A new study published in the Journal of Abnormal Psychology suggests that virtual reality (VR) technology may serve as a useful intervention tool for patients with body dysmorphic disorder (BDD). A VR experience effectively revealed a bias toward negative interpretations of ambiguous social scenes among individuals with BDD.
People with body dysmorphia persistently fixate on one or more aspects of their appearance, perceiving it to be flawed. This fixation leads them to engage in compulsive behaviors to hide their appearance even though the flaw is often imagined or remains unnoticed by others.
Study authors Berta J. Summers and her team say that a key characteristic of BDD is a bias that leads sufferers to interpret ambiguous social situations as negative or threatening — for example, interpreting a neutral facial expression as angry. Scholars have studied this bias by asking individuals with BDD to interpret hypothetical ambiguous situations. But Summers and her colleagues devised an experiment to capture these processes in a more real-world setting.
The researchers designed a virtual reality experiment among a sample of 50 subjects. The participants were 25 patients with BDD and 25 individuals with no psychiatric diagnoses. While wearing a VR headset, each participant experienced 13 scenarios that contained ambiguous social cues. For example, in one scenario, a stranger does a double take at the participant and then apologizes.
Each subject was then offered two explanations for the scene — one was benign (e.g., “She thought we may have known each other”) and the other was appearance-related (e.g., “She apologized for staring at me because of how I look”). The subject rated how likely they would be to make each interpretation.
Compared to the control subjects, participants with BDD were much more likely to endorse an appearance-related explanation for the scenarios. The control group, on the other hand, selected more of the benign explanations for the scenes compared to the BDD group. When the researchers looked at within-group differences, they found that the BDD group was equally likely to interpret a scene with a threatening explanation as with a benign explanation. The control group was more likely to choose a benign explanation over a threatening one.
The subjects also completed two self-report measures that assessed their disposition toward threat biases. The overall responses followed a similar pattern as the responses to the VR scenes, with the BDD group choosing more negative interpretations of ambiguous scenarios compared to the control group. When faced with these same scenarios, the control group chose more benign interpretations. The researchers say this suggests that the VR paradigm was successful in eliciting the threat interpretation biases characteristic of BDD.
The authors note that with the dispositional assessments, the BDD group chose more threatening interpretations than benign ones. This was not the case in the VR scenarios, where the BDD group was equally likely to choose either interpretation. The researchers propose that during real-life scenarios, people with BDD are open to more than one interpretation of a scene. “Perhaps there is a brief window of opportunity in which individuals with BDD have flexibility in their thinking that is not there when they are removed either hypothetically or temporally from a situation (in which case, they may be more likely to resolve ambiguity with negative/threat-related explanations),” Summers and her team suggest.
The study participants largely rated the VR situation as acceptable, engaging, and akin to scenarios they experience in real life. Summers and her colleagues conclude that their findings suggest that VR technology may provide a realistic setting for measuring moment to moment threat interpretation biases among people with BDD.
The study, “A Virtual Reality Study of Cognitive Biases in Body Dysmorphic Disorder”, was authored by Berta J. Summers, Anna C. Schwartzberg, and Sabine Wilhelm.
