ABSTRACT
Anorexia nervosa (AN) is a severe psychiatric disorder characterized by intense fear of gaining weight and persistent body image disturbance. Virtual reality–based mirror exposure therapy (VR-MET) may reduce body-related fear through embodied exposure, while attentional bias modification training (ABMT) may enhance exposure learning by promoting balanced attentional allocation. This controlled clinical study tested the hypothesis that adjunctive VR-MET would improve clinical outcomes beyond treatment as usual (TAU) alone, and that preceding VR-MET with ABMT would produce additional benefits in adolescent females with AN. Seventy-five female adolescents with AN were allocated to TAU, TAU+VR-MET or TAU+ABMT+VR-MET. Assessments were conducted pre- and post-intervention. Outcomes included eye-tracking indices of attentional bias (number of fixations, complete fixation time), state anxiety and fear of gaining weight, BMI and eating disorder–related measures. Compared with TAU alone, both VR-based conditions showed greater reductions in state anxiety and fear of gaining weight. State body dissatisfaction decreased significantly only in the TAU+VR-MET group. No significant changes were observed for BMI or most trait-level eating disorder measures. ABMT did not enhance clinical outcomes beyond VR-MET. Within the short-term assessment window, adjunctive VR-MET was associated with reductions in state-dependent emotional responses in adolescents with AN. Effects on trait-level symptoms were limited, and ABMT did not confer additional benefit in this unselected sample. Fully randomized studies with larger samples, extended exposure protocols, and follow-up assessments are needed to determine durability and broader clinical impact.