title: Identifying specific cues and contexts related to bingeing behavior for the development of effective virtual environments.
abstract: BACKGROUND
  Binge eating behavior constitutes a central feature of both bulimia nervosa (BN) and binge eating disorder (BED). Cue exposure therapy (CET) has been proposed as an effective intervention.
  
  
  OBJECTIVE
  To determine which situations and specific cues trigger higher levels of binge craving and to use the results in the development of virtual reality scenarios in which CET could be applied with BN and BED patients.
  
  
  METHODS
  Participants were 101 outpatients, 50 with BED and 51 with BN, according to DSM-5 criteria, and 63 healthy undergraduate students who completed a self-administered questionnaire to assess binge craving.
  
  
  RESULTS
  The likelihood of binge craving in the clinical group was greater when alone at home, during the afternoon/early evening and in the late evening/at night, at weekends, and at dinner time or between meals. Higher levels of craving were produced in the kitchen, bedroom, dining room, and bakery situations. With regard to the specific cues reported, the presence of and access to high calorie food and snacks was the most commonly reported cue. Although some gender differences regarding triggering factors were obtained, no statistical differences were observed between ED subtypes. BN and BED patients showed significantly higher levels of binge craving than controls in all the contexts except when feeling positive affect; in this situation, levels of craving were low in both groups.
  
  
  CONCLUSIONS
  This information regarding trigger contexts and specific cues can be used to create valid and reliable virtual environments for CET. Indeed, the data from this study may serve to develop a wide range of situations with different levels of binge craving, in which the therapeutic aim is to extinguish conditioned responses and facilitate the generalization of craving extinction.
authors.affiliation: Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Spain.
authors.forename: Joana
authors.initials: J
authors.lastname: Pla-Sanjuanelo
authors.affiliation: Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Ferrer-García
authors.affiliation: Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Spain. Electronic address: jgutierrezm@ub.edu.
authors.forename: José
authors.initials: J
authors.lastname: Gutiérrez-Maldonado
authors.affiliation: ICE-NET Lab, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Riva
authors.affiliation: Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain.
authors.forename: Alexis
authors.initials: A
authors.lastname: Andreu-Gracia
authors.affiliation: Department of Brain and Behavioural Sciences, University of Pavia, Italy.
authors.forename: Antonios
authors.initials: A
authors.lastname: Dakanalis
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), and Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Aranda
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Forcano
authors.affiliation: Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Ribas-Sabaté
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Nadine
authors.initials: N
authors.lastname: Riesco
authors.affiliation: Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Rus-Calafell
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sánchez
authors.affiliation: Department of Psychiatry, Hospital Germans Tries i Pujol, Barcelona, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: Sanchez-Planell
mesh_terms: D000293:Adolescent; D000328:Adult; D016739:Behavior, Addictive / Q000523:psychology / Q000628:therapy; D056912:Binge-Eating Disorder / Q000523:psychology* / Q000628:therapy; D002032:Bulimia / Q000523:psychology* / Q000628:therapy; D052018:Bulimia Nervosa / Q000523:psychology* / Q000628:therapy; D003198:Computer Simulation; D066249:Craving; D003463:Cues; D004644:Emotions; D004777:Environment; D005108:Extinction, Psychological; D005247:Feeding Behavior; D005260:Female; D005502:Food; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014584:User-Computer Interface; D055815:Young Adult
keywords: Binge eating; Clinical sample; Cue exposure; Food craving; Virtual reality