Design and Usability of Immersive VR for Eating Disorders: Evidence from the ARCADIA-EVE Protocol

Immersive Virtual Reality (VR) enables the creation of ecologically valid environments that can reliably elicit affective and behavioral responses, making it a promising medium for clinical interventions. Within the ARCADIA project, the Enhanced Food Exposure (EVE) protocol leverages VR cue exposure to target craving, emotional dysregulation, and context-specific triggers central to eating disorders. Building on traditional cue exposure therapy, EVE integrates real-time physiological monitoring, emotion-regulation strategies, and naturalistic hand-tracking interactions to enhance ecological fidelity and therapeutic engagement. This pilot study evaluated usability, realism, and tolerability of the VR tool through a dual-perspective approach involving a patient with bulimia nervosa and an eating disorder specialist. Both participants reported moderate-to-high presence and realism, minimal cybersickness, and excellent usability (SUS scores: 95.0 and 87.5). Qualitative accounts underscored the emotional salience of specific foods and contexts, confirming the tool’s ability to evoke authentic craving responses. At the same time, both users identified refinements to improve ecological validity, such as enhanced food models, smoother object manipulation, and simplified rating scales. The findings support the feasibility and face validity of the EVE scenario as a clinically relevant addition. By demonstrating comfort, intuitiveness, and credibility of the exposure scenarios, this work establishes essential human-factor criteria to advance toward controlled trials. More broadly, it demonstrates how VR can combine ecological realism and therapeutic precision to strengthen exposure-based treatments for complex eating disorders.