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      From avatars to body swapping: The use of virtual reality for assessing and treating body‐size distortion in individuals with anorexia

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          Abstract

          In the last 30 years, virtual reality (VR) has offered innovative solutions for assessing and treating body representation disturbances in anorexia nervosa (AN). The most recent and innovative trend is the exploitation of the so‐called VR‐based body swapping illusion. The aim of this case study was to report the use of this VR protocol within a multidisciplinary treatment of AN. A patient with a Diagnostic and Statistical Manual‐5 diagnosis of AN underwent an intensive multidisciplinary outpatient treatment. Three sessions of a VR‐based body swapping illusion (i.e., the experimental induction of being the owner of a virtual body as a result of a visuotactile stimulation) were delivered within the treatment protocol (i.e., beginning of the treatment; end of one cycle of the treatment; 1 year of follow‐up). We report the results obtained, discussing how the VR full body illusion was both able to effectively monitor changes of multisensory bodily integration and to act as a driver for these changes.

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          A Virtual Reality Full Body Illusion Improves Body Image Disturbance in Anorexia Nervosa

          Anouk Keizer, Annemarie van Elburg, Rossa Helms … (2016)
          Background Patients with anorexia nervosa (AN) have a persistent distorted experience of the size of their body. Previously we found that the Rubber Hand Illusion improves hand size estimation in this group. Here we investigated whether a Full Body Illusion (FBI) affects body size estimation of body parts more emotionally salient than the hand. In the FBI, analogue to the RHI, participants experience ownership over an entire virtual body in VR after synchronous visuo-tactile stimulation of the actual and virtual body. Methods and Results We asked participants to estimate their body size (shoulders, abdomen, hips) before the FBI was induced, directly after induction and at ~2 hour 45 minutes follow-up. The results showed that AN patients (N = 30) decrease the overestimation of their shoulders, abdomen and hips directly after the FBI was induced. This effect was strongest for estimates of circumference, and also observed in the asynchronous control condition of the illusion. Moreover, at follow-up, the improvements in body size estimation could still be observed in the AN group. Notably, the HC group (N = 29) also showed changes in body size estimation after the FBI, but the effect showed a different pattern than that of the AN group. Conclusion The results lead us to conclude that the disturbed experience of body size in AN is flexible and can be changed, even for highly emotional body parts. As such this study offers novel starting points from which new interventions for body image disturbance in AN can be developed.
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            The neuroscience of body memory: From the self through the space to the others.

            Giuseppe Riva (2017)
            Our experience of the body is not direct; rather, it is mediated by perceptual information, influenced by internal information, and recalibrated through stored implicit and explicit body representation (body memory). This paper presents an overview of the current investigations related to body memory by bringing together recent studies from neuropsychology, neuroscience, and evolutionary and cognitive psychology. To do so, in the paper, I explore the origin of representations of human body to elucidate their developmental process and, in particular, their relationship with more explicit concepts of self. First, it is suggested that our bodily experience is constructed from early development through the continuous integration of sensory and cultural data from six different representations of the body, i.e., the Sentient Body (Minimal Selfhood), the Spatial Body (Self Location), the Active Body (Agency), the Personal Body (Whole Body Ownership - Me); the Objectified Body (Objectified Self - Mine), and the Social Body (Body Satisfaction - Ideal Me). Then, it is suggested that these six representations can be combined in a coherent supramodal representation, i.e. the "body matrix", through a predictive, multisensory processing activated by central, top-down, attentional processes. From an evolutionary perspective, the main goal of the body matrix is to allow the self to protect and extend its boundaries at both the homeostatic and psychological levels. From one perspective, the self extends its boundaries (peripersonal space) through the enactment and recognition of motor schemas. From another perspective, the body matrix, by defining the boundaries of the body, also defines where the self is present, i.e., in the body that is processed by the body matrix as the most likely to be its one, and in the space surrounding it. In the paper I also introduce and discuss the concept of "embodied medicine": the use of advanced technology for altering the body matrix with the goal of improving our health and well-being.
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              Virtual Reality Body Swapping: A Tool for Modifying the Allocentric Memory of the Body.

              Silvia Serino, Elisa Pedroli, Anouk Keizer … (2016)
              An increasing amount of evidence has shown that embodiment of a virtual body via visuo-tactile stimulation can lead to an altered perception of body and object size. The current study aimed to investigate whether virtual reality (VR) body swapping can be an effective tool for modifying the enduring memory of the body. The experimental sample included 21 female participants who were asked to estimate the width and circumference of different body parts before any kind of stimulation and after two types of body swapping illusions ("synchronous visuo-tactile stimulation" and "asynchronous visuo-tactile stimulation"). Findings revealed that after participants embodied a virtual body with a skinny belly (independently of the type of visuo-tactile stimulation), there was an update of the stored representation of the body: participants reported a decrease in the ratio between estimated and actual body measures for most of the body parts considered. Based on the Allocentric Lock Theory, these findings provide first evidence that VR body swapping is able to induce a change in the memory of the body. This knowledge may be potentially useful for patients suffering from eating and weight disorders.
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                Author and article information

                Contributors
                Silvia Serino: s.serino@auxologico.it
                Journal
                Journal ID (nlm-ta): J Clin Psychol
                Journal ID (iso-abbrev): J Clin Psychol
                Journal ID (doi): 10.1002/(ISSN)1097-4679
                Journal ID (publisher-id): JCLP
                Title: Journal of Clinical Psychology
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0021-9762
                ISSN (Electronic): 1097-4679
                Publication date (Electronic): 15 December 2018
                Publication date (Print): February 2019
                Volume: 75
                Issue: 2 , Computer and Internet Based Media for Psychotherapy, Supervision, and Supervision of Supervision ( doiID: 10.1002/jclp.2019.75.issue-2 )
                Pages: 313-322
                Affiliations
                [ 1 ] Department of Psychology Università Cattolica del Sacro Cuore Milan Italy
                [ 2 ] Istituto Auxologico Italiano IRCCS Applied Technology for Neuro‐Psychology Lab Milan Italy
                [ 3 ] Istituto Auxologico Italiano, IRCCS Division of Endocrinology and Metabolism Milan Italy
                [ 4 ] Department of Clinical Sciences and Community Health University of Milan Milan Italy
                Author notes
                [*] [* ] Correspondence Silvia Serino, Istituto Auxologico Italiano IRCCS, Applied Technology for Neuro‐Psychology Lab, Via Magnasco 2, 20149 Milan, Italy. Email: s.serino@ 123456auxologico.it

                Article
                Publisher ID: JCLP22724
                DOI: 10.1002/jclp.22724
                PMC ID: 6590458
                PubMed ID: 30552669
                SO-VID: 35b9feed-24ac-41cd-aab5-905d0c8ad2f1
                Copyright © © 2018 The Authors. Journal of Clinical Psychology Published by Wiley Periodicals, Inc.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 1, Tables: 1, Pages: 10, Words: 5577
                Funding
                Funded by: MIUR
                Award ID: 201597WTTM
                Categories
                Subject: Research Article
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id jclp22724
                cover-date February 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:24.06.2019

                Keywords: anorexia nervosa,avatar,body‐size distortion,full body illusion,virtual reality
                Data availability:
                Keywords: anorexia nervosa, avatar, body‐size distortion, full body illusion, virtual reality

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