What question did this study set out to answer?

Evaluate the feasibility and acceptability of a VR-based mirror exposure therapy combined with eye-tracking in male adolescents with anorexia nervosa.

May 27, 2026

Virtual Reality Mirror Exposure Combined with Eye-Tracking Attentional Bias Modification in Adolescent Males with Anorexia Nervosa: A Feasibility Study

Key Points

Evaluate the feasibility and acceptability of a VR-based mirror exposure therapy combined with eye-tracking in male adolescents with anorexia nervosa.
Two males with anorexia nervosa received VR mirror exposure therapy and eye-tracking bias modification.
Feasibility assessed through protocol adherence, technical stability, and usability via the System Usability Scale (SUS).
Exploratory measures included clinical outcomes at pretreatment, posttreatment, and 3-month follow-up.
Both participants adhered to the protocol and reported high usability scores (SUS > 80).
Exploratory observations indicated improvements in body dissatisfaction, weight-related anxiety, and body appreciation maintained at follow-up.
Divergent eye-tracking patterns: typical AN presentation showed focus on weight-related areas, while muscle dysmorphia exhibited attention to muscular regions.

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.

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