Identifying specific cues and contexts related to bingeing behavior for the development of effective virtual environments.

BACKGROUND: Binge eating behavior constitutes a central feature of both bulimia nervosa (BN) and binge eating disorder (BED). Cue exposure therapy (CET) has been proposed as an effective intervention. OBJECTIVE: To determine which situations and specific cues trigger higher levels of binge craving and to use the results in the development of virtual reality scenarios in which CET could be applied with BN and BED patients. METHOD: Participants were 101 outpatients, 50 with BED and 51 with BN, according to DSM-5 criteria, and 63 healthy undergraduate students who completed a self-administered questionnaire to assess binge craving. RESULTS: The likelihood of binge craving in the clinical group was greater when alone at home, during the afternoon/early evening and in the late evening/at night, at weekends, and at dinner time or between meals. Higher levels of craving were produced in the kitchen, bedroom, dining room, and bakery situations. With regard to the specific cues reported, the presence of and access to high calorie food and snacks was the most commonly reported cue. Although some gender differences regarding triggering factors were obtained, no statistical differences were observed between ED subtypes. BN and BED patients showed significantly higher levels of binge craving than controls in all the contexts except when feeling positive affect; in this situation, levels of craving were low in both groups. CONCLUSIONS: This information regarding trigger contexts and specific cues can be used to create valid and reliable virtual environments for CET. Indeed, the data from this study may serve to develop a wide range of situations with different levels of binge craving, in which the therapeutic aim is to extinguish conditioned responses and facilitate the generalization of craving extinction.

[Cross-cultural adaptation of the Eating Disorder Examination into Spanish]. / Adaptación transcultural al castellano de la Eating Disorder Examination.

BACKGROUND AND OBJECTIVE: This study presents a cross-cultural adaptation into Spanish of the Eating Disorder Examination (EDE) by Fairburn and Cooper (1993). MATERIAL AND METHOD: The original English version was adapted by means of a complex successive translation-backtranslation procedure. The final Spanish version was then applied to 50 patients with eating disorders (17 diagnosed for anorexia nervosa, 19 for bulimia nervosa, and 14 for binge eating disorder) and to 30 normal control subjects. RESULTS: The means and standard deviations of the group in the 4 subscales were similar to the data obtained by the normative studies of the original English version. The Spanish version also showed similarly high Cronbach alpha coefficients for reliability. As for discriminative validity, the subscales discriminated significantly between the clinical groups and the control group. CONCLUSIONS: The Spanish version of the EDE presents adequate psychometric properties, similar to the original version.

Development of a VR Application for Binge Eating Treatment: Identification of Contexts and Cues Related to Bingeing Behavior in Spanish Italian Patients.

The objective of this study was to identify frequent situations and specific cues that produce the craving to binge in Spanish and Italian samples of patients with eating disorders (ED). There were two main aims: to assess transcultural differences in the contexts and cues that elicit food craving; and to develop valid, reliable VR environments for effective cue-exposure therapy (CET) for patients from both countries. Twenty-six Spanish and 75 Italian ED patients completed an ad hoc questionnaire to assess contexts and cues that trigger the craving to binge. No differences between groups were found. All patients reported experiencing higher levels of craving in the afternoon/early evening and in the late evening/night, between meals, when alone, and more frequently at the end of the week. Being in the dining room, the kitchen, the bedroom, the bakery and the supermarket were the specific situations that produced the highest levels of craving to binge. We used the questionnaire results to develop a virtual reality application for CET.