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Anorexia NervosaNCT06795555

Virtual Reality Exposure to Reduce Food Related Anxiety in Anorexia Nervosa

A study testing Virtual reality food exposure and Virtual Reality Nature Exposure in people with Anorexia Nervosa, run by University of Padova at 1 site in Italy.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Exposure to food stimuli often elicit aversive emotions in patients with anorexia nervosa, which can perpetuate eating-related avoidance. Exposure therapy has been shown to effectively reduce anxiety toward, and avoidance of, feared stimuli in several psychiatric disorders. Read more about this study

Who is it for?
Ages 14 years and older, women only
Conditions the study is for
Anorexia Nervosa
What is being tested?
Virtual reality food exposure and Virtual Reality Nature Exposure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteItaly
Study dates
1 Mar 2024to Dec 2025
Phase
Interventional
Are there results?
Not yet: the study is under way

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 14 years and older
  • Women only
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • current diagnosis of anorexia nervosa according to DSM-5 criteria
  • 14 years or older.

Who cannot join

  • diagnosis of neurological disorders
  • diagnosis of psychosis or substance abuse disorders
  • visual/hearing impairments not corrected by glasses/ear implants
  • non-tolerance of exposure to VR (i.e., cybersickness, dizziness)

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Valentina Cardi, PhD contact

+39 3713759534

valentina.cardi@unipd.it

Valentina Meregalli, PhD contact

+39 320 744 2384

valentina.meregalli@unipd.it

Italy1 site, 1 recruiting
  • University Hospital of Padova

    Padova, Italy, 35121

    Valentina Cardi, PhD, +39 3713759534, valentina.cardi@unipd.it

    Valentina Cardi, PhD

    Recruiting

Other trials in Italy

About this study

Official title: Virtual Food for Real Thought: a Pilot Randomised Controlled Trial of Virtual Reality Exposure in Anorexia Nervosa

Exposure to food stimuli often elicit aversive emotions in patients with anorexia nervosa, which can perpetuate eating-related avoidance. Exposure therapy has been shown to effectively reduce anxiety toward, and avoidance of, feared stimuli in several psychiatric disorders. Digital technologies, such as virtual reality (VR) have been employed to implement exposure therapy in situations where in vivo exposure is unfeasible, challenging, or perceived as threatening by patients. VR has also the potential to be used by individuals repeatedly in their own time and environment, to consolidate new learning. This pilot randomised controlled study evaluates the feasibility and clinical impact of repeated VR exposure to food stimuli in patients with anorexia nervosa attending intensive daycare treatment (treatment as usual, TAU). VR food exposure will be compared to the use of a relaxation-focused VR scenario (natural environment) and a control condition (no use of VR). Patients in all groups will receive TAU.

Read the detailed description

Patients with anorexia nervosa are recruited from daycare services at Eating Disorder Units in Italy. Inclusion criteria are: (1) current diagnosis of anorexia nervosa according to DSM-5 criteria; (2) 14 years or older. Exclusion criteria are: (1) diagnosis of neurological disorders, (2) diagnosis of psychosis or substance abuse disorders, (3) visual/hearing impairments not corrected by glasses/ear implants; (4) non-tolerance of exposure to VR (i.e., cybersickness, dizziness).

Each patient is randomly assigned to one of three conditions: repeated food exposure in a VR kitchen environment + TAU, repeated exposure to a VR natural setting + TAU, or TAU alone .

VR Food Exposure: Patients in this condition undergo one session of VR exposure in a kitchen environment each day for 5 consecutive days (from Monday, day 1, to Friday, day 5). Each session lasts 5 minutes. The VR environment has been specifically developed by the study team and it was tested in a previous one-session study. The scenario consists of a kitchen with foods of different calorie contents either immediately visible in the environment (for example on a table) or stored in drawings, refrigerators, cabinets. Once in the kitchen, patients can freely move, open the cupboards and the fridge, and grab and hold the foods. Patients are invited to explore the environment and interact with the stimuli they feel most comfortable with. Based on their preference, in each session participants access one of three versions of the virtual kitchen: the virtual kitchen alone, a virtual kitchen + a pink elephant (designed to induce positive mood), or a virtual kitchen + a reassuring voice that encourages to interact with foods and face food-related fears.

VR Nature Exposure: Patients in this condition undergo one session of VR exposure to a natural scenario each day, for 5 consecutive days (from Monday to Friday), through the NatureTreks app. Each session lasts 5 minutes. Participants perform the exposure while seated, and are instructed to observe the environment and try to relax. Based on their preference, in each session participants are able to choose one of three different natural environments: a white sand beach ("Blue Ocean"), a snowy mountain ("White Winter"), or a forest in autumn foliage ("Red Fall")

TAU: It consists of a daycare program (attendance Monday to Friday) including individual psychological therapy (based on cognitive-behavioral principles), nutritional counseling, assisted meals, group activities (e.g., psychotherapy, art therapy, music therapy, relaxation protocols), and psychoeducation for family members. For ethical reasons, at the end of the follow-up assessment, participants in the control group are given the opportunity to engage in VR exposure.

Patients in all conditions complete a baseline (day 0) and end of intervention (day 5) assessment. The baseline assessment includes:

  • Demographic questionnaire (age, years of education, current pharmacological treatments, height, weight)
  • Eating Disorder Examination Questionnaire
  • Depression, Anxiety and Stress Scale
  • Difficulties in Emotion Regulation Scale
  • Positive and Negative Affect Schedule
  • State and Trait Anxiety Scale
  • Motivational Ruler: patients are asked to rate, on a scale from 0 to 10 importance and ability to change.
  • Food evaluation: patients are asked to rate, on a scale from 0 to 100 wanting, liking and fear of 21 foods of different caloric content.
  • Meal related anxiety: just before starting their meal at the hospital, patients are asked to rate their current level of anxiety on a scale from 0 to 10.

The PANAS, the STAI, the motivational ruler, food evaluation, and meal related anxiety are completed at the end of intervention.

Each day, immediately before and after the exposure, participants in the food and nature exposure groups are asked to rate, on a scale from 0 to 100, their anxiety in the moment and also the anxiety they feel when thinking of the next meal. At the end of each exposure session, they are asked to rate their sense of presence and discomfort in the VR environment.

Being tested
Virtual reality food exposure, Virtual Reality Nature Exposure
Keywords
mental health, eating disorders, exposure therapy, virtual reality
Medical subject headings
Anorexia Nervosa, Psychological Well-Being, Feeding and Eating Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Virtual reality food exposureBehavioural

    Patients in this condition are exposed to a virtual kitchen environment once/day, for 5 consecutive days (from Monday, day 1, to Friday, day 5). Each session lasts 5 minutes. The VR environment was specifically developed by the study team (Natali et al, 2024) and it consists of a kitchen with foods of different calorie contents. Patients are invited to explore the environment; they can freely move, open the cupboards and the fridge, and grab and hold the foods. Participants can choose to interact with one of three versions of the virtual kitchen environment: a) a kitchen alone, b) a kitchen with a virtual pet which participants can interact with (and aimed at inducing positive mood) and c) a kitchen with a compassionate avatar which motivates the participant to face food-related fears.

  • Virtual Reality Nature ExposureBehavioural

    Patients in this condition complete a session of VR exposure to a natural scenario (from the NatureTreksVR app) for 5 consecutive days (from Monday to Friday), one session/day. Each session lasts 5 minutes. Participants can choose exposure to one of three different natural environments, at the start of each session: a white sand beach ("Blue Ocean"), a snowy mountain ("White Winter"), or a forest in autumn foliage ("Red Fall").

Study groups in NCT06795555
Study groupRoleWhat they receive
Virtual Reality Food ExposureExperimentalFive sessions of exposure to a virtual kitchen (one session/day, over a week). Participants in this arm will continue receiving treatment as usual for their eating disorder at the treatment center
Receives: Behavioral: Virtual reality food exposure
Virtual Reality Nature ExposureActive comparatorFive sessions of exposure to a virtual natural environment (one session/day, over a week). Participants in this arm will continue receiving treatment as usual for their eating disorder at the treatment center
Receives: Behavioral: Virtual Reality Nature Exposure
Treatment as usualNo interventionPatients in this condition will receive treatment as usual only

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change from baseline to end of intervention in meal related anxiety

    Meal related anxiety is assessed on a Likert scale from 0 (no anxiety) to 10 (extreme anxiety)

    Measured: Measurements at baseline and day 5

  2. Feasibility of exposure to the virtual reality environments

    Percentage of participants who interrupt exposure to the virtual reality environment before completion.

    Discomfort associated to the virtual reality exposure session, rated at the end of each session on a visual analogue scale (0-100).

    Measured: Following each of five exposure sessions, over a time period of five days

Secondary outcomes (4)
  1. Change from baseline to end of treatment in positive and negative affect

    The PANAS is a validated self-report instrument consisting of two subscales assessing respectively positive and negative affect. The score of each subscale can range from 10 to 50, with higher scores representing higher levels of positive/negative affect.

    Measured: Measurements at baseline and day 5

  2. Change from baseline to end of intervention in state anxiety

    The STAI state is a 20-item self-report scale for the assessment of state anxiety. Possible scores range from 0 to 80 and greater scores indicate greater anxiety

    Measured: Measurements at baseline and day 5

  3. Change from baseline to end of intervention in food pictures evaluation

    Food-related wanting, liking and fear will be measured in response to the presention of 21 pictures of foods of different caloric content, using a scale from 0 (not at all) to 100 (extremely).

    Measured: Measurements at baseline and day 5

  4. Effect sizes of changes in anxiety and meal related anxiety from before to after virtual reality exposure

    Ratings of general and meal related anxiety will be collected at the beginning and at the end of each virtual reality exposure session through a visual analogue scale ranging from 0 to 100.

    Measured: Measurements before and after each exposure session, over five days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Jan 2025
  2. Study start1 Mar 2024
  3. Primary completionSep 2025 (estimated)
  4. Study completionDec 2025 (estimated)

Resources

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
Randomised
Intervention model
Parallel groups
Model description
Patients are randomly assigned to one of three conditions: (1) treatment as usual + virtual food exposure; (2) treatment as usual + virtual nature exposure; (3) treatment as usual
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06795555
Sponsor's protocol ID
6048/AO/24
Status last verified
Jan 2025
First submitted
21 Jan 2025
Last updated
29 Jan 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: a plan will be established by the research team for data sharing following publication of the first manuscript

Publications

  • Gratz, K.L., Roemer, L. Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment 26, 41-54 (2004). https://doi.org/10.1023/B:JOBA.0000007455.08539.94

  • Terracciano A, McCrae RR, Costa PT Jr. Factorial and construct validity of the Italian Positive and Negative Affect Schedule (PANAS). Eur J Psychol Assess. 2003;19(2):131-141. doi: 10.1027//1015-5759.19.2.131.

    PubMed 20467578
  • Bottesi G, Ghisi M, Altoe G, Conforti E, Melli G, Sica C. The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples. Compr Psychiatry. 2015 Jul;60:170-81. doi: 10.1016/j.comppsych.2015.04.005. Epub 2015 Apr 15.

    PubMed 25933937
  • Calugi S, Milanese C, Sartirana M, El Ghoch M, Sartori F, Geccherle E, Coppini A, Franchini C, Dalle Grave R. The Eating Disorder Examination Questionnaire: reliability and validity of the Italian version. Eat Weight Disord. 2017 Sep;22(3):509-514. doi: 10.1007/s40519-016-0276-6. Epub 2016 Apr 2.

    PubMed 27039107

Questions about this trial

What is this clinical trial studying?

A study testing Virtual reality food exposure and Virtual Reality Nature Exposure in people with Anorexia Nervosa, run by University of Padova at 1 site in Italy.

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 2 inclusion and 4 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: looking for participants now, as of the sponsor's last update on 29 Jan 2025. 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 Italy. 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?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Valentina Cardi, PhD (+39 3713759534, valentina.cardi@unipd.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change from baseline to end of intervention in meal related anxiety (time frame: Measurements at baseline and day 5). The study lists 2 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 NCT06795555, which also lists 4 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 29 Jan 2025.

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