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Restaurant

Restaurant  

This environment simulates a restaurant where the patient can eat various menu options (hypocaloric/diuretic/standard/hypercaloric), alone or accompanied, as required by the situation. The healthcare professional will select the menu option the patient should be eating. In this environment, we mainly intend to work the anxiety towards certain foods, awareness on how good eating habits can prevent a subsequent purge/compensation, and not isolation during meals.

  • Exposure Therapy
    To reduce the anxiety caused by certain “forbidden” foods (usually, hypercaloric foods).
  • Exposure with Response Prevention (EPR)
    To be exposed to certain stimuli (food), which usually precede binge eating and/or compensatory behaviors (e.g., purge) with the aim of preventing the occurrence of such behaviors. The procedure consists of exposing the patient to foods that usually act as a trigger for binge eating. When the patient feels that he/she has broken the diet and wishes to vomit, we will try for him/her to focus on what his/her feelings and what he/she thinks, with the aim of being able to analyze and restructure it together with the therapist during the session. The aim is for the subject to verify he/she can control himself/herself and notice how anxiety, guilt, etc., can be reduced without the need to compensate (e.g., vomiting). These exposures can also work as behavioral tests through which the patient can test whether or not his/her irrational fears regarding the consequences of not compensating are met (e.g., put on a lot of weight, fat accumulation on a certain part of his/her body at once, etc.) (Saldaña, Tomás & Bachs, 1997).

CONFIGURATION VARIABLES

Companion
This variable will allow choosing whether the patient eats alone or accompanied and, in that case, whether the companion is male or female. This variable should be taken into account during the exposure based on whether the patient is more or less stressed when eating alone or with a companion, and whether he/she is worried when eating with a person of the same sex (e.g., because he/she tends to compare himself/herself with them) or of the opposite sex (e.g., for fear of feeling judged):

  • None: The patient appears eating alone, without any companion at his/her table and with no people on the tables surrounding him/her
  • Female: The patient eats while accompanied by another avatar (a woman). Also, there are people eating on the tables near them.
  • Male: The patient eats while accompanied by another avatar (a man). Also, there are people eating on the tables near them.

Conversation
In the case of the “Accompanied” configuration, the healthcare professional may choose the kind of conversation the patient’s companion will provide during the experience. It is important to keep in mind that this conversation will not be activated if there is no food on the table. In fact, it will not consist of a conversation per se (there will be no exchange), but only the companion will issue sentences/comments. However, the idea is to simulate a real situation in which a conversation takes place during a meal. The subject of said conversation may be:

  • None: In this option, the companion will not make any comments and will remain silent.
  • Neutral: In this modality, the companion will issue phrases regarding a neutral subject, such as the movies (going to the movies, favorite movies, upcoming releases…).
  • Bad: In this case, the companion will issue phrases related to physical appearance, food, social events where eating while with a group of people is included, etc. That is, subjects that often cause anxiety (or discomfort) to this type of patients. 

EVENTS

Choose menu
In this events, will appear the following menu options for the patient to take:

  • Hypocaloric: Menu consisting of foods with a low fat content: Water + grilled chicken breast together with a salad + natural yogurt.
  • Diuretic: Menu consisting of foods that help the elimination of liquid (urine), often eaten by people who wish to lose weight: Green tea + salad (lettuce, beet, and carrot) + Fruit (kiwi).
  • Standard: A normal diet’s menu: Water + Steamed vegetables + Omelette with tomato slices + Natural yogurt.
  • Hypercaloric: Menu including foods with higher fat content: 1 soft drink (Coca-Cola) + Hamburger with French fries + Pie.

View menu
The patient (and the companion, if also present) will have a menu in their hands with different menu options. However, the healthcare professional will be the one to choose the patient’s menu, by selecting the event described below.

The healthcare professional can make the avatar (patient) hold the menu in his/her hands for as long as he/she wants. When the healthcare professional wants the avatar to start eating, he/she must select the kind of menu to which he/she wishes to expose the patient from the “Menu” event.

Once the menu option is selected, the menu will automatically disappear and the first course of the chosen menu option will be displayed. Once the patient finishes the dish, the second course will appear (if there is one), and finally the dessert

Once the configuration/event variables have been selected and the patient has the corresponding course in front of him/her, he/she should pretend to eat the food by staring at the dish until the little circle that appears on the goggles is completed. Each time the patient stares at the dish, the avatar will ingest a portion of the food, until the food is finished (approximately, 7-10 bites). However, if the patient takes too long to perform this action, the system will automatically simulate a mouthful intake after approximately 30 seconds. The drinking action can also be activated by looking at the glass with the goggles. When finishing each course, the avatar will leave the cutlery on the plate. When the full menu is finished, the scene will return to its initial state, and the option to choose another menu will be available

In order for the healthcare professional to receive a more accurate feedback of the patient’s behavior during the experience, some signs will appear on the platform viewer notifying him/her of each time the patient ingests a portion of food, whether the patient has decided to eat it voluntarily, or if the system has automatically simulated the intake after 30 seconds, etc. The different signs (feedbacks) that will appear will be the following ones:

  • Initial state: Informs that the avatar is at the table, without the menu or the food, still in “standby mode”
  • Showing menu: Informs that the avatar (patient) is looking at the menu
  • Changing menu: A brief fade to black will be shown on the goggles at that moment, and immediately after it, the menu selected by the therapist will appear. 
  • Menu [kind of menu] – [course]: Signals the kind of menu and the specific course the avatar (patient) is eating. Example, “Hypercaloric menu-Hamburger”
  • Eating portion [number] of [number], voluntarily: Informs that the patient is currently taking a bite and what bite number it is (for example, 3 of 8 would inform the patient is eating the third bite of a total of 8 bites in which the course can be eaten), and also that he/she has voluntarily decided to eat it (it has been the patient who, using the goggles, has deliberately selected the action of eating that bite).
  • Eating portion [number] of [number], automatically: Informs that the patient is currently taking a bite and what bite number it is (for example, 3 of 8 would inform the patient is eating the third bite of a total of 8 bites in which the course can be eaten), but that the bite has not been voluntary (i.e., that 30 seconds have passed without the patient deciding to take a bite, and the system has performed the action automatically).
  • Menu [kind of menu] – Drinking: Informs that the patient has directed the goggles towards the drink to take a sip at that moment.
  • Finished course: Informs that the patient has finished the dish he/she was eating at that time.
  • Changing course: When the patient has finished a dish, a brief fade to black is shown on the goggles, and the next course of the menu will appear immediately afterwards. 
  • Menu [kind of menu] – Completed: Informs the patient has just finished eating the full menu (after eating the dessert). Example, “Hypercaloric menu – Completed”.

If the healthcare professional wants to expose the patient to the plate but not to eat it (that is, to watch the plate), it is sufficient for the patient to place the pointer of the viewer outside the plate (e.g. on the table) and, keeping your head in that position, lower your gaze to the plate (only with your eyes, otherwise you would place the pointer again on top of the food and the intake would begin).

REFERENCES

Saldaña, C., Bach, L., & Tomás, I. (1997). Técnicas de intervención en los trastornos del comportamiento alimentario – Dialnet. Aniedad y Estrés, 3(2–3), 319–337.