title: The Use of Videogames as Complementary Therapeutic Tool for Cognitive Behavioral Therapy in Bulimia Nervosa Patients.
abstract: Although cognitive behavioral therapy (CBT) has been demonstrated to be the most effective approach for the treatment of bulimia nervosa (BN), there is lack of studies showing whether a combination with a serious video game (SVG) might be useful to enhance patients' emotional regulation capacities and general outcome. The aims of this study were (a) to analyze whether outpatient CBT + SVG, when compared with outpatient CBT - SVG, shows better short-term outcome; (b) to examine whether the CBT + SVG group is more effective in reducing emotional expression and levels of anxiety than CBT - SVG. Thirty-eight patients diagnosed as having BN according to DSM-5 criteria were consecutively assigned to two outpatient group therapy conditions (that lasted for 16 weekly sessions): 20 CBT + SVG versus 18 CBT - SVG. Patients were assessed before and after treatment using not only a food and binging/purging diary and clinical questionnaires in the field of eating disorders but also additional indexes for measuring anger expression and anxiety. Regarding the post-treatment psychometric measures, most of the mean differences (Eating Disorder Inventory-2, Symptom Checklist-Revised, State-Trait Anxiety Index, and partially State-Trait Anger Expression Inventory) achieved moderate to high effect size (d > 0.5), in the sense that CBT + SVG obtained the best results compared with the CBT - SVG group. Regarding therapy outcome (dropout, partial remission, and total remission), CBT + SVG showed better results and a moderate effect size emerged for the comparison of the risk of dropout during the treatment, being higher for CBT - SVG compared with CBT + SVG (44.1 percent versus 20.0 percent, d = 0.54). Although the sample size in our study was low, and consequently results should be considered with caution, we have obtained promising findings suggesting that in the short-term CBT + SVG might be a good option not only for improving emotional dysregulation and approaching the current limitations of CBT - SVG in BN but also for enhancing the therapy adherence of patients.
authors.affiliation: 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain .|2 CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III , Barcelona, Spain .|3 Department of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain .
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Aranda
authors.affiliation: 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain .|2 CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III , Barcelona, Spain .|3 Department of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain .
authors.forename: Susana
authors.initials: S
authors.lastname: Jimenez-Murcia
authors.affiliation: 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain .|2 CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III , Barcelona, Spain .
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Santamaría
authors.affiliation: 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain .|2 CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III , Barcelona, Spain .
authors.forename: Cristina
authors.initials: C
authors.lastname: Giner-Bartolomé
authors.affiliation: 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain .
authors.forename: Gemma
authors.initials: G
authors.lastname: Mestre-Bach
authors.affiliation: 2 CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III , Barcelona, Spain .|4 Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona , Barcelona, Spain .
authors.forename: Roser
authors.initials: R
authors.lastname: Granero
authors.affiliation: 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain .
authors.forename: Isabel
authors.initials: I
authors.lastname: Sánchez
authors.affiliation: 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain .|2 CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III , Barcelona, Spain .
authors.forename: Zaida
authors.initials: Z
authors.lastname: Agüera
authors.affiliation: 5 Faculty of Social Sciences and Economics, University of Geneva , Geneva, Switzerland .
authors.forename: Maher H
authors.initials: MH
authors.lastname: Moussa
authors.affiliation: 5 Faculty of Social Sciences and Economics, University of Geneva , Geneva, Switzerland .
authors.forename: Nadia
authors.initials: N
authors.lastname: Magnenat-Thalmann
authors.affiliation: 5 Faculty of Social Sciences and Economics, University of Geneva , Geneva, Switzerland .
authors.forename: Dimitri
authors.initials: D
authors.lastname: Konstantas
authors.affiliation: 6 NetUnion , Lausanne, Switzerland .
authors.forename: Tony
authors.initials: T
authors.lastname: Lam
authors.affiliation: 7 Serious Game Interactive (SGI) , Copenhagen, Denmark .
authors.forename: Mikkel
authors.initials: M
authors.lastname: Lucas
authors.affiliation: 7 Serious Game Interactive (SGI) , Copenhagen, Denmark .
authors.forename: Jeppe
authors.initials: J
authors.lastname: Nielsen
authors.affiliation: 8 Mobihealth , Enschede, Netherlands .
authors.forename: Peter
authors.initials: P
authors.lastname: Lems
authors.affiliation: 4 Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona , Barcelona, Spain .
authors.forename: Salomé
authors.initials: S
authors.lastname: Tarrega
authors.affiliation: 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL , Barcelona, Spain .|3 Department of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain .|9 CIBER Salud Mental (CIBERSam), Instituto Salud Carlos III , Barcelona, Spain .
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Menchón
mesh_terms: D000328:Adult; D000786:Anger; D001007:Anxiety / Q000175:diagnosis; D052018:Bulimia Nervosa / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015930:Diet Records; D004644:Emotions; D005260:Female; D006801:Humans; D065228:Non-Randomized Controlled Trials as Topic; D010349:Patient Compliance; D010352:Patient Dropouts; D010555:Personality Inventory; D011594:Psychometrics; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018910:Video Games / Q000523:psychology*; D055815:Young Adult