Strengths and limits
eating disorder
REMISSION
One strength of this pilot study is the repeated-measure within-subject design, assessing the subjects before and after a clinical intervention, which ameliorated eating disorder psychopathology of BED. Thus, we could have drawn precise conclusions concerning contributing factors in the development, maintenance or remission of BED and behavioural patterns in a laboratory task in the VR. Findings of a repeated measure within a person in a state of clinical relevant BED compared to ameliorated psychopathology give a deeper insight into possible underlying mechanisms than comparing it to a matched control group. Another strength of the study is the usage of VR, which allows to investigate manual interaction with food in an experimentally controlled environment. Thus, a more ecologically valid situation could be created, where patients could interact with food using their actual hands instead of the commonly used button presses on keyboards. To make effects of VR even more present and the user experience even more immersive, it might be promising to include more modalities that occur within the interaction of food, like tactile feedback and smell. This could be achieved by standardized food prepared in a teaching kitchen and different objects placed at the position of the target objects to give tactile feedback. Last, the findings of the pilot-study concerning the behavioural patterns in the manual interaction with food could be replicated, emphasizing that this newly paradigm captures two different stages. A fast, impulsive first stage, where food is recognized faster and consequently movement towards food is initiated faster, and a slower, more controlled second stage, where food is collected slower and more cautiously. In this connection, the new paradigm does not seem to be sensitive to specific symptoms of BED, as the several assessed markers were not predicted by the behavioural biases in the interaction with food. Furthermore, healthy participants showed a similar behavioural pattern in the interaction with food as the patients with BED, even if a statistical comparison between the two groups would not be reasonable due to differences in the design, programming of the task and missing demographic matching between the two groups [