Enhancing Emotion Regulation Through Arousal Modulation with Modal and Amodal Virtual Food Representations

Introduction

In our daily lives, we are constantly exposed to a variety of food-related stimuli, including images, videos, and textual content. The immediate and automatic responses individuals exhibit when confronted with such stimuli are intimately linked to bodily activation, emotional and cognitive processing, and personal autobiographical experiences.

A growing body of evidence supports the link between food choices and one’s relationship with food, including emotional states, psychophysiological (arousal and stress) and social conditions, personal lived experiences, and autobiographical events. ¹ The automatic and immediate perception of food stimuli can significantly influence the type, timing, and amount of food consumed and is often associated with less conscious, more emotionally driven, and poorly planned eating behaviors. ²

For individuals with eating disorders, research suggests that controlled exposure to food cues can help reduce the symptomatology of the disorder, such as loss of control over overeating behavior, ³ and appears to modify food-related anxiety while inducing changes in brain circuits associated with attentional processes and emotional regulation. ⁴

Virtual reality (VR) technology, when used in cue exposure, has been shown to elicit emotional activations comparable with in vivo exposure by providing a deeper sense of presence that increases with the degree of immersion and interaction within the environment. The literature demonstrates that VR serves as a valuable adjunct in the treatment of various types of eating disorders, providing immersive therapeutic interventions that effectively address symptoms and promote recovery. ⁵

By harnessing the potential of VR, individuals can cultivate a healthier relationship with food and improve their overall well-being. In light of these findings, the Arousal Modulation with Virtual Representations (AM-VR) study within the broader Arcadia VR research project ⁶ —which aims to provide support and rehabilitation for eating behavior through artificial intelligence and virtual reality–based devices—has developed a VR protocol to investigate emotional responses to food stimuli. By incorporating both modal and amodal representations of food (i.e., images and words), the AM-VR project aims to assess the effectiveness of potential interventions in managing involuntary and emotional responses to food stimuli, thereby deepening our understanding of potential VR-based therapies.

Specifically, the AM-VR project has two aims. The first goal is to test whether VR exposure to an amodal representation of food stimuli (e.g., verbal descriptions), compared with the more extensively studied modal representation (e.g., images), can elicit the same emotional response, both subjectively and objectively, in individuals with eating disorders. This comparative analysis will provide valuable insights into the differential impact of different forms of food representation on emotional arousal.

The second goal is to integrate a brief guided technique that combines mindfulness and breathing instructions designed to activate cognitive and emotional processes to manage one’s reactions and behaviors in response to food stimuli. This intervention aims to promote emotional regulation and self-awareness, enabling individuals to better manage their relationship with food. By evaluating the effectiveness of this integrated approach, the AM-VR project aims to contribute to the development of innovative and effective VR-based interventions for eating disorders.

Modal and Amodal Representations in Food Choices

The format in which food is presented can potentially influence different eating behaviors. Modal food representations, such as pictures, tend to be more effective at inducing hunger and are commonly used in food advertisements and store displays. In contrast, amodal food representations, such as verbal descriptions, are less common and typically found in specific contexts, such as restaurant menus.

Understanding the impact of modal and amodal food representations on eating attitudes is particularly important for clinical populations with dysfunctional eating behaviors. Disorders such as emotional eating, food-related craving, and binge eating may be exacerbated by the type of food representation owing to a lack of inhibitory control over food intake.

However, research examining the effects of food representation formats in both healthy and clinical populations remains limited. For example, van den Hoek Ostende et al. ⁷ found that restrained individuals showed better inhibitory control for food compared with nonfood pictorial cues, as well as better inhibitory control for modal food cues (pictures) compared with amodal food cues (words). This outcome suggests that individuals may strategically activate inhibitory control for stimuli that they perceive as more threatening to their health, such as pictures of food.

Further investigation of the effects of modal and amodal food imagery on eating attitudes and self-regulation in both healthy and clinical populations is warranted. This understanding could inform the development of targeted interventions for dysfunctional eating behaviors and contribute to the creation of healthier food environments.

Arousal and Awareness Modulation in Food Exposure

To maximize the effectiveness of exposure therapy, it is critical to combine it with additional techniques that target cognitive or emotional processes and enable individuals to more effectively manage their responses and behaviors to food stimuli.

One potential strategy to enhance food exposure therapy is the integration of relaxation techniques and mindfulness practices aimed at managing psychophysiological and emotional responses to food cues. By fostering greater awareness and control over subjective reactions and physiological arousal levels, this approach may promote a healthier relationship with food.

Promising, although inconclusive, results have emerged regarding the use of body awareness and relaxation techniques ⁸ to manage food-related behaviors. In addition, research suggests that a lower capacity for mindfulness is significantly negatively correlated with eating disorder psychopathology, with this association being particularly pronounced for binge eating, emotional/external eating, and body dissatisfaction. ⁹

The use of brief and easy-to-learn relaxation and mindfulness interventions is an area with limited evidence but considerable potential. These techniques can include instructions to modify breathing frequency and mechanics, facilitating the development of awareness of internal states such as emotions, automatic responses, sensations, and internal dialogue. In addition, these instructions can be easily understood and learned for subsequent application in real-world contexts.

Gathering further evidence on the effectiveness of these techniques are essential. The implementation of brief and easily learned techniques may open new avenues for addressing immediate and unconscious responses to food stimuli, which are particularly prevalent in eating disorders. By expanding our understanding and application of these approaches, we can contribute to the development of innovative and effective treatments for dysfunctional eating behaviors.

The AM-VR Project and the Impact of the Study

The AM-VR project aims to evaluate the efficacy of a single-session arousal management intervention incorporating breathing regulation, meditation instructions, and emotion regulation techniques in response to virtual food representations (modal or amodal) compared with a psychoeducational intervention in individuals diagnosed with eating disorders.

Participants will complete questionnaires on demographics, eating behavior symptoms, and emotional perceptions, and rate food stimuli using self-report rating scales. They will be exposed to food stimuli in both modalities, and their arousal and emotional activation response will be assessed. Participants will then be randomly assigned to one of two conditions: a relaxation and arousal management exercise or an arousal management information session.

The effectiveness of the intervention will be assessed primarily by self-perceived and subjective measures (emotional valence of food, perceived craving, and arousal) and secondarily by psychophysiological arousal (skin conductance and heart rate variability). The autobiographical meaning of food will be assessed both before and after the interventions using open-ended questions and self-report scales to measure the emotional impact and relevance of memories.

We hypothesize that:

The arousal management group will show a greater reduction in physiological arousal than the psychoeducational group.

A pilot study is currently being conducted to assess the initial efficacy of the interventions in individuals without a diagnosis of an eating disorder and to select the set of food stimuli.

In summary, the AM-VR study will examine whether a brief relaxation and mindfulness intervention can modulate arousal induced by virtual exposure to food in either a modal (i.e., image) or amodal (i.e., verbal description) format. We anticipate that the immersive VR environment will increase individuals’ sense of presence, thereby enhancing their interaction with the environment and emotional engagement, providing valuable insights into the distinctions between different representations involved in overeating behavior. Furthermore, this project could significantly contribute to the development of personalized interventions in the treatment of eating disorders.