An Intervention Using a 'Serious Videogame' prior to CBT for Bulimia Nervosa

One patient had reduced impulsivity, and binge eating was greatly reduced.

Reprinted from Eating Disorders Review
November/December Volume 26, Number 6
©2015 IAEDP

Impulsivity is a common feature of bulimia nervosa (BN). The triad of behavioral disinhibition, impulsive decision-making, and emotional dysregulation often predicts relapse and dropout rates. A group in Spain recently used sessions with a "serious" videogame prior to cognitive behavioral therapy (CBT) to successfully treat a 34-year-old woman with BN (Frontiers in Psychology. 2015; July doi:10.3389/fpsyg.2015.00982).

Unlike conventional videogames, which are designed to entertain, serious videogames are designed to help improve skills, attitudes, and knowledge. For example, Playmancer™, a serious videogame, was developed to improve emotional regulation and impulsiveness in specific mental disorders and is currently being used by clinicians at the University Hospital of Bellvitage, Barcelona, Spain, to treat patients with eating disorders and addictions. 

A 34-year-old patient who binged and purged daily

Cristina Giner-Bartolomé and colleagues recently reported the case of a 34-year-old married mother of two with an earlier history of substance abuse problems until she was 21, when she received psychological treatment. With each pregnancy, the patient had steadily gained weight, until she her body mass index (BMI) was 34 kg/m2. During the 3 months before she entered the authors' study, she reported having daily binges followed by feelings of hopelessness and guilt, with episodes of vomiting. She also showed some classic traits of a Cluster B personality, with high levels of impulsivity, low tolerance for frustration, and poor emotional regulation. The woman also had occasional bouts of compulsive shopping. She had been treated with fluoxetine for the past 6 months.

At baseline, the authors obtained initial psychometric and neurophysiologic information, focusing on impulsivity levels measured with Conner's Continuous Performance II (CPT II), along with the Iowa Gambling Task (IGT), which evaluates decision-making, risk and reward and punishment. Eating and purging symptoms were recorded with food diaries kept by the patient. Other psychometric tests included the Eating Disorder Inventory 2 (ED-2) and the State-Trait Anxiety Inventory (STAI-S-T).

The second stage of the study involved 3 weeks of the use of the Playmancer videogame. Nine sessions of 26 minutes each were conducted and the 26 minutes were broken down as follows: 3 minutes of relaxing music, 20 minutes of the videogame, and 3 minutes of relaxing music. At the end of this stage the authors once more applied the CPTII.

One week after finishing the first intervention with the videogame, the authors once more measured the psychometric variables and levels of impulsivity (CPTII). A week after finishing the videogame intervention, the patient began group cognitive behavioral therapy (CBT). Three weeks after completing the CBT phase, the authors again applied the neuropsychological and psychometric tests. During each of the treatment stages the researchers recorded symptoms related to eating behavior, including the frequency of binge eating and vomiting.

At the end of treatment, the patient had lower levels of novelty-seeking, made fewer commission errors, had improved her ability for making decisions, and had fewer binge-eating episodes (the weekly average fell from 14.0 to 0.7). The authors noted that future studies might replicate their study with a larger sample of patients and add a control group. Although the patient was receiving an antidepressant, there had been no changes in her medication.