***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT The Consoli date d St and ards for Reporting of Trials ( CONSORT ) statement was developed to help improve the quality of reports of r and omized controlled trials ( RCTs ) . To date , a paucity of data exists regarding whether it has achieved this goal . OBJECTIVE To determine whether use of the CONSORT statement is associated with improvement in the quality of reports of RCTs . DESIGN AND SETTING Comparative before- and -after evaluation in which reports of RCTs published in 1994 ( pre-CONSORT ) were compared with RCT reports from the same journals published in 1998 ( post-CONSORT ) . We included 211 reports from BMJ , JAMA , and The Lancet ( journals that adopted CONSORT ) as well as The New Engl and Journal of Medicine ( a journal that did not adopt CONSORT and was used as a comparator ) . MAIN OUTCOME MEASURES Number of CONSORT items included in a report , frequency of unclear reporting of allocation concealment , and overall trial quality score based on the Jadad scale , a 5-point quality assessment instrument . RESULTS Compared with 1994 , the number of CONSORT checklist items in reports of RCTs increased in all 4 journals in 1998 , and this increase was statistically significant for the 3 adopter journals ( pre-CONSORT , 23.4 ; mean change , 3.7 ; 95 % confidence interval [ CI ] , 2.1 - 5.3 ) . The frequency of unclear reporting of allocation concealment decreased for each of the 4 journals , and this change was statistically significant for adopters ( pre-CONSORT , 61 % ; mean change , -22 % ; 95 % CI , -38 % to -6 % ) . Similarly , 3 of the 4 journals showed an improvement in the quality score for reports of RCTs , and this increase was statistically significant for adopter journals overall ( pre-CONSORT , 2.7 ; mean change , 0.4 ; 95 % CI , 0.1 - 0.8 ) . CONCLUSION Use of the CONSORT statement is associated with improvements in the quality of reports of RCTs Background Recent research identifies unhealthful weight-control behaviors ( fasting , vomiting , or laxative abuse ) induced by a negative experience of the body , as the common antecedents of both obesity and eating disorders . In particular , according to the allocentric lock hypothesis , individuals with obesity may be locked to an allocentric ( observer view ) negative memory of the body that is no longer up date d by contrasting egocentric representations driven by perception . In other words , these patients may be locked to an allocentric negative representation of their body that their sensory inputs are no longer able to up date even after a dem and ing diet and a significant weight loss . Objective To test the brief and long-term clinical efficacy of an enhanced cognitive-behavioral therapy including a virtual reality protocol aim ed at unlocking the negative memory of the body ( ECT ) in morbidly obese patients with binge eating disorders ( BED ) compared with st and ard cognitive behavior therapy ( CBT ) and an inpatient multimodal treatment ( IP ) on weight loss , weight loss maintenance , BED remission , and body satisfaction improvement , including psychonutritional groups , a low-calorie diet ( 1200 kcal/day ) , and physical training . Methods 90 obese ( BMI > 40 ) female patients with BED upon referral to an obesity rehabilitation center were r and omly assigned to conditions ( 31 to ECT , 30 to CBT , and 29 to IP ) . Before treatment completion , 24 patients discharged themselves from hospital ( 4 in ECT , 10 in CBT , and 10 in IP ) . The remaining 66 in patients received either 15 sessions of ECT , 15 sessions of CBT , or no additional treatment over a 5-week usual care inpatient regimen ( IP ) . ECT and CBT treatments were administered by 3 licensed psychotherapists , and patients were blinded to conditions . At start , upon completion of the inpatient treatment , and at 1-year follow-up , patients ' weight , number of binge eating episodes during the previous month , and body satisfaction were assessed by self-report question naires and compared across conditions . 22 patients who received all sessions did not provide follow-up data ( 9 in ECT , 6 in CBT , and 7 in IP ) . Results Only ECT was effective at improving weight loss at 1-year follow-up . Conversely , control participants regained on average most of the weight they had lost during the inpatient program . Binge eating episodes decreased to zero during the inpatient program but were reported again in all the three groups at 1-year follow-up . However , a substantial regain was observed only in the group who received the inpatient program alone , while both ECT and CBT were successful in maintaining a low rate of monthly binge eating episodes . Conclusions Despite study limitations , findings support the hypothesis that the integration of a VR-based treatment , aim ed at both unlocking the negative memory of the body and at modifying its behavioral and emotional correlates , may improve the long-term outcome of a treatment for obese BED patients . As expected , the VR-based treatment , in comparison with the st and ard CBT approach , was able to better prevent weight regain but not to better manage binge eating episodes . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 59019572 ; http://www.controlled-trials.com/IS RCT N59019572 ( Archived by WebCite at http://www.webcitation.org/6GxHxAR2 G Body image ( BI ) disturbances are considered to be central in eating disorders ( ED ) psychopathology . There are few studies focused on the treatment of BI disturbances in ED , and most of them have used " traditional methods . " The purpose of the present study was to probe the effectiveness of one specific component in the assessment and treatment of BI in ED by means of virtual reality ( VR ) . Two treatment conditions were applied : ( a ) The St and ard Body Image Treatment Condition ( SBIT ) and ( b ) the VR Condition .  Thirteen eating disordered patients were r and omly assigned to one of those conditions . No differences between both conditions were found in general ED measures , but patients treated in the VR condition showed a greater significant improvement in specific BI measures . These results suggest that BI treatment with VR could be more targeted to its disturbances . than traditional techniques are The aim of this article was to study the effect of virtual-reality exposure to situations that are emotionally significant for patients with eating disorders ( ED ) on the stability of body-image distortion and body-image dissatisfaction . A total of 85 ED patients and 108 non-ED students were r and omly exposed to four experimental virtual environments : a kitchen with low-calorie food , a kitchen with high-calorie food , a restaurant with low-calorie food , and a restaurant with high-calorie food . In the interval between the presentation of each situation , body-image distortion and body-image dissatisfaction were assessed . Several 2 x 2 x 2 repeated measures analyses of variance ( high-calorie vs. low-calorie food x presence vs. absence of people x ED group vs. control group ) showed that ED participants had significantly higher levels of body-image distortion and body dissatisfaction after eating high-calorie food than after eating low-calorie food , while control participants reported a similar body image in all situations . The results suggest that body-image distortion and body-image dissatisfaction show both trait and state features . On the one h and , ED patients show a general predisposition to overestimate their body size and to feel more dissatisfied with their body image than controls . On the other h and , these body-image disturbances fluctuate when participants are exposed to virtual situations that are emotionally relevant for them Binge eating is often preceded by reports of negative affect , but the mechanism by which affect may lead to binge eating is unclear . This study evaluated the effect of negative affect on neural response to anticipation and receipt of palatable food in women with bulimia nervosa ( BN ) versus healthy controls . We also evaluated connectivity between the amygdala and reward-related brain regions . Females with and without BN ( n=26 ) underwent functional magnetic resonance imaging ( fMRI ) during receipt and anticipated receipt of chocolate milkshake and a tasteless solution . We measured negative affect just prior to the scan . Women with BN showed a positive correlation between negative affect and activity in the putamen , cau date , and pallidum during anticipated receipt of milkshake ( versus tasteless solution ) . There were no significant relations between negative affect and receipt of milkshake . Connectivity analyses revealed a greater relation of amygdala activity to activation in the left putamen and insula during anticipated receipt of milkshake in the bulimia group relative to the control group . The opposite pattern was found for the taste of milkshake ; the control group showed a greater relation of amygdala activity to activation in the left putamen and insula in response to milkshake receipt than the bulimia group . Results show that as negative affect increases , so does responsivity of reward regions to anticipated intake of palatable food , implying that negative affect may increase the reward value of food for individuals with bulimia nervosa or that negative affect has become a conditioned cue due to a history of binge eating in a negative mood Background Many research ers and clinicians have proposed using virtual reality ( VR ) in adjunct to in vivo exposure therapy to provide an innovative form of exposure to patients suffering from different psychological disorders . The rationale behind the ' virtual approach ' is that real and virtual exposures elicit a comparable emotional reaction in subjects , even if , to date , there are no experimental data that directly compare these two conditions . To test whether virtual stimuli are as effective as real stimuli , and more effective than photographs in the anxiety induction process , we tested the emotional reactions to real food ( RF ) , virtual reality ( VR ) food and photographs ( PH ) of food in two sample s of patients affected , respectively , by anorexia ( AN ) and bulimia nervosa ( BN ) compared to a group of healthy subjects . The two main hypotheses were the following : ( a ) the virtual exposure elicits emotional responses comparable to those produced by the real exposure ; ( b ) the sense of presence induced by the VR immersion makes the virtual experience more ecological , and consequently more effective than static pictures in producing emotional responses in humans . Methods In total , 10 AN , 10 BN and 10 healthy control subjects ( CTR ) were r and omly exposed to three experimental conditions : RF , PH , and VR while their psychological ( Stait Anxiety Inventory ( STAI-S ) and visual analogue scale for anxiety ( VAS-A ) ) and physiological ( heart rate , respiration rate , and skin conductance ) responses were recorded . Results RF and VR induced a comparable emotional reaction in patients higher than the one elicited by the PH condition . We also found a significant effect in the subjects ' degree of presence experienced in the VR condition about their level of perceived anxiety ( STAI-S and VAS-A ) : the higher the sense of presence , the stronger the level of anxiety . Conclusions Even though preliminary , the present data show that VR is more effective than PH in eliciting emotional responses similar to those expected in real life situations . More generally , the present study suggests the potential of VR in a variety of experimental , training and clinical context s , being its range of possibilities extremely wide and customizable . In particular , in a psychological perspective based on a cognitive behavioral approach , the use of VR enables the provision of specific context s to help patients to cope with their diseases thanks to an easily controlled stimulation Body-image dissatisfaction is a problem that affects a substantial minority ofwomen and cuts across various diagnostic groups . College women with a significant level ofbody-image dissatisfaction were r and omly assigned to either a cognitive-behavioral treatment ( CBT ) program  ( n = 15 ) or to a waiting-list control group  ( n = 16 ) . The CBT program consisted of six structured , individual sessions that applied cognitive-behavioral procedures to the problem of negative body image . At pretest , posttest , and 7-week foUow-up , multiple aspects of body image and other areas of psychosocial functioning were assessed . Relative to the control condition , the CBT program successfully improved affective body image , weakened maladaptive body-image cognitions , and enhanced social self-esteem and feelings about physical fitness and sexuality . Treatment effects were largely maintained at followup . After posttest , the control group received a 3-week treatment with immediate effects that generally replicated those obtained in the 6-wer program Treating binge eating disorders is not easy : the disordered eating is usually combined with a patient who is overweight and often obese . As underlined by the current literature , treatment outcome must focus , at a minimum , on the binge eating characterizing this disorder , on weight changes , and preferably also changes in co-morbid psychopathology . To address these issues , cognitive behavioral therapy ( CBT ) is still considered the best approach . However , if we check the results of follow-up studies , different authors reported some relapse in the frequency of binge eating and small weight gains over the follow-up period . This paper describes the 6-month follow-up outcome of the Experiential Cognitive Therapy ( ECT ) , a multi factorial treatment for binge eating disorders , including virtual reality therapy . These results are compared in a r and omized controlled trial ( n = 36 ) with the ones obtained by CBT and nutritional groups only . The results showed that 77 % of the ECT group quit binging after 6 months versus 56 % for the CBT sample and 22 % for the nutritional group sample . Moreover , the ECT sample reported better scores in most psychometric tests including EDI-2 and body image scores The main goal of this paper is to preliminarily evaluate the efficacy of a virtual-reality (VR)-based multidimensional approach in the treatment of body image attitudes and related constructs .  The female binge eating disorder ( BED ) patients ( n=20 ) , involved in a residential weight control treatment including low-calorie diet ( 
    Output:
    
However , considering the available evidence , the use of VR in the assessment of those conditions showed some promise in identifying : ( 1 ) how those patients experienced their body image ; and ( 2 ) environments or specific kinds of foods that may trigger binge-purging cycle .
Some studies using VR-based environments associated to cognitive behavioral techniques showed their potential utility in improving motivation for change , self-esteem , body image disturbances and in reducing binge eating and purging behavior