# Innovative Approaches to Eating Disorders Treatment:
## 4 Discussion
### Limitations  
A common limitation in most of the studies is the lack of follow-up to verify whether the improvements are maintained over time or if more sessions are needed to consolidate learning. EDs have a significant impact on both the physical and mental health of patientsand can even lead to death [9]. Ensuring the long-term maintenance of the benefits observed in studies could help reduce these negative effects and decrease the likelihood of relapse.  
Another limitation is the lack of standardized software or protocols for the application of VR techniques. Each study uses its own software and protocol, making it difficult to compare them and to determine whether the results achieved are influenced by specific characteristics of the tools used, the capability of the software to induce a sense of presence, or if the use of certain devices interferes with the correct application of VR techniques. It would be advisable for researchers to consider offering their software for commercial use with appropriate validity measures and standardized protocols to promote more replicable research.  
Another limitation in various studies is the small sample size. Obtaining large samples in ED research is challenging, especially when focusing on a specific ED or attempting to include a significant number of men to increase sample diversity and, consequently, the generalizability of results. Strict eligibility criteria and participant dropouts often reduce the number of eligible participants, as seen in multiple studies in this review [30; 34]. However, it is necessary to make efforts to increase sample sizes in experiments to ensure robust conclusions.  
Linked to this limitation, some studies include both men and women in their samples but do not explore gender differences, likely due to the low number of men. This is important because, although EDs are more prevalent in women [7], men also suffer from them. Many studies focus on women for this reason, and because it is easier to obtain significant samples of women. However, other studies indicate that ICT is more effective in men than in women [39]. Future research with sufficient samples of both men and women is needed to explore possible gender differences in VR interventions. The absence of a control group not enrolled in VR interventions is another gap in many of the studies analyzed. While the studies demonstrate effectiveness compared to pre-intervention measurements, they do not provide evidence regarding whether VR interventions are more effective than non-VR interventions. Further research is also needed on the use of VR for treating BN, as the results are scarce.  
It is also important to consider the limitations of the present systematic review. The criterion of including only research written in English and Spanish limited the range of the search. Articles that could potentially be included in this review but are not written in these languages may have been excluded. Additionally, the effectiveness of these interventions can be influenced by session and sample length, participant engagement, and the heterogeneity of techniques and measures used. These differences make general conclusions more difficult to apply and sometimes they focus on particular cases.