# Attentional Bias Modification Training in Virtual Reality: Evaluation of User Experience
## 1 Introduction  
Virtual reality (VR) has emerged as a transformative technology, offering an immersive three-dimensional environment for diverse applications, including education, training, and psychological therapies [1]. Its integration into psychological treatment has not only eliminated physical limitations to treat a wide range of psychological disorders but has also allowed for the introduction of new techniques and expanded the treatment capacity of existing ones [2, 3]. Notably, within this realm, VR has exhibited promising results in addressing eating disorders by enhancing diagnostic accuracy, creating a better relationship between food and its emotional reactions, and modifying body-related experiences [4].  
Research has shown that individuals with anorexia nervosa often focus their attention on the more distressing aspects of their bodies [5]. This habitual attentional bias is consistently linked to disruptions in body image and is believed to contribute to intensifying negative emotions related to body image and the adoption of unhealthy behaviors aimed at altering body shape and weight, which are commonly observed in eating disorders [5]. Furthermore, this attentional bias might be amplified during mirror exposure therapy. Some studies indicate that prolonged mirror gazing could lead to distorted thinking andan exaggerated emphasis on perceived flaws [6], potentially undermining the effectiveness of mirror exposure therapies in certain cases. To reduce this attentional bias, several studies have effectively applied attentional bias modification training (ABMT) involving food-related cues, which reduced the attentional bias towards high-calorie food and, consequently, decreased its consumption in patients with binge eating disorders [7; 8]. Other studies have used ABMT to diminish the attentional bias toward negative words associated with body image [9], which could potentially increase dissatisfaction and dietary restrictions [10]. Moreover, exposure to images of participants' body parts improved their body satisfaction if those body parts were considered attractive and enhanced their body dissatisfaction if they were considered unattractive [11]. In more recent studies, ABMT procedures have incorporated VR techniques involving avatars mirroring participants' silhouettes. These methods have been applied to both healthy individuals [12] and patients diagnosed with anorexia nervosa [13]. They resulted in a decrease in attentional bias towards body parts associated with weight in both healthy individuals and patients, and reduced body dissatisfaction in those with anorexia nervosa.  
Using VR in ABMT allows for the modification of attentional biases in a more realistic setting, resembling environments closer to real-life scenarios than traditional laboratory or doctor's office setups. However, implementing VR in this kind of training requires user-friendly hardware and software to avoid creating additional barriers during treatment. Studies have shown that poor usability of software is linked to a reduced willingness to use it [14; 15]. Specifically, in ABMT, participants may find these tasks monotonous and repetitive, potentially leading to dropout from treatment [16; 17]. Discomfort and fatigue from extended use of VR glasses pose another challenge, potentially disrupting ongoing treatment [18]. Additionally, attitudes toward technology play a role in its acceptance [15]. The negative impact of any of these factors can hinder the progress of therapy, diminishing its effectiveness.  
The current study aimed to assess various aspects of an ABMT task conducted in VR, like its usability as well as participants' anxiety, fatigue, negative attitudes towards technology, and other factors. These elements could potentially impact how effective this training is for patients with eating disorders.