Virtual Reality Body Exposure and Attentional Bias Modification in the Treatment of Adolescents With Anorexia Nervosa

ABSTRACT Anorexia nervosa (AN) is a severe psychiatric disorder characterized by intense fear of gaining weight and persistent body image disturbance. Virtual reality–based mirror exposure therapy (VR‐MET) may reduce body‐related fear through embodied exposure, while attentional bias modification training (ABMT) may enhance exposure learning by promoting balanced attentional allocation. This controlled clinical study tested the hypothesis that adjunctive VR‐MET would improve clinical outcomes beyond treatment as usual (TAU) alone, and that preceding VR‐MET with ABMT would produce additional benefits in adolescent females with AN. Seventy‐five female adolescents with AN were allocated to TAU, TAU+VR‐MET or TAU+ABMT+VR‐MET. Assessments were conducted pre‐ and post‐intervention. Outcomes included eye‐tracking indices of attentional bias (number of fixations, complete fixation time), state anxiety and fear of gaining weight, BMI and eating disorder–related measures. Compared with TAU alone, both VR‐based conditions showed greater reductions in state anxiety and fear of gaining weight. State body dissatisfaction decreased significantly only in the TAU+VR‐MET group. No significant changes were observed for BMI or most trait‐level eating disorder measures. ABMT did not enhance clinical outcomes beyond VR‐MET. Within the short‐term assessment window, adjunctive VR‐MET was associated with reductions in state‐dependent emotional responses in adolescents with AN. Effects on trait‐level symptoms were limited, and ABMT did not confer additional benefit in this unselected sample. Fully randomized studies with larger samples, extended exposure protocols, and follow‐up assessments are needed to determine durability and broader clinical impact.