Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Novel interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient University eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients enrolled; nine (82%) completed treatment; 82% (9/11) provided follow-up data 7.1 (SD=2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < .001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of efficacy. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

Emotional eating (EE) can be understood as a manifestation of difficulties with emotion regulation (ER) among individuals with eating disorders. Existing interventions do not always successfully treat EE. We developed a novel ER intervention based upon virtual reality to improve EE among adults with an eating disorder diagnosis. The design pivoted to non-immersive virtual delivery to increase access, particularly given heightened demand during COVID-19 for EE treatment. The study aimed to investigate the feasibility, acceptability, and preliminary signals of effectiveness of this novel ER protocol that utilized evidence-based strategies such as mindfulness and imagery rescripting as well as innovative techniques such as virtual reality. Twenty-one adults with a history of an eating disorder diagnosis and self-reported EE were recruited from the Adult Eating Disorders Program within Stanford University to receive seven weekly one-hour virtual experiences (VE) focusing on ER. Participants chose between the novel VE-Emotion Regulation (VE-ER) intervention or continuing with their current treatment as usual. Before and after the seven sessions, participants completed an assessment by filling out online questionnaires. Overall, VE-ER treatment was feasible (100% completion), and participant and therapist acceptability of VE-ER treatment was fairly high. In terms of preliminary effectiveness, the results showed a significant reduction in the frequencies of disordered eating behaviors in both groups, but a greater improvement in EE in the VE-ER group. The VE-ER group also had a significant reduction in emotion dysregulation after the treatment.