Transcranial Magnetic Stimulation Meets Virtual Reality: The Potential of Integrating Brain Stimulation With a Simulative Technology for Food Addiction

Abstract

The aim of this perspective is to propose and discuss the integration of transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex with virtual reality (VR) food exposure for therapeutic interventions for food addiction. "Food addiction" is a dysfunctional eating pattern which is typically observed in eating disorders (ED) such as bulimia nervosa and binge eating disorder. Food addiction has been compared to substance use disorder due to the necessity of consuming a substance (food) and the presence of a dependence behavior. In recent years, VR has been applied in the treatment of ED because it triggers psychological and physiological responses through food exposure in place of real stimuli. Virtual reality-Cue exposure therapy has been proven as a valid technique for regulating anxiety and food craving in ED. More, TMS has been proven to modulate circuits and networks implicated in neuropsychiatric disorders and is effective in treating addiction such as nicotine craving and consumption and cocaine use disorder. The combination of a simulative technology and a neurostimulation would presumably provide better improvement compared to a single intervention because it implies the presence of both cognitive and neuropsychological techniques. The possible advantage of this approach will be discussed in the perspective.

Keywords: TMS; craving; exposure therapy; food addiction; virtual reality.

FIGURE 1

The CAVE is a 3-D immersive four-walled room in which the 3D visualization of the virtual scenario occurs through four stereoscopic projectors. There are three retro-projected screens (frontal, right, and left screens) and a direct-projection screen (floor screen). Four infrared cameras allow to monitor any movements that are made from the 3-D glasses. The depth information is encoded in the virtual scene of the CAVE and is restored and conveyed to the eyes by using the 3-D glasses. The user feels like he is moving around the object 360° thanks to different images and angles. As the user’s head moves, the image rotates with it, almost in real-time. This technology guarantees a real life-like experience.