The aim of this study is to evaluate the feasibility and preliminary effects of PrevED MR, a group-based preventive intervention for adolescents and young adults at risk of developing eating disorders. PrevED MR is based on dialectical behavior therapy skills and uses mixed reality and virtual reality activities to support emotion regulation, mindfulness, distress tolerance, and body-related acceptance.
Participants will be randomly assigned to either the PrevED MR intervention group or a waiting-list control group. The intervention will be delivered over 6 weeks, with two sessions per week, for a total of 12 sessions. Assessments will be conducted at baseline and after the intervention to examine changes in eating disorder symptoms, body image acceptance, emotion regulation strategies, rumination, usability, sense of presence, cybersickness, satisfaction, and adherence.
Adolescents and young adults aged 13 to 35 years.
Spanish-speaking participants who are able to understand the study procedures and complete the assessment instruments.
Students recruited from participating schools, universities, or related recruitment settings.
Participants at mid-to-high risk of developing eating disorders, as assessed by the Eating Attitudes Test-26 (EAT-26) and selected subscales of the Eating Disorder Inventory-3 (EDI-3).
Current or past self-reported diagnosis of an eating disorder.
Current severe psychiatric symptoms or diagnosis that could interfere with participation, including suicidal, manic, or psychotic symptoms.
Severe neurodevelopmental disorder, intellectual disability, or other cognitive impairment that could interfere with understanding or completing the study procedures.
Physical, motor, or sensory impairment that could interfere with the assessment procedures or the use of the mixed/virtual reality intervention.
Parallel
PrevED MR Intervention
BehavioralPrevED MR is a 6-week group-based preventive intervention for adolescents and young adults at risk of developing eating disorders. The program includes 12 face-to-face group sessions delivered twice weekly and combines psychoeducation, paper-based exercises, group activities, and guided mixed/virtual reality experiences. The intervention is based on dialectical behavior therapy skills and targets mindfulness, emotion identification, emotion regulation, distress tolerance, acceptance, and non-judgmental body-related exposure.
Change in Eating Disorder Symptoms
Eating disorder symptoms will be assessed using the Eating Attitudes Test-26 and selected subscales of the Eating Disorder Inventory-3. The Eating Attitudes Test-26 total score includes 26 items scored from 0 to 3, with a total score ranging from 0 to 78; higher scores indicate greater eating disorder symptomatology. The Eating Disorder Inventory-3 Drive for Thinness subscale includes 7 items scored from 0 to 5, with a total score ranging from 0 to 35; higher scores indicate a stronger drive for thinness. The Eating Disorder Inventory-3 Body Dissatisfaction subscale includes 10 items scored from 0 to 5, with a total score ranging from 0 to 50; higher scores indicate greater body dissatisfaction. A reduction in scores from baseline to post-intervention indicates improvement.
Change in Body Image Acceptance
Body image acceptance and body image-related psychological flexibility will be assessed using the Body Image Acceptance and Action Questionnaire. The questionnaire includes 12 items scored from 1 to 7, with a total score ranging from 12 to 84. Higher scores indicate greater body image-related psychological inflexibility and lower body image acceptance. Therefore, a reduction in scores from baseline to post-intervention indicates improvement.
Change in Emotion Regulation Strategies
Emotion regulation strategies will be assessed using the Emotion Regulation Questionnaire. The questionnaire includes 10 items scored from 1 to 7, with higher item scores indicating greater agreement with each statement. The Cognitive Reappraisal subscale includes 6 items and ranges from 6 to 42; higher scores indicate greater use of cognitive reappraisal. The Expressive Suppression subscale includes 4 items and ranges from 4 to 28; higher scores indicate greater use of expressive suppression. Higher cognitive reappraisal scores are generally interpreted as a more adaptive emotion regulation strategy, whereas higher expressive suppression scores are generally interpreted as a less adaptive emotion regulation strategy.
Change in Rumination and Worry
Rumination and worry-related repetitive negative thinking will be assessed using the Penn State Worry Questionnaire. The questionnaire includes 16 items assessing the tendency to worry, using response options ranging from 1 to 5. The total score ranges from 16 to 80, with higher scores indicating higher levels of worry and repetitive negative thinking. Therefore, a reduction in scores from baseline to post-intervention indicates improvement.
System Usability
The System Usability Scale (SUS) is a widely used 10-item self-report questionnaire designed to assess perceived usability of a system, product, or technology. Items are rated on a 5-point Likert scale from 1 (Strongly Disagree) to 5 (Strongly Agree), with scores converted to a 0-100 scale. Higher scores indicate better perceived usability.
Cybersickness Symptoms
The Simulator Sickness Questionnaire (SSQ) is a self-report instrument designed to assess symptoms of motion sickness or discomfort experienced during or after virtual reality exposure. The SSQ consists of 16 items grouped into three subscales: Nausea, Oculomotor, and Disorientation. Participants rate the severity of each symptom on a 4-point Likert scale: 0 (None), 1 (Slight), 2 (Moderate), 3 (Severe). Total and subscale scores are calculated according to standardized formulas, with higher scores indicating greater severity of simulator-induced discomfort.
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Universitat Internacional de Catalunya
Lead sponsor
Ministerio de Ciencia e Innovación, Spain
Collaborator
