Embracing innovation: cognitive reappraisal for the reduction of anxiety in eating disorders, an experimental study in virtual reality

Eating disorders (EDs) frequently co-occur with heightened anxiety due to difficulties in emotion regulation. Individuals with EDs often employ maladaptive emotion regulation strategies to reduce anxiety, while underutilizing adaptive strategies. This study aimed to investigate the effectiveness of the adaptive strategy cognitive reappraisal in reducing anxiety in patients with an ED within a Virtual Reality (VR) setting. 45 individuals with an ED diagnosis were exposed to a VR restaurant. Before, during and after the scenario, self-reported and physiological anxiety were measured. Participants were randomly assigned to a cognitive reappraisal or suppression intervention. Additionally, ED psychopathology severity, emotion regulation strategies and ED subtype were investigated as possible moderators. VR effectively induced self-reported (subjective) anxiety among individuals with EDs (p < 0.001). Anxiety decreased during the scenario, with no significant difference between both interventions (p = 0.849). No moderation of emotion regulation strategies and ED subtype was found, but there appeared a trend towards individuals with severe ED psychopathology benefitting significantly more from reappraisal than suppression. Findings for physiological anxiety were non-significant. While VR effectively increased subjective anxiety, cognitive reappraisal might only be helpful for individuals with severe EDs. The study highlights the potential of integrating VR-assisted therapies in the ED field as adjuncts to exposure in emotion regulation training.