Award Title: Using the Person-Based Approach to design novel Virtual Reality treatments for eating disorders
Funder: Department of Health and Social Care

Abstract: Research Question: Can novel Virtual Reality treatments be developed for eating disorders, and are such treatments acceptable to young people with ED? A person-based approach Background: Eating disorders are serious mental illnesses with significant associated mortality and morbidity. Most eating disorders begin during adolescence, and they affect 1 in 20 adolescent girls and 1 in 50 adolescent boys. Rates of hospital admission with an eating disorder have more than doubled since 2016. However existing treatments do not work for as many as half of those with an eating disorder, and people often relapse following treatment, particularly if they have residual symptoms of dissatisfaction with their weight and shape.Aims and objectives: The overarching aim is to use the Person-Based Approach to co-design a suite of novel Virtual Reality interventions for use alongside the usual treatment of 14-25-year-olds with eating disorders for whom an overvaluation of shape and weight is a key part of their illness(Anorexia Nervosa, Bulimia Nervosa, and the related Other Specified Feeding and Eating Disorders). As part of the Fellowship, I will then design a study protocol and apply for funding for a feasibility trial of their use. Ultimately, the aim is to test effectiveness of the intervention in real-world settings, and working alongside experienced therapists will ensure that the resulting interventions will be appropriate for use within the NHS.Specific Objectives:	Use the Person-Based Approach to co-develop the following interventions within Virtual Reality: 	a graded-exposure scenarioto practice a challenging real-life situation, of ordering in a caf. 	a gamified attentional re-training taskto train attention away from underweight bodies. 	an intervention to explore inhabiting and viewing different versions of one's body in Virtual Reality, to address the overvaluation of shape and weight. 	Bring together the most successful aspects of Objectives 1(i) to 1(iii) into a single novel intervention and test its acceptabilityin a separate group. 	Design a study protocol and apply for further funding for a feasibility studyof this novel treatment.Methods: I will use the Person-Based Approach (a methodology developed by my research mentor Prof Yardley) to enable the existing evidence base to be combined with qualitative work with people with lived experience. The iterativeintervention design and optimisation process that is central to the Person-Based Approach will ensure that the resulting interventions are engaging and acceptable for people with eating disorders, as well as drawing on the existing evidence base.Timelines for delivery: The process of iterative co-design is necessary but time-intensive, and I envisage that Objectives 1(i, ii and iii) will be complete around 3.5 years into the project. Objective 2 will draw the most successful elements together over the following year. The final six months will be spent applying for funding and IRAS to conduct a feasibility study. Anticipated impact and dissemination: This work will result in a novel intervention as an adjunctive treatment for eating disorders which has potential for a significant positive impact on patients. It will be widely disseminated including via peer-reviewed literature, conferences social media and via charity collaborators.

Lay Abstract: Eating disorders are serious mental illnesses which have significant consequences, including on physical health. Having an eating disorder increases the risk of early death between two to six times. Eating disorders affect over 1 in 20 adolescent girls, and almost 1 in 50 adolescent boys. Rates of admission to hospital with an eating disorder have more than doubled since 2016. Current treatments work for under half those affected, and many people relapse. Feeling unhappy with one's body is associated with being less likely to recover, and more likely to relapse with an eating disorder.This project will develop novel treatments using Virtual Reality (VR), for eating disorders where diagnosis includes a 'disturbance of the way in which body weight or shape is experienced', or 'undue influence of body weight or shape on self-evaluation' - that is, Bulimia Nervosa, Anorexia Nervosa, and other similar eating disorders. The project will use the 'Person-Based Approach' to design and optimise three novel VR-based treatments for eating disorders. This method combines existing research evidence with qualitative feedback from people with personal experience of an eating disorder. Results are used to design novel interventions, which will then be tried by a new group of people with an eating disorder. This group will be recorded whilst they 'think aloud' during their experience of the new interventions, and during detailed qualitative interviews. Their feedback will be used to refine the interventions. The final stage will involve a third group of people with eating disorders trying and giving feedback on the VR intervention as a further check of its acceptability and potential usefulness. I will collaborate with a VR company whose previous work has involved developing software that enables people to experience what it might be like to have a different-sized body, and to view their own body from an external perspective, and they will programme the novel VR interventions.The novel VR-based treatments will address different aspects of eating disorders, selected on the basis of the existing evidence and the views of PPI groups conducted as part of the preparatory work for this application. Three treatments will be developed:	A caf environment -h; this will enable people with an eating disorder to practice a situation that many find challenging, of visiting a caf; they will be able to work through increasing levels of difficulty. 	An attention-retraining game -h; this will aim to shift attention away from smaller bodies, at which eye tracking studies suggest people with eating disorders spend more time looking. 	Experiencing different bodies -h; this will enable people to have the experience of being in a different-sized body (1stperson perspective), of viewing their own body from the outside (3rdperson perspective), or of being in an abstract representation of a body. Following the design of these three treatments, the next stage will be to combine the most successful elements. This process will also use the Person-based Approach to make sure the final treatment is as accessible and engaging as possible for people with an eating disorder. The final stage of the project will be to apply for NHS ethics and further funding to enable me to test the feasibility of using the final intervention alongside existing ED treatments in the NHS. Throughout the project, the PPI group will support the design of study materials, the interpretation of results, and the dissemination of findings. The project is also supported by a group of clinician experts, by parents and carers of people with eating disorders, and by the eating disorders charity, Beat.

Research Activity Codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health Categories: MENTAL HEALTH