TYPE Editorial PUBLISHED 13 June 2023 DOI 10.3389/fpsyg.2023.1225454 Editorial: Can virtual reality be a OPEN ACCESS solution for assessing and treating psychological symptoms caused EDITED AND REVIEWED BY Nicholas T. Bello, Rutgers, The State University of New Jersey, United States *CORRESPONDENCE by eating and weight disorders? Julia Vázquez-de Sebastián jvazquezds@gmail.com Dimitra Anastasiadou Julia Vázquez-de Sebastián1,2,3*, Dimitra Anastasiadou1,4*, dimitra.anastasiadou@uab.cat Desiderio Cano Porras5 , Doron Friedman6 , RECEIVED 19 May 2023 ACCEPTED 30 May 2023 Carmina Castellano-Tejedor2,7 and Pilar Lusilla-Palacios1,8,9,10 PUBLISHED 13 June 2023 1 Psychiatry, Mental Health and Addictions Research Group, Vall d’Hebron Research Institute, Barcelona, CITATION Spain, 2 RE-FiT Barcelona Research Group, Vall d’Hebron Research Institute and Parc Sanitari Pere Virgili, Vázquez-de Sebastián J, Anastasiadou D, Cano Barcelona, Spain, 3 Health and Sport Psychology PhD Program, Psychology Department, Autonomous Porras D, Friedman D, Castellano-Tejedor C and University of Barcelona, Bellaterra, Spain, 4 Department of Clinical and Health Psychology, Autonomous Lusilla-Palacios P (2023) Editorial: Can virtual University of Barcelona, Barcelona, Spain, 5 Department of Cognitive Science and Artificial Intelligence, reality be a solution for assessing and treating Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands, 6 School of psychological symptoms caused by eating and Communications, Reichman University, Herzliya, Israel, 7 GIES Research Group, Basic Psychology weight disorders? Front. Psychol. 14:1225454. Department, Autonomous University of Barcelona, Barcelona, Spain, 8 Psychiatry Department, Vall doi: 10.3389/fpsyg.2023.1225454 d’Hebron University Hospital, Barcelona, Spain, 9 Department of Psychiatry and Legal Medicine, COPYRIGHT Universitat Autònoma de Barcelona, Barcelona, Spain, 10 Biomedical Network Research Centre on Mental © 2023 Vázquez-de Sebastián, Anastasiadou, Health (CIBERSAM), Barcelona, Spain Cano Porras, Friedman, Castellano-Tejedor and Lusilla-Palacios. This is an open-access article distributed under the terms of the Creative KEYWORDS Commons Attribution License (CC BY). The use, eating and weight disorders, obesity, virtual reality, psychological treatment, distribution or reproduction in other forums is permitted, provided the original author(s) and psychotherapy the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these Editorial on the Research Topic terms. Can virtual reality be a solution for assessing and treating psychological symptoms caused by eating and weight disorders? Recent scientific literature suggests that incorporating Virtual Reality (VR) into psychological interventions for Eating and Weight Disorders (EWD) has promising potential for addressing the root causes of these conditions beyond traditional weight control or weight recovery-focused strategies. For instance, VR may provide multisensory (e.g., visual, auditory, olfactory, and haptic cues) and extrinsic feedback, such as objective information regarding performance, or embodiment experiences. Thus, applying theory- driven choices in VR can contribute to increasing patients’ motivation and adherence to clinical treatments, and can support clinicians to personalize interventions. Moreover, VR is emerging as a promising tool for patients, as it can facilitate the promotion of healthy behaviors, reduce negative body image concerns, address the internalization of weight stigma, and offer them the opportunity to safely and effectively confront adverse stimuli in controlled environments (Riva et al., 2020; Al-Rasheed et al., 2022). One key question addressed in this Research Topic is whether the latest VR developments can be successfully implemented to enhance the efficacy of evidence-based psychological techniques for people living with EWD. Studies included in this Research Topic suggest that VR has the capacity to create immersive and experiential platforms for delivering interventions in a life-like and fully engaging manner, which could ultimately improve clinical effectiveness (Anastasiadou et al.; Behrens et al.; Döllinger et al.; Harris et al.; van der Waal et al.). Harris et al. explored the effect of high levels of immersion and interactivity. Particularly, the authors analyzed Frontiers in Psychology 01 frontiersin.org Vázquez-de Sebastián et al. 10.3389/fpsyg.2023.1225454 the effects of VR food stimuli on participants’ cravings, by adding Recent progress in generative Artificial Intelligence, and olfactory and interaction cues within the virtual environment. This specifically breakthroughs with large language models (Brown study concluded that VR could be a useful tool for exposure et al., 2020), are also likely to facilitate further research and treatments; in this case, food cravings increased through the use application in the development of VR systems as therapeutic tools of VR. to address EWD. First, the generation of VR scenarios, including Additionally, immersive VR has the potential to enhance personalized scenarios, is likely to become easier and cheaper due the understanding of the factors involved in EWD for both to automated generation of technical code and content (Pollak clinicians/researchers and patients. One important advantage is et al., 2023). Additionally, offline analysis of psychological textual the ability to gather objective data on patients’ eating behavior content, such as MI transcripts, has become feasible (Wu et al., and emotional responses, providing valuable insights into the 2023). Finally, it is becoming easier to integrate intelligent virtual psychological mechanisms underlying obesity. For instance, van humans in psychological VR applications (Nakash et al., 2022), and der Waal et al. used visuotactile stimulation in VR to explore the these virtual humans are becoming increasingly sophisticated and complex interplay between emotions and body-size perceptions competent in their dialogue capabilities (Chiu et al., 2015). among healthy participants, providing insights into participants’ Considering the accelerated technological advance and the negative emotional responses toward avatars with obesity. growing body of literature, interdisciplinary collaboration among VR technology also helps to incorporate immersive researchers, clinicians, and VR designers is essential to ensure psychoeducational cues and participatory environments to a successful transfer to the clinical implementation of VR in empower people with EWD to better manage their condition. the treatment of EWD. Additionally, to ensure a transition into Furthermore, the integration of Cognitive-Behavioral Therapy evidence-based practice, VR products should undergo testing and (CBT) and Motivational Interviewing (MI) with VR exposure to validation before clinical application, and the personal data and challenging situations, which may be difficult to recreate in the real information of patients using VR products must be secure and world, can enhance clinical interventions. For instance, VR allows protected. This will strengthen the quality of the VR technology and participants to maintain self-conversations using embodiment facilitate its incorporation into solutions for assessing and treating and body-swapping techniques, as in the SOCRATES project psychological symptoms associated with EWD. (Anastasiadou et al.). Such techniques consist on alternatively In sum, improving the quality of future studies is crucial embodying two different avatars; one being the patient’s look- for evaluating the effectiveness of these interventions in different alike avatar, and the other being a virtual counselor. This study clinical populations considering their specific needs, and ensuring shows that incorporating VR-driven body-swapping with MI, the transferability of these results in clinical practice. can promote healthier lifestyles among patients with obesity (Anastasiadou et al.). Another advantage of using VR in the treatment of EWD is the ability to address body image disturbances Author contributions by allowing individuals to embody visually altered virtual bodies. Döllinger et al. developed a VR prototype system that employs JV-dS, DA, DC, DF, and PL-P drafted the manuscript. CC-T personalized avatars with photorealistic features, which can be provided critical revisions. All authors approved the final version modulated in real-time. Such a system may enable people with of the manuscript. obesity to engage in virtual scenarios that simulate real-world challenges related to body image concerns (Döllinger et al.). Hence, exposure to virtual situations can provide a safe and Funding effective way to address negative feelings about body image, This study has been funded by the European Union’s Horizon a critical factor in overweight and obesity. This approach can 2020 Research and Innovation Program (grant agreement no. lead to improved body image acceptance and body awareness, 951930) and the Serra Húnter Program in the form of a grant thus helping individuals with EWD to develop new, healthier awarded to DA. The funders had no role in decision to publish or habits and attitudes (Ferrer-García and Gutiérrez-Maldonado, preparation of the manuscript. 2012). Moreover, VR-based interventions offer the possibility to enhance engagement in treatment by providing a unique and Conflict of interest impactful therapeutic experience. However, it is necessary to consider various factors influencing the user experience, such The authors declare that the research was conducted as familiarity with VR, individual characteristics like age and in the absence of any commercial or financial relationships gender, and also, specific technological design and technical that could be construed as a potential conflict features, such as the quality of graphics and audio in the VR of interest. environment. Besides, by tailoring VR interventions to meet the specific needs and preferences of the target audience, researchers and designers can improve their effectiveness and implementation. Publisher’s note Understanding all these factors is essential for optimizing the design and effectiveness of VR interventions for treating EWD in All claims expressed in this article are solely those of the clinical practice (Behrens et al.). authors and do not necessarily represent those of their affiliated Frontiers in Psychology 02 frontiersin.org Vázquez-de Sebastián et al. 10.3389/fpsyg.2023.1225454 organizations, or those of the publisher, the editors and the claim that may be made by its manufacturer, is not guaranteed or reviewers. Any product that may be evaluated in this article, or endorsed by the publisher. References Al-Rasheed, A., Alabdulkreem, E., Alduailij, M., Alduailij, M., Alhalabi, W., Alharbi, Nakash, T., Haller, T., Shekel, M., Pollak, D., Lewenchuse, M., Klomek, A. B., S., et al. (2022). Virtual reality in the treatment of patients with overweight and obesity: et al. (2022). “Increasing resilience and preventing suicide: training and interventions a systematic review. Sustain. Sci. Pract. Policy 14, 3324. doi: 10.3390/su14063324 with a distressed virtual human in virtual reality,” in Proceedings of the 22nd ACM International Conference on Intelligent Virtual Agents, 1–8.? Brown, T., Mann, B., Ryder, N., Subbiah, M., Kaplan, J. D., Dhariwal, P., et al. (2020). Language models are few-shot learners. Adv. Neural Inform. Process. Syst. 33, Pollak, D., Giron, J., and Friedman, D. (2023). “Inceptor: an open source tool for 1877–1901. automated creation of 3D social scenarios,” in 2023 IEEE Conference on Virtual Reality Chiu, C. C., Morency, L. P., and Marsella, S. (2015). “Predicting co-verbal gestures: a and 3D User Interfaces Abstracts and Workshops (VRW), IEEE, 474–476. deep and temporal modeling approach,” in Intelligent Virtual Agents: 15th International Riva, G., Malighetti, C., Chirico, A., Di Lernia, D., Mantovani, F., and Dakanalis, A. Conference, IVA 2015, Delft, The Netherlands, August 26-28, 2015, Proceedings 15 (2020). “Virtual reality,” in Rehabilitation Interventions in the Patient With Obesity, ed (Cham: Springer International Publishing), 152–166. P. Capodaglio (Cham: Springer International Publishing), 189–204. Ferrer-García, M., and Gutiérrez-Maldonado, J. (2012). The use of virtual reality in the study, assessment, and treatment of body image in eating disorders Wu, Z., Balloccu, S., Kumar, V., Helaoui, R., Reforgiato Recupero, D., and Riboni, and nonclinical samples: a review of the literature. Body Image 9, 1–11. D. (2023). Creation, analysis and evaluation of AnnoMI, a dataset of expert-annotated doi: 10.1016/j.bodyim.2011.10.001 counselling dialogues. Future Internet 15, 110. doi: 10.3390/fi15030110 Frontiers in Psychology 03 frontiersin.org