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      Virtual reality in the treatment of eating disorders

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          Abstract

          Over the last 25 years, virtual reality (VR) has offered innovative solutions for targeting different key symptoms of eating disorders: from craving to negative emotions, from attentional biases to body dissatisfaction. The present narrative review assesses the existing literature in these areas trying to identify their different levels of clinical evidence. Specifically, the review presents four clinical approaches based upon VR and their implications in the treatment of eating disorders: VR cue exposure, VR reference frame shifting, VR for correcting body distortions and attentional biases. In general, existing findings demonstrate the clinical value of VR. On one side, the present review suggests that two VR‐based techniques—VR exposure and reference frame shifting—have a significant research support and provide a possible advantage over traditional cognitive‐behavioural therapy (CBT) for bulimia nervosa and binge eating disorder. On the other side, two emerging VR applications—multisensory body illusions and the use of VR for the modification of attentional biases—even if supported by preliminary data still need further research.

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            Remembering the past and imagining the future: a neural model of spatial memory and imagery.

            The authors model the neural mechanisms underlying spatial cognition, integrating neuronal systems and behavioral data, and address the relationships between long-term memory, short-term memory, and imagery, and between egocentric and allocentric and visual and ideothetic representations. Long-term spatial memory is modeled as attractor dynamics within medial-temporal allocentric representations, and short-term memory is modeled as egocentric parietal representations driven by perception, retrieval, and imagery and modulated by directed attention. Both encoding and retrieval/imagery require translation between egocentric and allocentric representations, which are mediated by posterior parietal and retrosplenial areas and the use of head direction representations in Papez's circuit. Thus, the hippocampus effectively indexes information by real or imagined location, whereas Papez's circuit translates to imagery or from perception according to the direction of view. Modulation of this translation by motor efference allows spatial updating of representations, whereas prefrontal simulated motor efference allows mental exploration. The alternating temporal-parietal flows of information are organized by the theta rhythm. Simulations demonstrate the retrieval and updating of familiar spatial scenes, hemispatial neglect in memory, and the effects on hippocampal place cell firing of lesioned head direction representations and of conflicting visual and ideothetic inputs. (c) 2007 APA, all rights reserved.
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              Multisensory brain mechanisms of bodily self-consciousness.

              Recent research has linked bodily self-consciousness to the processing and integration of multisensory bodily signals in temporoparietal, premotor, posterior parietal and extrastriate cortices. Studies in which subjects receive ambiguous multisensory information about the location and appearance of their own body have shown that these brain areas reflect the conscious experience of identifying with the body (self-identification (also known as body-ownership)), the experience of where 'I' am in space (self-location) and the experience of the position from where 'I' perceive the world (first-person perspective). Along with phenomena of altered states of self-consciousness in neurological patients and electrophysiological data from non-human primates, these findings may form the basis for a neurobiological model of bodily self-consciousness.
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                Author and article information

                Contributors
                giuseppe.riva@unicatt.it
                Journal
                Clin Psychol Psychother
                Clin Psychol Psychother
                10.1002/(ISSN)1099-0879
                CPP
                Clinical Psychology & Psychotherapy
                John Wiley and Sons Inc. (Hoboken )
                1063-3995
                1099-0879
                05 June 2021
                May-Jun 2021
                : 28
                : 3 , Virtual Reality in Clinical Practice ( doiID: 10.1002/cpp.v28.3 )
                : 477-488
                Affiliations
                [ 1 ] Applied Technology for Neuro‐Psychology Lab. Istituto Auxologico Italiano Milan Italy
                [ 2 ] Humane Technology Lab. Università Cattolica del Sacro Cuore Milan Italy
                Author notes
                [*] [* ] Correspondence

                Giuseppe Riva, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy.

                Email: giuseppe.riva@ 123456unicatt.it

                Author information
                https://orcid.org/0000-0003-3657-106X
                https://orcid.org/0000-0002-1321-8784
                https://orcid.org/0000-0002-8422-1358
                Article
                CPP2622
                10.1002/cpp.2622
                8362149
                34048622
                9c10735e-434f-4081-8b14-b295e04be633
                © 2021 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.

                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
                : 07 May 2021
                : 26 January 2021
                : 21 May 2021
                Page count
                Figures: 1, Tables: 1, Pages: 12, Words: 11021
                Funding
                Funded by: Italian Ministry of Education, University and Research ‐ PRIN project (201597WTTM: Unlocking the memory of the body: Virtual Reality in Anorexia Nervosa)
                Categories
                Comprehensive Review
                Comprehensive Reviews
                Custom metadata
                2.0
                May/June 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.5 mode:remove_FC converted:13.08.2021

                Clinical Psychology & Psychiatry
                attentional biases,eating disorders,full body illusions,virtual reality,vr cue exposure,vr reference frame shifting

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