Psychological distance affects real movements in virtual reality: distance to food in anorexia nervosa

Abstract Background Patients with restrictive Anorexia Nervosa (AN-R) severely restrict their food intake, often showing significant food avoidance behavior, especially for diet-goal threatening and high-calorie foods. Still, stringent comparisons of avoidance behaviors in relation to calorie dense foods, low-calorie food and abstract (amodal) food cues are required to better understand the underlying mechanisms. Methods Approach-avoidance behavior was measured in individuals with AN-R (n = 21) and Healthy Controls (HC; n = 19) using a virtual reality stop-signal task. In a virtual environment, participants had to reach a digitally rendered hand toward low-calorie, high-calorie and amodal (packaged) food cues, as well as nonfood cues (shoes). If a stop-sign appeared, they had to inhibit this movement (stop-trials). They also rated how much they liked and wanted each stimulus on a visual analog scale from 0 to 100. Results Participants showed more approach behavior towards amodal food cues compared to high-calorie concrete food cues (t[39] = 25.38, p <.001, d = 4.01). Furthermore, patients with AN-R reported lower wanting for high-calorie foods (t[37] = 2.13, p =.040, d = 2.13) and greater wanting for nonfood cues (t[37] = -3.35, p =.002, d = 3.35). Across groups, liking was highest for high-calorie food, both packaged (t[39] = 4.03, p =.002, d = 0.40) and unpackaged (t[39] = 3.53, p =.007, d = 0.36). Conclusions Food presentation can influence approach behavior toward food cues. Future research is needed to determine whether the use of abstract food cues can facilitate food approach behavior in individuals with AN-R.