Can an intervention based on a serious videogame prior to cognitive behavioral therapy be helpful in bulimia nervosa? A clinical case study.

Cristina Giner-Bartolomé,Susana Jiménez-Murcia,Fernando Fernández-Aranda,Juan J Santamaría,Ana B Fagundo,José M Menchón,Robert Ladouceur,Isabel Sánchez

doi:10.3389/fpsyg.2015.00982

Abstract

Background: Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity.Design: Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an “A-B-A-C-A” single case experimental design. Impulsivity levels were assessed with the Conner’s Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure.Results: After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention.Discussion: This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN.

Highlights

Bulimia nervosa (BN) has often been associated with impulsivity (Fischer et al, 2003; Vaz-Leal et al, 2014)
The frequency of binges decreased during and after the VG intervention. This case report suggests that using the Playmancer VG to reduce impulsivity prior to cognitive behavioral therapy (CBT) may enhance the final results of the treatment for BN
This paper presents a case report of a patient diagnosed with BN, using a VG based on biofeedback (Playmancer; JimenezMurcia et al, 2009; Fernandez-Aranda et al, 2012) as an additional intervention to treatment as usual (TAU) (CBT) designed to address impulsivity control and emotion regulation

Summary

Introduction

Bulimia nervosa (BN) has often been associated with impulsivity (Fischer et al, 2003; Vaz-Leal et al, 2014). Though cognitive behavioral therapy (CBT) is the treatment of choice for BN (Fairburn et al, 1993; Wilson and Shafran, 2005; Shapiro et al, 2007), in some cases, this treatment modality alone might be insufficient for reducing high levels of impulsivity (Agüera et al, 2012; Hedman et al, 2014). Impulsivity is associated with a temperament dimension of personality that is less susceptible to change (Cloninger et al, 1993; Agüera et al, 2012). For these reasons, it is not surprising that impulsivity is not altered after CBT, at least not without introducing an additional intervention designed to treat it.

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