title: Physiological and brain activity after a combined cognitive behavioral treatment plus video game therapy for emotional regulation in bulimia nervosa: a case report.
abstract: BACKGROUND
  PlayMancer is a video game designed to increase emotional regulation and reduce general impulsive behaviors, by training to decrease arousal and improve decision-making and planning. We have previously demonstrated the usefulness of PlayMancer in reducing impulsivity and improving emotional regulation in bulimia nervosa (BN) patients. However, whether these improvements are actually translated into brain changes remains unclear.
  
  
  OBJECTIVE
  The aim of this case study was to report on a 28-year-old Spanish woman with BN, and to examine changes in physiological variables and brain activity after a combined treatment of video game therapy (VGT) and cognitive behavioral therapy (CBT).
  
  
  METHODS
  Ten VGT sessions were carried out on a weekly basis. Anxiety, physiological, and impulsivity measurements were recorded. The patient was scanned in a 1.5-T magnetic resonance scanner, prior to and after the 10-week VGT/CBT combined treatment, using two paradigms: (1) an emotional face-matching task, and (2) a multi-source interference task (MSIT).
  
  
  RESULTS
  Upon completing the treatment, a decrease in average heart rate was observed. The functional magnetic resonance imaging (fMRI) results indicated a post-treatment reduction in reaction time along with high accuracy. The patient engaged areas typically active in healthy controls, although the cluster extension of the active areas decreased after the combined treatment.
  
  
  CONCLUSIONS
  These results suggest a global improvement in emotional regulation and impulsivity control after the VGT therapy in BN, demonstrated by both physiological and neural changes. These promising results suggest that a combined treatment of CBT and VGT might lead to functional cerebral changes that ultimately translate into better cognitive and emotional performances.
authors.affiliation: University Hospital of Bellvitge-IDIBELL, Department of Psychiatry, Barcelona, Spain.
authors.forename: Ana Beatriz
authors.identifier: http://orcid.org/0000-0003-1703-9457
authors.initials: AB
authors.lastname: Fagundo
authors.forename: Esther
authors.identifier: http://orcid.org/0000-0002-2331-3232
authors.initials: E
authors.lastname: Via
authors.forename: Isabel
authors.identifier: http://orcid.org/0000-0001-5874-8204
authors.initials: I
authors.lastname: Sánchez
authors.forename: Susana
authors.identifier: http://orcid.org/0000-0002-3596-8033
authors.initials: S
authors.lastname: Jiménez-Murcia
authors.forename: Laura
authors.identifier: http://orcid.org/0000-0002-8478-1451
authors.initials: L
authors.lastname: Forcano
authors.forename: Carles
authors.identifier: http://orcid.org/0000-0003-4574-6597
authors.initials: C
authors.lastname: Soriano-Mas
authors.forename: Cristina
authors.identifier: http://orcid.org/0000-0003-3129-5326
authors.initials: C
authors.lastname: Giner-Bartolomé
authors.forename: Juan J
authors.identifier: http://orcid.org/0000-0001-9957-9363
authors.initials: JJ
authors.lastname: Santamaría
authors.forename: Maher
authors.identifier: http://orcid.org/0000-0001-9394-9984
authors.initials: M
authors.lastname: Ben-Moussa
authors.forename: Dimitri
authors.identifier: http://orcid.org/0000-0002-2664-9348
authors.initials: D
authors.lastname: Konstantas
authors.forename: Tony
authors.identifier: http://orcid.org/0000-0002-3940-7129
authors.initials: T
authors.lastname: Lam
authors.forename: Mikkel
authors.identifier: http://orcid.org/0000-0003-1669-1195
authors.initials: M
authors.lastname: Lucas
authors.forename: Jeppe
authors.identifier: http://orcid.org/0000-0003-4278-3093
authors.initials: J
authors.lastname: Nielsen
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0002-9273-871X
authors.initials: P
authors.lastname: Lems
authors.forename: Narcís
authors.identifier: http://orcid.org/0000-0001-9633-0888
authors.initials: N
authors.lastname: Cardoner
authors.forename: Jose M
authors.identifier: http://orcid.org/0000-0002-6231-6524
authors.initials: JM
authors.lastname: Menchón
authors.forename: Rafael
authors.identifier: http://orcid.org/0000-0002-6765-1866
authors.initials: R
authors.lastname: de la Torre
authors.forename: Fernando
authors.identifier: http://orcid.org/0000-0002-2968-9898
authors.initials: F
authors.lastname: Fernandez-Aranda
mesh_terms: D000328:Adult; D001007:Anxiety; D001921:Brain / Q000502:physiology*; D052018:Bulimia Nervosa / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004644:Emotions; D005260:Female; D006339:Heart Rate; D006801:Humans; D011930:Reaction Time; D018910:Video Games
keywords: bulimia nervosa; eating disorders; emotional regulation; fMRI; impulsivity; neuroimaging; video game therapy