Patients’ experiences of virtual food exposure: a qualitative study of individual semi-structured interviews

Abstract Background People with anorexia nervosa (AN) experience negative emotions around eating. Repeated exposure to food might help patients to learn regulating these emotions in a helpful way. In recent years, virtual reality (VR) has gained momentum to facilitate exposure to feared stimuli in a practical and scalable way. In this qualitative study, patients with AN were exposed to a VR scenario consisting of a kitchen storing threatening foods. Some participants were exposed to elements to enhance inhibitory learning of food-related anxiety and avoidance (i.e., a virtual pet to induce positive mood and an avatar speaking a motivational message). Participants’ experience in the virtual environment was documented to establish the feasibility and acceptability of this method. Methods Participants ( N = 71) completed a single exposure session following randomisation to one of the three different scenarios: (1) a virtual kitchen only ( n = 24), (2) a virtual kitchen plus a virtual pet aimed at inducing positive mood ( n = 25), or (3) a virtual kitchen plus an avatar speaking a motivational message ( n = 22). Following exposure, participants provided feedback about their experience of the VR scenario in semi-structured interviews. Data were transcribed verbatim and thematic analysis was used to identify common themes. Results Four major themes were identified: (1) VR as a credible and useful tool to explore and change food-related difficulties, (2) The opportunity for personalisation, (3) Acceptability of the avatar and motivational message for social support and (4) Acceptability of the pet. Some sub-themes were also described. Conclusions Participants welcomed the use of a virtual kitchen incorporating psychological techniques to address food-related anxiety and avoidance; the environment elicited a sense of safety and tolerable levels of anxiety. They were generally enthusiastic about the use of the pet to induce positive mood and were in favour of adding social support. Participants made several suggestions to adapt and personalise the experience of the virtual kitchen, based on personal needs, preferences and stage of the illness. Trial registration (REC Number) 18/NW/0853.