Body image disturbance is one of the most prominent clinical characteristics of eating disorders (Garner, 2002, Stice, 2002, Schwartz and Brownell, 2004 and Nye and Cash, 2006). Body image is also one of the most relevant prognostic factors in the treatment of bulimia nervosa (BN) (Fairburn et al., 1993 and Stice and Shaw, 2002) and anorexia nervosa (AN) (Thompson, 1992 and Gleaves et al., 1993). Dissatisfaction with one's body as well as body image disturbance is associated with problematic behaviors and attitudes toward food, such as lack of control over eating, adopting restrictive diets, and demonstrating bulimic symptomatology. Therefore, the persistence of body dissatisfaction after treatment of eating disorders is a reliable predictor of relapse in AN and BN patients (Shisslak and Crago, 2001, Stice, 2002 and Cash and Hrabosky, 2004). Despite the relevance of body image in eating disorder treatment, most studies fail to evaluate or treat body image (Rosen, 1996). In cases where body image is a treatment target, the effect of the treatment on patients' body image is not analyzed (Farrell et al., 2006). Psychoeducational treatment for BN, pure behavioral treatments, pharmacological treatments, interpersonal therapy, and psychodynamic therapy are ineffective in terms of global body image improvement (Cash and Grant, 1996). Some treatments for eating disorders (Thompson et al., 1996) include educational components addressing body image in BN (Fairburn, 2002) and AN (Vitousek, 2002); however the effect of these interventions on body image is unknown (Nye and Cash, 2006).
From a transdiagnostic perspective (Fairburn et al., 2003), body image intervention must prevent the maintenance of eating disorder psychopathology. Fairburn et al. (2009) enhanced Cognitive Behavioral Treatment (CBT) for eating disorders with other components addressing important aspects of these disorders including perfectionism, interpersonal problems, and self-esteem. Several studies (Rosen, 1996, Farrell et al., 2006 and Nye and Cash, 2006) suggest that interventions based on body image distortion could improve evidence-based treatments for eating disorders (NICE, 2004) However, there has been no controlled study proving the effectiveness of body image treatment in eating disorders (Nye and Cash, 2006). Hence, it would be illuminating to compare the statistical and clinical effectiveness of treatments with or without a component focused on body image (Cash and Hrabosky, 2004 and Farrell et al., 2006).
A previous study conducted by our group with participants diagnosed with eating disorders showed that treatment for body image disturbances is more effective using CBT based on VR techniques than using traditional CBT treatment alone (Perpiñá et al., 1999). Two treatment conditions were established in that study. In one condition, CBT for body image was applied in eight group sessions as well as six individual sessions with VR (Perpiñá et al., 2000), a total of 14 sessions. In the other condition, we applied CBT for body image in eight group sessions without VR as well as six relaxation sessions (which were included so that both groups had the same number of sessions) (Perpiñá et al., 1999). We found that in participants with serious eating disorders, the number of sessions was not as important as their content. Furthermore, treatment centered on body image reduced both the eating disorder psychopathology and the secondary psychopathology (depression, anxiety, negative emotions); these results persisted at the one year follow-up (Perpiñá et al., 1999). One of the limitations of that study was that the participants had undergone various eating disorder treatments prior to our intervention.
Information and Communication Technologies (ICT) are widely used as therapeutic tools in the field of neuropsychology (Rizzo et al., 1998) and also in the treatment of anxiety disorders: acrophobia (North and North, 1996), agoraphobia (North et al., 1997), spider phobia (Carlin et al., 1997), fear of public speaking (North et al., 1998), claustrophobia (Botella et al., 2000 and Botella et al., 2004) and eating disorders (Perpiñá et al., 1999 and Riva et al., 2002).
The aim of the present study is to test whether adding a component of treatment on body image in CBT for eating disorders produces a greater improvement than CBT alone. Given our previous studies (Perpiñá et al., 1999) we use VR techniques for the treatment of body image.
For the present research we carried out a controlled study with participants diagnosed with eating disorders in which we compared the CBT for eating disorders to the CBT for eating disorders plus a specific treatment component for body image using VR. Post-treatment and one year follow-up results are presented. Statistical and clinical improvement for both treatment situations are analyzed and compared.
