment programs of the eating disorders unit.
The day-patient program followed a cognitive-behavioral therapy model and included nutritional rehabilitation, behavioral strategies for improving eating and weight gain, individual and group psychotherapy, and parental support. Attendance ranged from 6 to 11 hours per day, depending on patient risk. The home-treatment program served as transitional care between hospitalization and outpatient treatment and focused on medical stabilization, weight restoration, family involvement, psychoeducation, emotional regulation, and social skills development. Both cognitive-behavioral therapy and family-based therapy were delivered either in person or remotely. Standard treatment procedures for eating disorders were applied across all groups.
| Study group | Role | What they receive |
|---|---|---|
| Treatment as usual + VR-based body + Attentional Bias Modification Training. | Experimental | In this group, five sessions of VR-based body exposure will be added to the usual treatment, as in the other experimental group. Additionally, at the beginning of each exposure session, participants will undergo attentional bias modification training. The training involves the visual selection of geometric figures that approximately correspond to specific body parts, with each figure presented in different colors. Participants must detect and identify figures appearing on different parts of the avatar's body. In 50% of the trials, discrimination will be based on shape, and in the remaining 50%, it will be based on color. Throughout the training, figures will appear on weight-related body parts in 45% of the trials, on non-weight-related body parts in another 45% of the trials, and on one of three neutral stimuli located next to the avatar in the remaining 10% of trials. Receives: Behavioral: Attentional Bias Modification Training; Behavioral: VR-based body exposure; Behavioral: Usual Care for Eating Disorders |
| Treatment as usual + VR-based body exposure | Experimental | Patients assigned to this group will receive the usual treatment provided by their clinical unit, in addition to five weekly sessions of a VR-based body exposure intervention. During these sessions, participants will undergo body exposure using a virtual avatar representing their actual body measurements. The avatar's BMI will be progressively increased across sessions until a healthy BMI is reached. Receives: Behavioral: VR-based body exposure; Behavioral: Usual Care for Eating Disorders |
| Treatment as usual | Active comparator | Patients assigned to this group will receive the usual treatment from the center where they are recruited for the study and will be required to complete the evaluations according to the same schedule as the experimental group. Receives: Behavioral: Usual Care for Eating Disorders |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Drive for Thinness (EDI-DT)
Change in drive for thinness scores as measured by the Eating Disorder Inventory-3 - drive for thinness (EDI-DT) scale. Scores range from 0 to 28, with higher scores indicating greater drive for thinness.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in Body Dissatisfaction (EDI-BD)
Change in body dissatisfaction scores as measured by the Eating Disorder Inventory-3 - body dissatisfaction (EDI-BD) scale. Scores range from 0 to 40, with higher scores indicating greater body dissatisfaction.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in Body Dissatisfaction (BIAS - BD)
Body dissatisfaction scores were assessed using the Figural Drawing Scale for Body Image Assessment (BIAS-BD). Scores range from -80 to 80, with higher absolute values indicating greater body dissatisfaction.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in Body Distortion (BIAS - BD)
Body distortion scores were assessed using the Figural Drawing Scale for Body Image Assessment (BIAS-BD). Scores range from -80 to 80, with higher absolute values indicating greater body distortion.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in complete fixation time towards weight-related body parts
Change in attentional bias towards weight-related body parts, measured as the total fixation time of gaze (evaluated in milliseconds). Higher values indicate greater attentional bias.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in the number of fixations towards weight-related body parts
Change in attentional bias towards weight-related body parts, measured as the number of fixations of gaze. Higher values indicate greater attentional bias.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in Body Mass Index values
Change in Body Mass Index was calculated as weight (kg) divided by height (m) squared. Higher values indicate greater BMI.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in Fear of Gaining Weight
Change in fear of gaining weight, measured using a visual analogue scale (0-100). Higher scores indicate greater fear of gaining weight.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in Anxiety
Change in anxiety, measured using a visual analogue scale (0-100). Higher scores indicate greater anxiety.
Measured: Assessed at baseline (before the body exposure session); every 2 minutes during the exposure session; at the end of the exposure session; at the end of treatment (6 weeks); and at 6-month follow-up.
Change in Body-related Anxiety (PASTAS)
Change in body-related anxiety as measured by the Physical Appearance State Anxiety Scale (PASTAS). Total scores range from 0 to 32, with higher scores indicating greater body-related anxiety.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in Body Appreciation (BAS)
Change in body appreciation as measured by the Body Appreciation Scale (BAS), with scores ranging from 13 to 65; higher scores indicate greater body appreciation.
Measured: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Mar 2021
- Study start21 Dec 2021
- Primary completion2 Feb 2023
- Study completion29 Feb 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for Anorexia NervosaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Model description
- Participants were partially randomly assigned to three study groups. To address recruitment challenges due to the limited availability of new adolescent patients and delays in ABMT software development, historical data from a previous randomized controlled trial conducted by the same research team were incorporated. Only participants who met the current study's inclusion and exclusion criteria were included to ensure comparability, as the previous trial employed the same design, assessments, and treatment-as-usual procedures. The historical dataset comprised 21 participants. Newly recruited participants were randomly assigned to one of three groups using block randomization with a computer-generated sequence to ensure balanced group sizes.
- Masking
- None (open label)
- Enrolment
- 75 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Barcelona
- Sponsor type
- University, hospital or other
- Collaborators
- Hospital Sant Joan de Deu
- Responsible party
- Principal investigator, Jose Gutierrez Maldonado, University of Barcelona
- Investigators
- José Gutiérrez-Maldonado, Principal investigator, jgutierrezm@ub.edu
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04786951
- Sponsor's protocol ID
- PID2019-108657RB-I00
- Acronym
- AN-VR-ABMT
- Status last verified
- Jan 2026
- First submitted
- 25 Feb 2021
- Last updated
- 16 Jan 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: The data presented in this study will be available on request from the corresponding author. The data are not publicly available due to patients' privacy restrictions.
Publications
Reed, D. L., Thompson, J. K., Brannick, M. T., & Sacco, W. P. (1991). Development and validation of the Physical Appearance State and Trait Anxiety Scale (PASTAS). Journal of Anxiety Disorders, 5(4), 323-332. https://doi.org/10.1016/0887-6185(91)90032-O
Smeets E, Jansen A, Roefs A. Bias for the (un)attractive self: on the role of attention in causing body (dis)satisfaction. Health Psychol. 2011 May;30(3):360-7. doi: 10.1037/a0022095.
PubMed 21553980Rodgers RF, DuBois RH. Cognitive biases to appearance-related stimuli in body dissatisfaction: A systematic review. Clin Psychol Rev. 2016 Jun;46:1-11. doi: 10.1016/j.cpr.2016.04.006. Epub 2016 Apr 12.
PubMed 27116714Bauer A, Schneider S, Waldorf M, Braks K, Huber TJ, Adolph D, Vocks S. Selective Visual Attention Towards Oneself and Associated State Body Satisfaction: an Eye-Tracking Study in Adolescents with Different Types of Eating Disorders. J Abnorm Child Psychol. 2017 Nov;45(8):1647-1661. doi: 10.1007/s10802-017-0263-z.
PubMed 28133705Tuschen-Caffier B, Bender C, Caffier D, Klenner K, Braks K, Svaldi J. Selective Visual Attention during Mirror Exposure in Anorexia and Bulimia Nervosa. PLoS One. 2015 Dec 29;10(12):e0145886. doi: 10.1371/journal.pone.0145886. eCollection 2015.
PubMed 26714279Williamson DA, White MA, York-Crowe E, Stewart TM. Cognitive-behavioral theories of eating disorders. Behav Modif. 2004 Nov;28(6):711-38. doi: 10.1177/0145445503259853.
PubMed 15383683Jansen A, Nederkoorn C, Mulkens S. Selective visual attention for ugly and beautiful body parts in eating disorders. Behav Res Ther. 2005 Feb;43(2):183-96. doi: 10.1016/j.brat.2004.01.003.
PubMed 15629749
Study at a glance
From the registry record, last updated by the sponsor on 16 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- AN-VR-ABM: Attentional Bias Modification and Body Exposure Using Virtual Reality and Eye-Tracking to Enhance Treatment for Adolescents With Anorexia Nervosa
- ClinicalTrials.gov ID
- NCT04786951
- Acronym / sponsor ID
- AN-VR-ABMT / PID2019-108657RB-I00
- Conditions
- Anorexia Nervosa
- Keywords
- Attentional bias, Virtual Reality, Body exposure procedure, Attentional bias modification training
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 75 participants (actual)
- Lead sponsor
- University of BarcelonaUniversity, hospital or other
- Collaborators
- Hospital Sant Joan de Deu
- Study start
- 21 Dec 2021 (actual)
- Primary completion
- 2 Feb 2023 (actual)
- Study completion
- 29 Feb 2024 (actual)
- First posted
- 8 Mar 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Anorexia Nervosa (AN) is considered one of the most severe subtypes of eating disorders (EDs), characterized by significant medical complications, high mortality rates, and high comorbidity with other disorders, such as anxiety disorders. Similarly to what occurs in anxiety disorders, several studies have suggested the presence of dysfunctional body-related attentional bias (AB) in patients with EDs, and specifically in patients with AN. Individuals with AN tend to focus their attention on their body in a dysfunctional manner, engaging in body-checking behaviors and excessively scrutinizing their general appearance and weight-related body parts. This body-related AB has been associated with higher levels of body dissatisfaction, which represents one of the most important risk factors for the development and maintenance of EDs.
Moreover, body-related AB may contribute to reducing the effectiveness of body exposure-based treatments used in patients with AN. For this reason, it is necessary to develop new treatment techniques by incorporating specific components aimed at reducing body-related AB. It has been proposed that attentional bias modification techniques could be integrated into body exposure therapy as an effective approach to reduce body-related AB, body dissatisfaction, and body anxiety.
To date, our research group has been the first to use a combination of virtual reality (VR) and eye-tracking (ET) technologies to assess the presence of body-related AB in non-clinical samples. In order to improve treatments for AN, the present project aims to develop a novel attentional bias modification procedure using ET and VR technologies. In addition, this project seeks to integrate this AB modification procedure into a body exposure-based treatment designed to reduce the fear of weight gain experienced by patients with AN.
Finally, the project aims to evaluate whether combining two distinct components-body exposure-based therapy and attentional bias modification training-results in a more effective intervention. It is expected that the inclusion of a VR-based body exposure procedure in standard AN treatment, enhanced through the illusion of ownership over a virtual body, will lead to improved treatment outcomes. Furthermore, it is anticipated that the addition of attentional bias modification training to the body exposure-based procedure will further enhance treatment effectiveness.
Detailed description
Attentional bias (AB) refers to the tendency to allocate greater attention to certain types of stimuli or information (e.g., disorder-relevant information) over other types of information. Adolescent patients with Anorexia Nervosa (AN) have been shown to focus more on self-perceived unattractive body parts than on other body parts. Dysfunctional body-related AB is thought to maintain body image disturbances commonly reported by adolescents with AN by selectively processing body-related information that is consistent with dysfunctional cognitive schemas (e.g., "I am getting a fatter belly"), while schema-inconsistent information (e.g., "I am getting thinner") receives less attention and is often visually neglected.
Dysfunctional body-related AB may also contribute to the reduced effectiveness of body exposure-based treatments for adolescents with AN. Therefore, there is a need to develop novel treatment approaches by incorporating specific components aimed at reducing body-related AB in this population. In a previous project conducted by our group, preliminary evidence supported the effectiveness of body-related AB modification in adolescent patients with AN following a virtual reality (VR)-based mirror exposure intervention. A key factor underlying these results may lie in the structure of the procedure, in which patients were required to sequentially focus on different parts of a virtual body (from head to feet) and verbally express their thoughts and emotions related to each body area.
Building on these findings, the present project aims to further advance this line of research by integrating attentional bias modification techniques into body exposure therapy as an effective approach to reducing body-related AB, body dissatisfaction, and body anxiety in adolescents with AN. To date, our research group has been among the first to combine virtual reality (VR) and eye-tracking (ET) technologies to assess body-related AB in both clinical and non-clinical samples. Specifically, this project seeks to determine whether the addition of attentional bias modification training to body exposure-based therapy results in a more effective intervention for adolescents diagnosed with AN.
It is hypothesized that incorporating AB modification training into the body exposure-based procedure (experimental group) will lead to greater treatment efficacy compared with treatment as usual (control group). Specifically, adolescents in the experimental group are expected to show a significant increase in body mass index (BMI) and a significant reduction in core AN symptomatology (e.g., fear of weight gain, body image disturbances), as well as a reduction in body-related AB, from pre- to post-treatment, compared with the control group. These improvements are also expected to be maintained at the six-month follow-up.
The project will be conducted at the Eating Disorders Units of Hospital Sant Joan de Déu (Barcelona, Spain), which specializes in the treatment of adolescents with eating disorders.
Adolescent patients with AN will be exposed to an immersive virtual environment using a VR head-mounted display (HTC Pro Eye) equipped with integrated eye-tracking. In addition to the two controllers typically provided with the HTC Pro Eye system, three additional body trackers will be used to enable full-body motion tracking. The virtual environment will consist of a room featuring a large mirror positioned on the front wall, approximately 1.5 m in front of the participant, and large enough to reflect the entire body. A young female avatar wearing a basic white T-shirt, blue jeans, and black trainers will be created for the intervention.
Regarding the treatment protocol, all sessions will last approximately one hour and will be conducted once per week. Each session will begin with the induction of the full-body illusion (FBI) and the assessment of visual analogue scales (VASs). Body exposure will initially involve a virtual body with the same BMI as the adolescent patient. The attentional bias modification training will be based on an adaptation of the AB induction procedure proposed by Smeets, Jansen, and Roefs (2011). The training will involve the visual selection of geometric figures (e.g., squares, rectangles, circles) that approximately correspond to specific body parts, with each figure presented in different colors. Participants will be required to detect and identify figures appearing on different parts of the avatar's body. In 50% of the trials, discrimination will be based on shape, while in the remaining 50% it will be based on color. Throughout the training, figures will appear on weight-related body parts in 45% of the trials and on non-weight-related body parts in another 45% of the trials. In the remaining 10% of trials, figures will appear on one of three neutral stimuli positioned next to the avatar.
Raw eye-tracking data will be processed using Ogama (Open Gaze and Mouse Analyzer) software to obtain quantitative measures of visual attention. Weight-related and non-weight-related areas of interest (AOIs) will be defined a priori. Weight-related AOIs will be determined based on the weight-related body items of the PASTAS questionnaire and mapped onto a frontal-view image of a female avatar. These weight-related AOIs will include the legs, thighs, buttocks, hips, abdomen, and waist. All remaining body parts (head, neck, chest, shoulders, arms, and feet) will be classified as non-weight-related AOIs. Selective visual attention will be assessed using total fixation duration and the number of fixations within each AOI.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
- Model description
- Participants were partially randomly assigned to three study groups. To address recruitment challenges due to the limited availability of new adolescent patients and delays in ABMT software development, historical data from a previous randomized controlled trial conducted by the same research team were incorporated. Only participants who met the current study's inclusion and exclusion criteria were included to ensure comparability, as the previous trial employed the same design, assessments, and treatment-as-usual procedures. The historical dataset comprised 21 participants. Newly recruited participants were randomly assigned to one of three groups using block randomization with a computer-generated sequence to ensure balanced group sizes.
| Arm | Type | Receives |
|---|---|---|
| Treatment as usual + VR-based body + Attentional Bias Modification Training. | Experimental | Behavioral: Attentional Bias Modification Training, Behavioral: VR-based body exposure, Behavioral: Usual Care for Eating DisordersIn this group, five sessions of VR-based body exposure will be added to the usual treatment, as in the other experimental group. Additionally, at the beginning of each exposure session, participants will undergo attentional bias modification training. The training involves the visual selection of geometric figures that approximately correspond to specific body parts, with each figure presented in different colors. Participants must detect and identify figures appearing on different parts of the avatar's body. In 50% of the trials, discrimination will be based on shape, and in the remaining 50%, it will be based on color. Throughout the training, figures will appear on weight-related body parts in 45% of the trials, on non-weight-related body parts in another 45% of the trials, and on one of three neutral stimuli located next to the avatar in the remaining 10% of trials. |
| Treatment as usual + VR-based body exposure | Experimental | Behavioral: VR-based body exposure, Behavioral: Usual Care for Eating DisordersPatients assigned to this group will receive the usual treatment provided by their clinical unit, in addition to five weekly sessions of a VR-based body exposure intervention. During these sessions, participants will undergo body exposure using a virtual avatar representing their actual body measurements. The avatar's BMI will be progressively increased across sessions until a healthy BMI is reached. |
| Treatment as usual | Active comparator | Behavioral: Usual Care for Eating DisordersPatients assigned to this group will receive the usual treatment from the center where they are recruited for the study and will be required to complete the evaluations according to the same schedule as the experimental group. |
Who may qualify
- Ages
- 12 to 17 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (4 listed)
- Female adolescents aged 12-17 years.
- Primary diagnosis of anorexia nervosa according to DSM-5 criteria.
- Body weight below the expected range for height, age, and sex.
- Ability to understand and communicate in Spanish.
Key exclusion criteria (6 listed)
- Presence of severe mental disorders other than anorexia nervosa.
- Significant cognitive impairment that would interfere with participation.
- Visual or auditory deficits that could interfere with VR-based body exposure therapy.
- Epilepsy.
- Pregnancy.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Attentional Bias Modification TrainingCombine usual treatment with an additional five VR-based body-exposure therapy sessions and five sessions of Attentional Bias Modification Training. | Behavioural | Treatment as usual + VR-based body + Attentional Bias Modification Training. |
| VR-based body exposureCombine the usual treatment with an additional five VR-based body-exposure therapy sessions | Behavioural | Treatment as usual + VR-based body + Attentional Bias Modification Training., Treatment as usual + VR-based body exposure |
| Usual Care for Eating DisordersParticipants were recruited from the day-patient and home-treatment programs of the eating disorders unit. The day-patient program followed a cognitive-behavioral therapy model and included nutritional rehabilitation, behavioral strategies for improving eating and weight gain, individual and group psychotherapy, and parental support. Attendance ranged from 6 to 11 hours per day, depending on patient risk. The home-treatment program served as transitional care between hospitalization and outpatient treatment and focused on medical stabilization, weight restoration, family involvement, psychoeducation, emotional regulation, and social skills development. Both cognitive-behavioral therapy and family-based therapy were delivered either in person or remotely. Standard treatment procedures for eating disorders were applied across all groups. | Behavioural | Treatment as usual, Treatment as usual + VR-based body + Attentional Bias Modification Training., Treatment as usual + VR-based body exposure |
Primary outcome
Change in Drive for Thinness (EDI-DT)
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in drive for thinness scores as measured by the Eating Disorder Inventory-3 - drive for thinness (EDI-DT) scale. Scores range from 0 to 28, with higher scores indicating greater drive for thinness.
Change in Body Dissatisfaction (EDI-BD)
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in body dissatisfaction scores as measured by the Eating Disorder Inventory-3 - body dissatisfaction (EDI-BD) scale. Scores range from 0 to 40, with higher scores indicating greater body dissatisfaction.
Change in Body Dissatisfaction (BIAS - BD)
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Body dissatisfaction scores were assessed using the Figural Drawing Scale for Body Image Assessment (BIAS-BD). Scores range from -80 to 80, with higher absolute values indicating greater body dissatisfaction.
Change in Body Distortion (BIAS - BD)
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Body distortion scores were assessed using the Figural Drawing Scale for Body Image Assessment (BIAS-BD). Scores range from -80 to 80, with higher absolute values indicating greater body distortion.
Change in complete fixation time towards weight-related body parts
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in attentional bias towards weight-related body parts, measured as the total fixation time of gaze (evaluated in milliseconds). Higher values indicate greater attentional bias.
Change in the number of fixations towards weight-related body parts
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in attentional bias towards weight-related body parts, measured as the number of fixations of gaze. Higher values indicate greater attentional bias.
Change in Body Mass Index values
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in Body Mass Index was calculated as weight (kg) divided by height (m) squared. Higher values indicate greater BMI.
Change in Fear of Gaining Weight
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in fear of gaining weight, measured using a visual analogue scale (0-100). Higher scores indicate greater fear of gaining weight.
Change in Anxiety
Time frame: Assessed at baseline (before the body exposure session); every 2 minutes during the exposure session; at the end of the exposure session; at the end of treatment (6 weeks); and at 6-month follow-up.
Change in anxiety, measured using a visual analogue scale (0-100). Higher scores indicate greater anxiety.
Change in Body-related Anxiety (PASTAS)
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in body-related anxiety as measured by the Physical Appearance State Anxiety Scale (PASTAS). Total scores range from 0 to 32, with higher scores indicating greater body-related anxiety.
Change in Body Appreciation (BAS)
Time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.
Change in body appreciation as measured by the Body Appreciation Scale (BAS), with scores ranging from 13 to 65; higher scores indicate greater body appreciation.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 Jan 2026.
- BackgroundReed, D. L., Thompson, J. K., Brannick, M. T., & Sacco, W. P. (1991). Development and validation of the Physical Appearance State and Trait Anxiety Scale (PASTAS). Journal of Anxiety Disorders, 5(4), 323-332. https://doi.org/10.1016/0887-6185(91)90032-O
- Background: PubMed 21553980Smeets E, Jansen A, Roefs A. Bias for the (un)attractive self: on the role of attention in causing body (dis)satisfaction. Health Psychol. 2011 May;30(3):360-7. doi: 10.1037/a0022095.
- Background: PubMed 27116714Rodgers RF, DuBois RH. Cognitive biases to appearance-related stimuli in body dissatisfaction: A systematic review. Clin Psychol Rev. 2016 Jun;46:1-11. doi: 10.1016/j.cpr.2016.04.006. Epub 2016 Apr 12.
- Background: PubMed 28133705Bauer A, Schneider S, Waldorf M, Braks K, Huber TJ, Adolph D, Vocks S. Selective Visual Attention Towards Oneself and Associated State Body Satisfaction: an Eye-Tracking Study in Adolescents with Different Types of Eating Disorders. J Abnorm Child Psychol. 2017 Nov;45(8):1647-1661. doi: 10.1007/s10802-017-0263-z.
- Background: PubMed 26714279Tuschen-Caffier B, Bender C, Caffier D, Klenner K, Braks K, Svaldi J. Selective Visual Attention during Mirror Exposure in Anorexia and Bulimia Nervosa. PLoS One. 2015 Dec 29;10(12):e0145886. doi: 10.1371/journal.pone.0145886. eCollection 2015.
- Background: PubMed 15383683Williamson DA, White MA, York-Crowe E, Stewart TM. Cognitive-behavioral theories of eating disorders. Behav Modif. 2004 Nov;28(6):711-38. doi: 10.1177/0145445503259853.
- Background: PubMed 15629749Jansen A, Nederkoorn C, Mulkens S. Selective visual attention for ugly and beautiful body parts in eating disorders. Behav Res Ther. 2005 Feb;43(2):183-96. doi: 10.1016/j.brat.2004.01.003.
- Individual participant dataSharing planned: No. The data presented in this study will be available on request from the corresponding author. The data are not publicly available due to patients' privacy restrictions.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
José Gutiérrez-Maldonado principal investigator
jgutierrezm@ub.edu
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Attentional Bias Modification Training and VR-based body exposure in people with Anorexia Nervosa, run by University of Barcelona at 1 site in Spain.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 16 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Drive for Thinness (EDI-DT) (time frame: Assessed at baseline, at the end of treatment (6 weeks), and at 6-month follow-up.). The study lists 11 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04786951, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Jan 2026.