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Marchesi G, Cammisuli DM, Semonella M, Castelnuovo G, Pietrabissa G. The Efficacy of Cognitive Remediation Therapy for Anorexia Nervosa: A Systematic Review of Systematic Reviews. Brain Sci 2024; 14:118. [PMID: 38391693 PMCID: PMC10886621 DOI: 10.3390/brainsci14020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is an intervention specifically focused on addressing cognitive difficulties associated with the eating disorder. This systematic review of systematic reviews and meta-analysis aimed to provide a summary of the existing literature examining the efficacy of CRT in improving the neuropsychological, psychological, and clinical parameters of patients with AN. METHODS Systematic reviews and meta-analyses were sought in electronic databases, encompassing studies that explored the impact of CRT on AN. Three eligible reviews were identified based on the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was employed to evaluate the methodological quality of the reviews, and all included reviews demonstrated satisfactory methodological quality with an R-AMSTAR score of ≥22. Relevant information was extracted from each review and qualitatively compiled. RESULTS Findings suggest that CRT can help people increase their awareness of cognitive styles and information processing and have a positive effect on patients' responses to treatment. CONCLUSIONS Further research is required to better understand its impact on other relevant outcomes, including psychological variables, to optimize the treatment's benefits.
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Affiliation(s)
- Gloria Marchesi
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | | | | | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 20149 Milan, Italy
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2
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Dajon M, Sudres JL. Accompagner l’orthorexie dans les troubles des conduites alimentaires : création et évaluation d’un programme psychothérapeutique. L'ÉVOLUTION PSYCHIATRIQUE 2022. [DOI: 10.1016/j.evopsy.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3
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Phonological working memory is adversely affected in adults with anorexia nervosa: a systematic literature review. Eat Weight Disord 2022; 27:1931-1952. [PMID: 35133643 PMCID: PMC9287223 DOI: 10.1007/s40519-022-01370-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Cognitive restraint has potentiating and deleterious effects on working memory (WM) in anorexia nervosa (AN). Conflicting evidence may be due to heterogeneity of tasks examining different WM components (e.g., verbal/auditory versus visuospatial), and differences in adolescent versus adult AN. Additionally, differential cognitive profiles of restricting versus binge/purging subtypes, comorbid psychiatric disorders and psychotropic medication use may confound findings. METHODS To address these conflicts, 25 studies, published between 2016 and 2021, investigating WM in children, adolescents and adults with AN were systematically reviewed using PRISMA guidelines. RESULTS In 71% of WM tasks, no difference in performance between AN patients and age-matched controls was reported, while 29% of WM tasks showed worse performance. Adults with AN displayed deficits in 44% of the verbal/auditory tasks, while performance remained unaffected in 86% of visuospatial tasks. CONCLUSION Examining age groups and WM subsystems separately revealed novel findings of differentially affected WM components in AN. Comorbidities and psychotropic medications were common among AN participants and should be regarded as critical confounding factors for WM measures. Future studies examining different components of WM, acknowledging these confounding factors, may reveal specific deficits in AN to aid treatment improvement strategies. LEVEL OF EVIDENCE I, systematic review.
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4
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Meneguzzo P, Tenconi E, Todisco P, Favaro A. Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit. EUROPEAN EATING DISORDERS REVIEW 2021; 29:770-782. [PMID: 34118097 PMCID: PMC8453548 DOI: 10.1002/erv.2848] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022]
Abstract
Objective Cognitive remediation therapy (CRT) has been proposed as an add‐on treatment approach that could increase the engagement in treatment of anorexia nervosa (AN) patients and reduce maintaining factors, but prior studies have evaluated CRT in individual and group settings, difficult protocols for rehabilitation settings. Our aim is to evaluate the CRT rolling protocol implementation in an inpatient specialised unit. Methods A historical longitudinal controlled study was designed to include 31 AN patients for the CRT program, and 28 AN patients treated as usual. The CRT rolling group was implemented in a multidisciplinary inpatient rehabilitation ward with both adolescent and adult patients and an 8‐weeks protocol. To evaluate the treatment implementation effect, different self‐administered questionnaires were used. Results The study found greater improvements of the CRT group in clinical symptomatology (p = 0.039), flexibility (p = 0.003), self‐confidence about the ability to change (p < 0.001), and less short‐term focus (p < 0.001), with no differences between restrictive and binge‐purging patients. Conclusion This study demonstrates that CRT rolling group protocol is feasible in an inpatient treatment setting and may improve a rehabilitation program's outcome. Our results have shown how CRT can influence cognitive styles considered AN maintenance factors, positively affecting both restrictive and binge‐purge type. Cognitive remediation therapy (CRT) could be implemented in an inpatient setting with a rolling protocol CRT improves flexibility, drive to change, and therapy engagement No differences between restrictive or binge/purge subgroups Both adolescent and adult patients improved their cognitive styles
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy.,Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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5
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Plemeniti Tololeski B, Suhodolčan Grabner A, Kumperscak HG. Adolescents With Autism Spectrum Disorder and Anorexia Nervosa Comorbidity: Common Features and Treatment Possibilities With Cognitive Remediation Therapy and Oxytocin. Front Psychiatry 2021; 12:686030. [PMID: 34413796 PMCID: PMC8369034 DOI: 10.3389/fpsyt.2021.686030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Autistic traits or autism spectrum disorder (ASD) can be found in 4% to 52% of anorexic patients, which makes the treatment of these patients very challenging. In this review, possible ways to treat ASD and anorexia nervosa (AN) comorbidity in children and adolescents are summarized. Over recent years, the focus has shifted from searching for the evidence of connections between these two disorders, which have started with Gillberg's study in 1983, to searching for more effective and holistic treatment of this comorbidity. The latter is known to contribute to more severe courses and worse prognosis, which is probably related to the obstacles in both diagnosing and treating. Since AN usually starts in early adolescence and high-functioning ASD children seem to begin struggling with increased pressure in adolescence, while various comorbidities can occur, it is important to improve the treatment of this comorbidity in young patients and to tailor it specifically in terms of diagnosing. In this paper, a literature review is conducted on common features and promising treatment possibilities. We describe cognitive remediation therapy and the promising pharmacotherapeutic candidate oxytocin with a special focus on adolescents.
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Affiliation(s)
- Barbara Plemeniti Tololeski
- Centre for Mental Health, Unit for Adolescent Psychiatry, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Hojka Gregoric Kumperscak
- Department for Child and Adolescent Psychiatry, University Medical Centre, Maribor, Slovenia.,Faculty for Medicine, University of Maribor, Maribor, Slovenia
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6
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Dandil Y, Baillie C, Tchanturia K. Cognitive Remediation Therapy as a Feasible Treatment for a Young Person With Anorexia Nervosa and Autism Spectrum Disorder Comorbidity: A Case Study. Clin Case Stud 2019. [DOI: 10.1177/1534650119890425] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anorexia nervosa (AN) is a challenging illness to treat with inefficiencies in central coherence and set-shifting known to be cognitive maintaining factors for the eating disorder. AN is further complicated by comorbidities such as autism spectrum disorder (ASD). Cognitive remediation therapy (CRT) aims to address problems with cognitive style and meta-cognition by stimulating the neural connections involved in cognitive processing through cognitive tasks, reflection, and behavioral experiments. However, to date, no reported studies are supporting individual CRT for patients with AN and ASD comorbidity. This single complex case study provides preliminary evidence to support the efficacy of individual CRT in the treatment of a 21-year-old female patient with AN and ASD comorbidity. Clinical and self-report data collected before and after CRT indicate improvements in cognitive flexibility and central coherence, alongside an increase in body mass index (BMI). This case study reflects the possible ways to adapt and calibrate treatment to individual needs and the efficacy of CRT, before proceeding to more complex individual psychological work, such as cognitive behavioral therapy.
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Affiliation(s)
- Yasemin Dandil
- South London and Maudsley NHS Foundation Trust, UK
- King’s College London, UK
| | | | - Kate Tchanturia
- South London and Maudsley NHS Foundation Trust, UK
- King’s College London, UK
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Herbrich LR, Kappel V, Winter SM, van Noort BM. Executive functioning in adolescent anorexia nervosa: Neuropsychology versus self- and parental-report. Child Neuropsychol 2018; 25:816-835. [PMID: 30348052 DOI: 10.1080/09297049.2018.1536200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is limited research concerning the relationship between neuropsychological assessment and self-report of executive functioning in adolescent anorexia nervosa (AN); available studies demonstrate only low to moderate correlations. Therefore, this study examines the association between neuropsychological test performance and self-report in AN. Forty adolescent inpatients with AN completed an extensive neuropsychological assessment, including set-shifting, central coherence, and questionnaires assessing executive functioning in daily life (BRIEF-SR). Their parents filled out an analog version (BRIEF-PF). Statistical analyses revealed low to medium positive and negative correlations between neuropsychological measures and BRIEF subscales. Similarly, self- and parental ratings were only slightly positively correlated, with patients scoring significantly higher than their parents on two subscales. The results support previous findings of modest correlations between self-report and performance-based testing and emphasize the importance of a multiple format assessment of executive functioning in adolescent AN.
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Affiliation(s)
- Laura Rebecca Herbrich
- a Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy , Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Viola Kappel
- a Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy , Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Sibylle Maria Winter
- a Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy , Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Betteke Maria van Noort
- a Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy , Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
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8
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Roberts ME. Feasibility of group Cognitive Remediation Therapy in an adult eating disorder day program in New Zealand. Eat Behav 2018; 30:1-4. [PMID: 29738943 DOI: 10.1016/j.eatbeh.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 04/13/2018] [Accepted: 04/30/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To explore the feasibility of integrating group Cognitive Remediation Therapy (gCRT) into an eating disorder day program in Auckland, New Zealand. METHOD A consecutive series of 28 patients took part over an 8-month period in the context of a service audit. Main outcome measures were the Detail and Flexibility Questionnaire (DFlex) and qualitative feedback from patients. RESULTS Significant shifts in self-report inefficient cognitive style were observed pre/post gCRT with large effect sizes (Cohen's dav) for both cognitive rigidity and attention to detail outcomes. Patient feedback was positive, with themes of enjoyment, increased insight, and positive social interaction/esteem boosting in the context of the group emerging. CONCLUSIONS Support for the acceptability, adaptation, expansion, practicality, and limited-efficacy testing of gCRT in an Australasian day program setting has been found, suggesting integration of this module into existing day treatment programs is merited. Larger scale trials may help delineate the clinical characteristics of good responders.
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Affiliation(s)
- Marion E Roberts
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Department of General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
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Timko CA, Goulazian TJ, Fitzpatrick KK, Rodriguez D. Cognitive remediation therapy (CRT) as a pretreatment intervention for adolescents with anorexia nervosa during medical hospitalization: a pilot randomized controlled trial protocol. Pilot Feasibility Stud 2018; 4:87. [PMID: 29983992 PMCID: PMC6016143 DOI: 10.1186/s40814-018-0277-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe psychiatric condition characterized by low body weight, fear of weight gain/becoming fat and/or behavior that interferes with weight gain, and body disturbance. Though there have been recent advances in the treatment of AN, there continues to be an urgent need to increase treatment options. Cognitive remediation therapy (CRT) has been successfully used as an adjunctive treatment for individuals with AN. In this study, we pilot the use of CRT plus an innovative parent involvement component as a pre-treatment intervention on a medical unit. We hypothesize that adding CRT with parent involvement to a standard hospital stay is feasible, acceptable by patients and staff, and may improve treatment outcomes post-hospitalization. METHODS/DESIGN This is a pilot randomized controlled trial with three arms. Participants are adolescents aged 12-18 with AN; 60 participants will be included. They are randomized into one of three groups: treatment as usual (TAU, standard care at Children's Hospital of Philadelphia), CRT + contact control (known as "Family Fun Time"), and CRT + Teach the Parent. Intervention will occur on an inpatient basis. Follow-up will be outpatient and will continue until 6 months post-discharge. Psychosocial, neurocognitive, and behavioral measures will be collected throughout the study, and group differences will be evaluated at 4 weeks, 3 months, and 6 months post-discharge. The study will take place at The Children's Hospital of Philadelphia. DISCUSSION This pilot randomized controlled trial will inform feasibility of the integration of a pre-treatment intervention into a medical hospital stay for AN. We will assess recruitment procedures, treatment administration, and participant retention. Finally, a comprehensive assessment battery will be evaluated. Secondary goals are to conduct a preliminary evaluation of whether or not CRT with parent involvement increases rate of weight gain and treatment engagement and decreases parental accommodation of symptoms post-discharge. If successful, this pilot study will inform a larger controlled trial fully powered to examine the secondary goals. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02883413.
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Affiliation(s)
- C. Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA
| | - Tiffanie J. Goulazian
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA
| | | | - Daniel Rodriguez
- Department of Urban Public Health and Nutrition, La Salle University, Philadelphia, PA 19141 USA
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10
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Evaluation of individual cognitive remediation therapy (CRT) for the treatment of young people with anorexia nervosa. Eat Weight Disord 2017; 22:667-673. [PMID: 27704340 DOI: 10.1007/s40519-016-0322-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Research suggests that there are cognitive inefficiencies underlying Anorexia Nervosa (AN), with CRT showing promise in improving these inefficiencies in adults. This area has yet to be explored in a younger population. The aim of this study was to evaluate the use of CRT for young people. METHODS A within-subjects design was used to compare the performance of children and adolescents with AN on several neuropsychological measures administered before and after a course of CRT. RESULTS Ninety-two female participants diagnosed with AN aged between 11 and 17 (M = 14.8, SD = 1.6), all receiving treatment at a specialist inpatient unit. The assessment consisted of the Rey-Osterrieth Complex Figure test (ROCFT), the Behaviour Rating Inventory of Executive Function-Self-Report (BRIEF-SR), and the D-KEFS Colour-Word Interference Test (CWT). Repeated-measures t tests were used to analyse the ROCFT and BRIEF-SR data. There was a significant improvement in Central Coherence Index (p < .001), Immediate Recall (p < .001), Shift (p < .001) Cognitive Shift (p = 002), Behavioural shift (p < .001), Emotional Control (p < .001), Working Memory (p = .001), Plan/Organize (p < .001), Monitor (p = .001) BRI (p < .001), MI (p = .001), and GEC (p < .001). On the D-KEFS CWT, a repeated-measure Wilcoxon signed-rank test revealed a significant improvement in Error Rate (p = .019) and a repeated-measures t test revealed a significant improvement in time taken (p < .001). CONCLUSIONS Results suggest that CRT for children and adolescents with AN could strengthen specific cognitive domains.
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11
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Tchanturia K, Giombini L, Leppanen J, Kinnaird E. Evidence for Cognitive Remediation Therapy in Young People with Anorexia Nervosa: Systematic Review and Meta-analysis of the Literature. EUROPEAN EATING DISORDERS REVIEW 2017; 25:227-236. [DOI: 10.1002/erv.2522] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
- South London and Maudsley NHS Foundation Trust; London UK
- Illia State University; Tbilisi Georgia
| | - Lucia Giombini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
- Rhodes Wood Hospital; Elysium Healthcare; London UK
| | - Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
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Cognitive Remediation Therapy for Adolescents with Anorexia Nervosa-Treatment Satisfaction and the Perception of Change. Behav Sci (Basel) 2017; 7:bs7020023. [PMID: 28420211 PMCID: PMC5485453 DOI: 10.3390/bs7020023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 11/16/2022] Open
Abstract
Cognitive remediation therapy (CRT) has recently been developed for children and adolescents with anorexia nervosa (AN). It focuses on decreasing rigid cognitions and behaviors, as well as increasing central coherence. Overall, CRT has been proven feasible for young individuals with AN, but little is known regarding the specifics of its feasibility, and the perception of change associated with the intervention. Consequently, the aim of the current study was to explore service users’ perspective on CRT with a specific focus on treatment delivery, treatment content, and perceived change. Twenty adolescents (age 13–18) with AN participated in a 10-session course of CRT. A 20-item treatment evaluation questionnaire was administered at the end of treatment, focusing on four aspects of the intervention: (1) general attitudes towards treatment, (2) treatment specifics, (3) the perception of change and (4) the patient-therapist relation. The main findings suggest high levels of treatment satisfaction, but somewhat limited perceptions of change. The current study is one of the most detailed accounts of adolescents’ perspective on CRT published on eating disorders, and highlights several important aspects of the treatment viewed through the eye of the receiver.
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Herbrich L, van Noort B, Pfeiffer E, Lehmkuhl U, Winter S, Kappel V. Follow-up Assessment of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2017; 25:104-113. [DOI: 10.1002/erv.2501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/18/2016] [Accepted: 12/02/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Laura Herbrich
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Betteke van Noort
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Ernst Pfeiffer
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Ulrike Lehmkuhl
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Sibylle Winter
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Viola Kappel
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
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14
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van Passel B, Danner U, Dingemans A, van Furth E, Sternheim L, van Elburg A, van Minnen A, van den Hout M, Hendriks GJ, Cath D. Cognitive remediation therapy (CRT) as a treatment enhancer of eating disorders and obsessive compulsive disorders: study protocol for a randomized controlled trial. BMC Psychiatry 2016; 16:393. [PMID: 27832747 PMCID: PMC5105298 DOI: 10.1186/s12888-016-1109-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) and Obsessive Compulsive Disorder (OCD) are among the most incapacitating and costly of mental disorders. Cognitive Behaviour Therapy (CBT), medication, and combination regimens, to which in AN personalised guidance on weight control is added, are moderately successful, leaving room for more effective treatment algorithms. An underlying deficit which the two disorders share is cognitive inflexibility, a trait that is likely to impede treatment engagement and reduce patients' ability to benefit from treatment. Cognitive remediation therapy (CRT) is an easy-to-use intervention aimed at reducing cognitive inflexibility and thereby enhancing treatment outcome, which we aim to test in a controled study. METHODS In a randomized-controlled multicenter clinical trial 64 adult patients with AN and 64 with OCD are randomized to 10 bi-weekly sessions with either CRT or a control condition, after which Treatment As Usual (TAU) is started. All patients are evaluated during single-blind assessments at baseline, post-CRT/control intervention, and after 6 months. Indices of treatment effect are disorder-specific symptom severity, quality of life, and cost-effectivity. Also, moderators and mediators of treatment effects will be studied. DISCUSSION To our knowledge, this is the first randomized controlled trial using an control condition evaluating the efficacy and effectiveness of CRT as a treatment enhancer preceding TAU for AN, and the first study to investigate CRT in OCD, moreover taking cost-effectiveness of CRT in AN and OCD into account. TRIAL REGISTRATION The Netherlands Trial Register NTR3865 . Registered 20 february 2013.
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Affiliation(s)
- Boris van Passel
- Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB The Netherlands
- Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR The Netherlands
| | - Unna Danner
- Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK The Netherlands
| | - Alexandra Dingemans
- Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, Leiden, 2333 ZZ The Netherlands
| | - Eric van Furth
- Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, Leiden, 2333 ZZ The Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Einthovenweg 20, Leiden, 2333 ZC The Netherlands
| | - Lot Sternheim
- Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS The Netherlands
| | - Annemarie van Elburg
- Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS The Netherlands
| | - Agnes van Minnen
- Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB The Netherlands
- Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR The Netherlands
| | - Marcel van den Hout
- Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS The Netherlands
| | - Gert-Jan Hendriks
- Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB The Netherlands
- Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR The Netherlands
| | - Daniëlle Cath
- Altrecht Academic Anxiety Centre, Nieuwe Houtenseweg 12, Utrecht, 3524 SH The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS The Netherlands
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Treasure J, Cardi V, Leppanen J, Turton R. New treatment approaches for severe and enduring eating disorders. Physiol Behav 2015; 152:456-65. [DOI: 10.1016/j.physbeh.2015.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/22/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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Abbate-Daga G, Buzzichelli S, Marzola E, Aloi M, Amianto F, Fassino S. Does depression matter in neuropsychological performances in anorexia nervosa? A descriptive review. Int J Eat Disord 2015; 48:736-45. [PMID: 26032280 DOI: 10.1002/eat.22399] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 12/16/2014] [Accepted: 02/12/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This review aims to examine the impact of depressive symptoms on the assessment of cognitive flexibility, central coherence, and decision-making in individuals with anorexia nervosa (AN). METHOD An online search was carried out using PubMed and PsycInfo. Articles were selected for review if they were published in English between 1990 and 2014 and used the Wisconsin Card Sorting Test, the Trail Making Task parts A and B, the Brixton Test, the Rey-Osterrieth Complex Figure Test, and/or the Iowa Gambling Task. RESULTS Sixty-two studies were included. Thirty (48%) of the studies statistically assessed the association between depression and neurocognition in AN versus healthy controls. Where significant correlations were found, it became clear that the more serious the depression, the greater the neuropsychological impairment. Only six (10%) studies examined whether increased depressive symptoms were able to eliminate the differences between individuals with AN and healthy controls, and one study found that depressive symptoms did eliminate group differences in cognitive flexibility and decision-making. DISCUSSION Only a subgroup of articles on neuropsychology in AN adjusted for depression. However, given the role of depression that some articles suggest, future studies should pay closer attention to the evaluation of this potential confounder.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Aloi
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.,Ambulatory for Clinical Research and Treatment of Eating Disorders, Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
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Talbot A, Hay P, Buckett G, Touyz S. Cognitive deficits as an endophenotype for anorexia nervosa: an accepted fact or a need for re-examination? Int J Eat Disord 2015; 48:15-25. [PMID: 25046823 DOI: 10.1002/eat.22332] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate whether impaired set shifting and weak central coherence represent state or trait characteristics and, therefore, candidate endophenotypes of anorexia nervosa (AN). METHOD Forty-nine individuals with lifetime AN (24 acutely unwell, 10 weight recovered, and 15 fully recovered) and 43 healthy controls completed the Wisconsin Card Sorting Test (WCST), the Matching Familiar Figures Test, and the Rey Complex Figure Task measuring cognitive flexibility, local processing, and global processing, respectively. Participants also completed questionnaires assessing eating disorder, anxiety and depressive symptoms, obsessional traits, interpersonal functioning, and quality of life. Body mass index was calculated from height and weight measurements. RESULTS Participants with lifetime AN demonstrated poorer set shifting ability than healthy controls as evidenced by a greater number of perseverative errors on the WCST. When participants were grouped according to illness status, only those in the two recovered groups demonstrated poorer set shifting ability than healthy controls while patients with acute AN performed comparably to all other groups. There were no significant differences between groups on measures of local and global processing. No relationship was found between specific clinical features of AN and cognitive performance. DISCUSSION The results of this study are consistent with a global trend toward set shifting difficulties in patients with AN but do not support weak central coherence as a candidate endophenotype for AN. These findings have clinical implications in terms of treatment selection and planning, particularly in relation to the use of cognitive remediation therapy with patients with AN.
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Affiliation(s)
- Amy Talbot
- The Redleaf Practice, Wahroonga, New South Wales, Australia; Department of Psychology, University of Sydney, New South Wales, Australia
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Abbate-Daga G, Buzzichelli S, Marzola E, Amianto F, Fassino S. Clinical investigation of set-shifting subtypes in anorexia nervosa. Psychiatry Res 2014; 219:592-7. [PMID: 25017616 DOI: 10.1016/j.psychres.2014.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 11/17/2022]
Abstract
While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
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Claes L, Fagundo AB, Jiménez-Murcia S, Agüera Z, Giner-Bartolome C, Granero R, Sánchez I, Riesco N, Menchón JM, Tarrega S, Fernandez-Aranda F. Is Non-suicidal Self-injury Related to Impulsivity in Anorexia Nervosa? Results from Self-report and Performance-based Tasks. EUROPEAN EATING DISORDERS REVIEW 2014; 23:28-33. [DOI: 10.1002/erv.2329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Laurence Claes
- Faculty of Psychology and Educational Sciences; University of Leuven; Leuven Belgium
| | - Ana B. Fagundo
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III; Barcelona Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
| | - Zaida Agüera
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III; Barcelona Spain
| | | | - Roser Granero
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III; Barcelona Spain
- Departament de Psicobiologia i Metodologia; Universitat Autònoma de Barcelona; Spain
| | - Isabel Sánchez
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Nadine Riesco
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Jose Manuel Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
- CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III; Barcelona Spain
| | - Salomé Tarrega
- Departament de Psicobiologia i Metodologia; Universitat Autònoma de Barcelona; Spain
| | - Fernando Fernandez-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
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Tchanturia K, Lounes N, Holttum S. Cognitive remediation in anorexia nervosa and related conditions: a systematic review. EUROPEAN EATING DISORDERS REVIEW 2014; 22:454-62. [PMID: 25277720 DOI: 10.1002/erv.2326] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/07/2022]
Abstract
Research evidence for cognitive remediation therapy's (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK; South London and Maudsley NHS Trust Eating Disorders National Service, UK; Illia University Tbilisi, Georgia
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21
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Dingemans AE, Danner UN, Donker JM, Aardoom JJ, van Meer F, Tobias K, van Elburg AA, van Furth EF. The effectiveness of cognitive remediation therapy in patients with a severe or enduring eating disorder: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:29-36. [PMID: 24281361 DOI: 10.1159/000355240] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 08/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Individuals with eating disorders show deficits in neuropsychological functioning which might preexist and underlie the etiology of the eating disorders and influence relapse. Deficits in cognitive flexibility, i.e., set-shifting and central coherence, might perpetuate the symptoms. Cognitive remediation therapy (CRT) was developed to improve cognitive flexibility, thereby increasing the likelihood of improved outcome. The focus of CRT is on how patients think, rather than on what patients think. The present study investigated the effectiveness of CRT for patients with a severe or enduring eating disorder by means of a randomized controlled trial comparing intensive treatment as usual (TAU) to CRT plus TAU. METHODS Eighty-two patients were randomly assigned to CRT plus TAU (n = 41) or TAU alone (n = 41). Outcome measures were set-shifting, central coherence, eating disorder and general psychopathology, motivation, quality of life and self-esteem. Assessments were performed at baseline (n = 82) and after 6 weeks (T1; n = 75) and 6 months (T2; n = 67). Data were analyzed by means of linear mixed model analyses. RESULTS Patients who received CRT in addition to TAU improved significantly more with regard to eating disorder-related quality of life at the end of treatment (T1) and eating disorder psychopathology at follow-up (T2), compared to those who received TAU only. Moreover, moderator analyses revealed that patients with poor baseline set-shifting abilities benefited more from CRT than patients with no deficits in set-shifting abilities at baseline; the quality of life of the former group was higher than that of the latter at follow-up. CONCLUSIONS CRT seems to be promising in enhancing the effectiveness of concurrent treatment.
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Dahlgren CL, Lask B, Landrø NI, Rø Ø. Developing and evaluating cognitive remediation therapy (CRT) for adolescents with anorexia nervosa: a feasibility study. Clin Child Psychol Psychiatry 2014; 19:476-87. [PMID: 23761592 DOI: 10.1177/1359104513489980] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive Remediation Therapy (CRT) aims at improving neuropsychological weaknesses and associated thinking styles in patients with anorexia nervosa (AN). It has only recently been developed for adolescents with AN, and evidence of its applicability for this particular patient group is limited. This study aimed to test the feasibility of individually tailored and delivered CRT for young females with AN. METHODS A sample of 20 in- and outpatients (13-18 years) with AN participated in once- or twice weekly individual CRT sessions. The CRT materials used were available in a "CRT Resource Pack." Feasibility was assessed with regards to the recruitment process, the delivery of the intervention, the materials used and clinical experiences. RESULTS Overall results indicate that the intervention was feasible with regards to (a) the recruitment of both in- and outpatients, (b) individual tailoring and delivery, (c) the CRT materials adapted to suit young females with AN, and (d) the acceptability for clinicians involved in the study. There were no voluntary dropouts, with 19 of 20 patients completing the entire course of treatment. CONCLUSIONS The findings have implications for the refinement of CRT for the youngest AN population, and strengthens our understanding of the core components in the development and evaluation of novel interventions targeting AN. This study will help inform the design of a subsequent randomized controlled trial.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK Care UK, London, UK
| | - Nils-Inge Landrø
- Center for the Study of Human Cognition, Department of Psychology, University of Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
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23
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Lindvall Dahlgren C, Rø O. A systematic review of cognitive remediation therapy for anorexia nervosa - development, current state and implications for future research and clinical practice. J Eat Disord 2014; 2:26. [PMID: 25254110 PMCID: PMC4173002 DOI: 10.1186/s40337-014-0026-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/27/2014] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To systematically review studies of cognitive remediation therapy (CRT) for anorexia nervosa (AN), and to discuss findings with references to clinical practice and future research. METHOD The literature was reviewed using the PubMed, Web of Science and PsycINFO search terms "cognitive remediation therapy" AND "anorexia nervosa". Papers published online between 2005 and 2013 were selected on the basis of three inclusion criteria: 1) studies of any design focusing on CRT for AN, 2) papers that were written in English or had an available published English translation, and 3) papers published in peer reviewed journals. RESULTS A total of 45 papers were identified of which 21 were recognized as being relevant for the review. Relevant papers were divided into three different categories 1) single case reports, 2) case series and 3) randomised controlled trials (RCTs). Single case studies and case series yielded strong evidence of feasibility and acceptability of CRT for AN despite great variety in sample compositions. Four RCTs demonstrate that CRT has the potential of enhancing the effectiveness of current treatments, reduce attrition, increase cognitive set-shifting abilities and quality of life, as well as reduce eating disorder psychopathology. DISCUSSION The number of CRT studies published is growing rapidly, in particular RCTs. Further research is needed to define the primary aim of delivering CRT to patients with eating disorders, and to establish how to best measure the effect of the intervention. Moreover, researchers and clinicians should focus on identifying and assessing specific versus non-specific CRT contributions, and explore long-term effects of the intervention. It is imperative that adolescent RCTs are conducted to evaluate how CRT may be effective as a treatment for this young patient group.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway ; Department of Psychiatry, Centre for Research on Eating Disorders at Oxford (CREDO), University of Oxford, Warneford Hospital, Oxford, UK
| | - Oyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway ; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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24
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Brockmeyer T, Ingenerf K, Walther S, Wild B, Hartmann M, Herzog W, Bents H, Friederich HC. Training cognitive flexibility in patients with anorexia nervosa: a pilot randomized controlled trial of cognitive remediation therapy. Int J Eat Disord 2014; 47:24-31. [PMID: 24166941 DOI: 10.1002/eat.22206] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/04/2013] [Accepted: 09/14/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Inefficient cognitive flexibility is considered a neurocognitive trait marker involved in the development and maintenance of anorexia nervosa (AN). Cognitive Remediation Therapy (CRT) is a specific treatment targeting this cognitive style. The aim of this study was to investigate the feasibility and efficacy (by estimating the effect size) of specifically tailored CRT for AN, compared to non-specific cognitive training. METHOD A prospective, randomized controlled, superiority pilot trial was conducted. Forty women with AN receiving treatment as usual (TAU) were randomized to receive either CRT or non-specific neurocognitive therapy (NNT) as an add-on. Both conditions comprised 30 sessions of computer-assisted (21 sessions) and face-to-face (9 sessions) training over a 3-week period. CRT focused specifically on cognitive flexibility. NNT was comprised of tasks designed to improve attention and memory. The primary outcome was performance on a neuropsychological post-treatment assessment of cognitive set-shifting. RESULTS Data available from 25 treatment completers were analyzed. Participants in the CRT condition outperformed participants in the NNT condition in cognitive set-shifting at the end of the treatment (p = 0.027; between-groups effect size d = 0.62). Participants in both conditions showed high treatment acceptance. DISCUSSION This study confirms the feasibility of CRT for AN, and provides a first estimate of the effect size that can be achieved using CRT for AN. Furthermore, the present findings corroborate that neurocognitive training for AN should be tailored to the specific cognitive inefficiencies of this patient group.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Abstract
Few treatments for eating disorders have established a base of empirical support, and those that have are still limited by high dropout rates and low abstinence rates. Thus, there is a critical need for innovative eating disorder treatments to fill this gap. The past decade has seen a surge in the development of novel treatments that address eating pathology. This review provides an overview of the emerging psychological treatments for eating disorders, including descriptions of the therapeutic rationales, treatment techniques, and research support. The review will cover face-to-face interventions that are provided in the context of individual or group psychotherapy. Treatments included in this review were organized into the following six categories based on their underlying therapeutic rationales: (1) cognition-focused approaches, (2) emotion regulation approaches, (3) exposure-based approaches, (4) motivational enhancement, (5) integrative approaches, and (6) family- and couple-based interventions.
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Affiliation(s)
- Kelly C Berg
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA,
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26
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Fagundo AB, Santamaría JJ, Forcano L, Giner-Bartolomé C, Jiménez-Murcia S, Sánchez I, Granero R, Ben-Moussa M, Magnenat-Thalmann N, Konstantas D, Lam T, Lucas M, Nielsen J, Bults RGA, Tarrega S, Menchón JM, de la Torre R, Cardi V, Treasure J, Fernández-Aranda F. Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa. EUROPEAN EATING DISORDERS REVIEW 2013; 21:493-9. [PMID: 24092598 DOI: 10.1002/erv.2259] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/21/2013] [Indexed: 11/11/2022]
Abstract
Although standard psychological treatments have been successful in treating several core features in eating disorders (ED), other characteristics such as emotional regulation or impulsivity appear to be more resistant to change. There is a growing body of evidence to support the efficacy of cognitive remediation for cognitive and emotional difficulties in ED. Playmancer/ Islands is a video game (VG) designed to specifically treat mental disorders, characterized by problems in impulse control. The objective of the game is to increase self-control over emotions, decision making and behaviours. The aim of this study is to describe the results from a consecutive series of nine bulimia nervosa patients who were treated with the VG in addition to cognitive behaviour therapy (CBT). The outcomes included clinical and psychopathological questionnaires, and physiological measures were obtained during the VG. Emotional regulation improved, heart rate variability increased, and respiratory rate and impulsivity measures reduced after the treatment. These findings suggest that VG training may enhance treatment for ED.
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Affiliation(s)
- Ana B Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
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27
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Dahlgren CL, Lask B, Landrø NI, Rø Ø. Neuropsychological functioning in adolescents with anorexia nervosa before and after cognitive remediation therapy: a feasibility trial. Int J Eat Disord 2013; 46:576-81. [PMID: 23828636 DOI: 10.1002/eat.22155] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate neuropsychological functioning in adolescents with anorexia nervosa (AN) before and after receiving cognitive remediation therapy (CRT). METHOD Twenty young females with AN participated in an individually-delivered CRT treatment program. Neuropsychological and psychiatric assessments were administered before and after treatment. Weight, depression, anxiety, duration of illness, and level of eating disorder psychopathology were considered as covariates in statistical analyses. RESULTS Significant changes in weight, depression, visio-spatial memory, perceptual disembedding abilities, and verbal fluency were observed. Changes in weight had a significant effect on improvements in visuo-spatial memory and verbal fluency. Results also revealed a significant effect of depressive symptoms on perceptual disembedding abilities. DISCUSSION The results suggest improvements on a number of neuropsychological functions during the course of CRT. Future studies should explore the use of additional assessment instruments, and include control groups to assess the effectiveness of the intervention.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital Ullevål HF, Norway
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28
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Abbate-Daga G, Buzzichelli S, Marzola E, Amianto F, Fassino S. Effectiveness of cognitive remediation therapy (CRT) in anorexia nervosa: A case series. J Clin Exp Neuropsychol 2012; 34:1009-15. [DOI: 10.1080/13803395.2012.704900] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
OBJECTIVE Many patients with anorexia nervosa develop an intractable and debilitating illness course. Our aims were to (i) conduct a systematic review of randomised controlled trials (RCTs) of treatment for chronic anorexia nervosa participants, and (ii) identify research informing novel therapeutic approaches for this group. METHODS Systematic search (SCOPUS plus previous reviews date 2011) of literature for (i) RCTs of treatment that included anorexia nervosa participants with a mean duration of illness of at least 3 years, (ii) studies reporting new treatments addressing factors associated with chronicity. RESULTS Evidence of efficacy for treatment approaches in severe and enduring anorexia nervosa is limited. Only one unpublished RCT designed to test a specific psychological approach for these patients was identified. There is a probable advantage for specialist psychotherapy over treatment as usual, and a promising study of relapse prevention with cognitive behaviour therapy (CBT) for anorexia nervosa (CBT-AN). Open trials have, however, reported developments in psychological therapies that warrant further specific evaluation. These include forms of CBT modified for anorexia nervosa, cognitive remediation therapy with emotion skills training, the Maudsley Model for Treatment of Adults with Anorexia Nervosa, the Community Outreach Partnership Program, Specialist Supportive Clinical Management and the approach of Strober with its emphasis on therapeutic alliance and flexible goals. CONCLUSIONS Treatment trials need to move beyond targeting core eating disorder pathology (primarily weight restoration) and examine efficacy and effectiveness in minimising harm and reducing personal and social costs of chronic illness. There is also a need to develop better definitions of chronicity, with or without treatment 'resistance' specifiers.
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Affiliation(s)
- Phillipa J Hay
- School of Medicine, University of Western Sydney, Penrith, Australia.
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Abstract
BACKGROUND Perseveration, persistence and perfectionism are traits that have been suggested to be relevant to the eating disorders. This study explored the levels and correlates of these three traits in the eating disorders and control groups. METHOD A measure of these three elements (the Persistence, Perseveration and Perfectionism Questionnaire - PPPQ-22) was administered to 99 women with eating disorders, 25 women with other psychiatric disorders, and 91 non-clinical women. Differences in PPPQ-22 scores across groups were measured, as were the associations between PPPQ-22 scores and eating attitudes. RESULTS The eating disordered groups showed lower levels of persistence (the drive towards goal achievement) than the non-clinical group, but did not show higher levels of perseveration (the following of rules, without considering whether goals are achieved). Both women with eating disorders and non-clinical controls showed correlations between eating disorder symptoms and perseveration. CONCLUSIONS The current study, using a relatively new measure, suggests that low levels of persistence, rather than high levels of perseveration, may be implicated in the eating disorders. It was less clear that perfectionism per se was a useful construct in understanding eating pathology. If confirmed by future research, persistence should be considered in treatment of these complex and challenging conditions.
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Pretorius N, Dimmer M, Power E, Eisler I, Simic M, Tchanturia K. Evaluation of a Cognitive Remediation Therapy Group for Adolescents with Anorexia Nervosa: Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2012; 20:321-5. [DOI: 10.1002/erv.2176] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Natalie Pretorius
- Child and Adolescent Eating Disorders Service; Maudsley Hospital; London; UK
| | - Mandy Dimmer
- Child and Adolescent Eating Disorders Service; Maudsley Hospital; London; UK
| | - Eoin Power
- Child and Adolescent Eating Disorders Service; Maudsley Hospital; London; UK
| | - Ivan Eisler
- Section of Family Therapy, Institute of Psychiatry; King's College London; London; UK
| | - Mima Simic
- Child and Adolescent Eating Disorders Service; Maudsley Hospital; London; UK
| | - Kate Tchanturia
- Section of Eating Disorders, Division of Psychological Medicine, Institute of Psychiatry; King's College London; London; UK
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Tchanturia K, Davies H, Roberts M, Harrison A, Nakazato M, Schmidt U, Treasure J, Morris R. Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task. PLoS One 2012; 7:e28331. [PMID: 22253689 PMCID: PMC3257222 DOI: 10.1371/journal.pone.0028331] [Citation(s) in RCA: 268] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/06/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND People with eating disorders (ED) frequently present with inflexible behaviours, including eating related issues which contribute to the maintenance of the illness. Small scale studies point to difficulties with cognitive set-shifting as a basis. Using larger scale studies will lend robustness to these data. METHODOLOGY/PRINCIPAL FINDINGS 542 participants were included in the dataset as follows: Anorexia Nervosa (AN) n = 171; Bulimia Nervosa (BN) n = 82; Recovered AN n = 90; Healthy controls (HC): n = 199. All completed the Wisconsin Card Sorting Task (WCST), an assessment that integrates multiple measurement of several executive processes concerned with problem solving and cognitive flexibility. The AN and BN groups performed poorly in most domains of the WCST. Recovered AN participants showed a better performance than currently ill participants; however, the number of preservative errors was higher than for HC participants. CONCLUSIONS/SIGNIFICANCE There is a growing interest in the diagnostic and treatment implications of cognitive flexibility in eating disorders. This large dataset supports previous smaller scale studies and a systematic review which indicate poor cognitive flexibility in people with ED.
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Affiliation(s)
- Kate Tchanturia
- Division of Psychological Medicine, Institute of Psychiatry, King's College London (KCL), London, United Kingdom.
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Jenkins PE, O'Connor H. Discerning thoughts from feelings: the cognitive-affective division in eating disorders. Eat Disord 2012; 20:144-58. [PMID: 22364345 DOI: 10.1080/10640266.2012.654058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article delineates the phenomenon of "cognitive-affective division" in eating disorders, used to refer to the difficulty some patients face in translating what they "think" cognitively to what they "feel" emotionally. A clinical description of cognitive-affective division is first presented, drawing on existing research, before moving on to discuss psychological theories that might shed some light on this often-seen but seldom understood phenomenon. These include the role of emotion awareness and alexithymia, cognitive and emotional development, and neuropsychological theories. We discuss implications for treatment and further research of the cognitive-affective division in eating disorders.
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Affiliation(s)
- Paul E Jenkins
- Department of Clinical Psychology, University of Southampton, Southampton, UK.
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Rockwell RE, Boutelle K, Trunko ME, Jacobs MJ, Kaye WH. An innovative short-term, intensive, family-based treatment for adolescent anorexia nervosa: case series. EUROPEAN EATING DISORDERS REVIEW 2011; 19:362-7. [PMID: 21308869 DOI: 10.1002/erv.1094] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In order to improve the dissemination of new expert-based treatments for adolescents with anorexia nervosa, we have developed an innovative 1-week intensive family-based evaluation and treatment programme. Ages of the adolescents in the programme ranged from 10 to 18 years (mean = 15.0, SD = 2.1). We report the outcomes of the first 19 cases. METHOD Data were obtained from a retrospective chart review and a follow-up of cases at 52 to 738 days (mean = 278.4, SD = 193.8) post-treatment. The primary outcome measure was ideal body weight (IBW) percentage. RESULTS At admission, the duration of illness ranged from less than 1 to 8 years (mean 2.1, SD = 1.7). Admission IBW ranged from 69.3 to 99.1% (mean = 84.3%, SD = 8.7). Follow-up IBW ranged from 84.4 to 134.6% (mean = 99.3%, SD = 11.8). All but one patient reported a sustained gain in weight post-treatment (mean = 15.0, SD = 14.5). DISCUSSION These data provide further support for the notion that short-term family-based therapy may be useful for weight restoration and maintenance in some adolescents with anorexia nervosa.
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Affiliation(s)
- Roxanne E Rockwell
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
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Safer DL, Chen EY. Anorexia nervosa as a disorder of emotion dysregulation: Theory, evidence, and treatment implications. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1468-2850.2011.01251.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Money C, Davies H, Tchanturia K. A Case Study Introducing Cognitive Remediation and Emotion Skills Training for Anorexia Nervosa Inpatient Care. Clin Case Stud 2011. [DOI: 10.1177/1534650110396545] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Difficulties in executive functioning and emotional processing are reported in anorexia nervosa (AN).This case study describes the application of cognitive remediation and emotion skills training (CREST), an intervention that has been piloted in an inpatient eating disorders (EDs) unit. CREST is a 10-session treatment package, which primarily addresses emotion processing difficulties, one of the maintaining features of AN. The stages of CREST are described, which includes targeting thinking styles, recognizing emotions in the self and others, strategies to manage emotions, and practice of emotion expression. Clinical and self-report data collected before and after CREST indicate improvements in identifying emotions and using healthier emotion regulation strategies, alongside an increase in body mass index (BMI) and reduction in ED symptomatology. This case study provides preliminary evidence for the acceptability and effectiveness of CREST as a low-intensity intervention before proceeding to more comprehensive therapies, such as cognitive behavior therapy to address the ED more fully.
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Affiliation(s)
- Claire Money
- South London and Maudsley NHS Foundation Trust, UK
| | | | - Kate Tchanturia
- South London and Maudsley NHS Foundation Trust, UK, King's College London, UK,
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Abstract
OBJECTIVE This study aimed to evaluate the clinical benefit of Cognitive Remediation Therapy (CRT), designed to reduce the perfectionism associated with Anorexia Nervosa (AN) in an outpatient setting. METHOD The study used patient feedback and a self-report pre and post measure of perfectionism to assess the benefits of the intervention. RESULTS Patient feedback was positive, with most having found the therapy stimulating and with self reported improvements in the flexibility in thinking in their everyday lives. A selfreport measure showed both positive and negative changes to perfectionism. DISCUSSION This study suggests CRT is a promising intervention for the perfectionism associated with AN in an outpatient setting. However, CRT is not a stand alone treatment, but a pre-therapy intervention.
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Abstract
Cognitive Remediation Therapy (CRT) was designed to address the inflexible and detail focused thinking styles frequently reported in individuals with Anorexia Nervosa (AN). This paper reports the development and acceptability of a pilot of CRT for AN in group format. Four group sessions were designed and piloted with 30 patients in an eating disorder service. The voluntary drop out rate was 20%. Outcome measures targeting patients' self-reported cognitive flexibility, self esteem and motivation to change were completed in the first and last sessions. Statistically significant gains were found in self reported ability to change (p=0.03). Both patients and group facilitators found the group acceptable, useful and a positive experience.
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Roberts ME, Tchanturia K, Treasure JL. Exploring the neurocognitive signature of poor set-shifting in anorexia and bulimia nervosa. J Psychiatr Res 2010; 44:964-70. [PMID: 20398910 DOI: 10.1016/j.jpsychires.2010.03.001] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 02/26/2010] [Accepted: 03/01/2010] [Indexed: 12/30/2022]
Abstract
Poor set-shifting has been implicated as a risk marker, maintenance factor and candidate endophenotype of eating disorders (ED). This study aimed to add clarity to the cognitive profile of set-shifting by examining the trait across ED subtypes, assessing whether it is a state or trait marker, and whether it runs in families. A battery of neuropsychological tasks was administered to 270 women with current anorexia (AN) and bulimia nervosa (BN), women recovered from AN, unaffected sisters of AN and BN probands, and healthy control women. Set-shifting was examined using both individual task scores and a composite variable (poor/intact/superior shifting) calculated from four neuropsychological tasks. Poor set-shifting was found at a higher rate in those with an ED particularly binge/purging subtypes. Some evidence for poor set-shifting was also present in those recovered from AN and in unaffected sisters of AN and BN. Clinically, poor set-shifting was associated with a longer duration of illness and more severe ED rituals but not body mass index. In sum, poor set-shifting is a transdiagnostic feature related to aspects of the illness but not to malnutrition. In part it is a familial trait, and is likely involved in the maintenance of the illness.
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Affiliation(s)
- Marion E Roberts
- Institute of Psychiatry, Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, King's College London, United Kingdom.
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Kemps E, Wilsdon A. Preliminary evidence for a role for impulsivity in cognitive disinhibition in bulimia nervosa. J Clin Exp Neuropsychol 2010; 32:515-21. [PMID: 20524223 DOI: 10.1080/13803390903264122] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study investigated cognitive disinhibition in bulimia nervosa (BN) and examined whether impulsivity could account for this neuropsychological deficiency. Inhibitory processing of 13 women with BN (16-29 years) was compared against that of 13 healthy control participants matched for age, education, and socioeconomic status on a battery of widely used tasks: Stroop task, Haylings sentence completion test, excluded letter fluency, and Matching Familiar Figures Test. The women were also administered the Barratt Impulsiveness Scale (BIS-11). The BN patients displayed significant impairments on all inhibition measures and posited significantly higher impulsivity scores than the controls. Moreover, controlling for impulsivity reduced the group differences in Stroop color naming and excluded letter fluency to nonsignificance, indicating that poor inhibitory control in BN is at least partly attributable to an impulsive disposition.
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Affiliation(s)
- Eva Kemps
- Flinders University, Adelaide, SA 5001, Australia.
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Tchanturia K, Lock J. Cognitive remediation therapy for eating disorders: development, refinement and future directions. Curr Top Behav Neurosci 2010; 6:269-87. [PMID: 21243481 DOI: 10.1007/7854_2010_90] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In this chapter, we aim to address some basic conceptual and practical questions about cognitive remediation therapy (CRT) for eating disorders. We begin by providing an overall historical, conceptual, and theoretical framework for CRT. Next, we discuss the specific indications for how and why CRT might be useful for eating disorders based on existing neuropsychological research evidence. We also provide an overview of the types of tasks and stimuli used in CRT and a general protocol for a manualized version of CRT. In addition, modifications of the adult CRT manual for use with adolescents as well as preliminary acceptability of the approach with this younger age group are described. We also propose various ways to integrate CRT in a variety of inpatient and outpatient programmes. Finally, a discussion of potential future directions in research using the tools of neurocognitive assessment, imaging and treatment research is provided.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, King's College London, UK.
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Serpell L, Waller G, Fearon P, Meyer C. The roles of persistence and perseveration in psychopathology. Behav Ther 2009; 40:260-71. [PMID: 19647527 DOI: 10.1016/j.beth.2008.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 07/14/2008] [Accepted: 07/23/2008] [Indexed: 11/25/2022]
Abstract
Two constructs were hypothesized to be of importance in psychological disorders: persistence (the ability to keep going to reach a goal, even when the task is difficult or drawn out) and perseveration (the tendency to continue a behavior, even when it ceases to be effective or rewarding). These are contrasted with perfectionism (having high standards for oneself or others). A measure was developed to address these constructs (the Persistence, Perseveration and Perfectionism Questionnaire; PPPQ). The PPPQ was administered to 325 nonclinical participants, alongside a measure of psychological disturbance. Factor analysis resulted in a 22-item version of the measure, consisting of subscales with good psychometric properties corresponding to the 3 theoretical constructs. Persistence was associated with lower levels of psychopathology, whereas perseveration was associated with higher levels of psychopathology. Perfectionism was weakly associated with psychopathology. Further work is needed to develop these constructs with clinical groups, but the findings support the hypothesis that persistence is an adaptive construct whereas perseveration is maladaptive.
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Affiliation(s)
- Lucy Serpell
- Department of Clinical, Educational & Health Psychology, University College London and Central and North West London NHS Foundation Trust, London.
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Southgate L, Tchanturia K, Treasure J. Building a model of the aetiology of eating disorders by translating experimental neuroscience into clinical practice. J Ment Health 2009. [DOI: 10.1080/09638230500347541] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lopez C, Roberts ME, Tchanturia K, Treasure J. Using neuropsychological feedback therapeutically in treatment for anorexia nervosa: two illustrative case reports. EUROPEAN EATING DISORDERS REVIEW 2008; 16:411-20. [DOI: 10.1002/erv.866] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Nunn K, Frampton I, Gordon I, Lask B. The fault is not in her parents but in her insula-A neurobiological hypothesis of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2008; 16:355-60. [DOI: 10.1002/erv.890] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Whitney J, Easter A, Tchanturia K. Service users' feedback on cognitive training in the treatment of anorexia nervosa: a qualitative study. Int J Eat Disord 2008; 41:542-50. [PMID: 18433016 DOI: 10.1002/eat.20536] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is little evidence to guide the treatment of anorexia nervosa (AN). Cognitive Remediation Therapy (CRT) may be helpful in reducing perfectionism and rigidity and preparing patients for involvement in later psychological interventions. The aim of this study was to examine service users' experiences of participating in CRT. METHOD Written feedback, following 10 CRT sessions, from 19 AN patients was analyzed using grounded theory approach. RESULTS Patients' feedback was generally positive. They found CRT refreshing and appreciated that it did not revolve around food. Patients found CRT helpful in reducing perfectionism and rigidity. The majority expressed how they were able to implement skills in their real life. Some changes were suggested, these included varying levels of difficulty and more guidance in implementing skills. CONCLUSION CRT is a promising component in the treatment of AN. Further research is being conducted to evaluate CRT.
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Affiliation(s)
- Jenna Whitney
- Section of Eating Disorders, Institute of Psychiatry, King's College, London, United Kingdom
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Treasure J, Lopez C, Roberts M. Endophenotypes in eating disorders: moving toward etiologically based diagnosis and treatment focused on pathophysiology. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17455111.1.2.171] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It is hoped that the greater understanding neuroscience will bring to the field of psychiatry will lead to a more biologically based system of classification and diagnosis for psychiatric disorders. The clarification of endophenotypes might produce the ‘macros’ from which such a system could be constructed. The aim of this paper is to discuss the evidence for continuities between eating disorders and developmental disorders of childhood (autistic spectrum disorders and attention-deficit hyperactivity disorder) and possible shared endophenotypes. We review the evidence for obsessive–compulsive traits and disinhibition as intermediate phenotypes, and for information-processing styles such as weak set shifting, central coherence, disinhibition and reward sensitivity as possible endophenotypes. Finally we discuss the implications that this has for treatment.
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Affiliation(s)
- Janet Treasure
- Department Academic Psychiatry, 5th Floor Thomas Guy House, Guys Campus, London, SE1 9RT, UK
- King’s College London, Psychological Medicine Department, Institute of Psychiatry, London, UK
- South London & Maudsley NHS Trust, London, UK
| | - Carolina Lopez
- King’s College London, Psychological Medicine Department, Institute of Psychiatry, London, UK
| | - Marion Roberts
- King’s College London, Psychological Medicine Department, Institute of Psychiatry, London, UK
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Roberts ME, Demetriou L, Treasure JL, Tchanturia K. Neuropsychological profile in the overweight population: an exploratory study of set-shifting and central coherence. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/14750708.4.6.821] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roberts ME, Tchanturia K, Stahl D, Southgate L, Treasure J. A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychol Med 2007; 37:1075-1084. [PMID: 17261218 DOI: 10.1017/s0033291707009877] [Citation(s) in RCA: 341] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim was to critically appraise and synthesize the literature relating to set-shifting ability in eating disorders. PsycINFO, Medline, and Web of Science databases were searched to December 2005. Hand searching of eating-disorder journals and relevant reference sections was also undertaken. METHOD The 15 selected studies contained both eating disorder and healthy control groups, and employed at least one of the following six neuropsychological measures of set-shifting ability; Trail Making Test (TMT), Wisconsin Card Sort Test (WCST), Brixton task, Haptic Illusion, CatBat task, or the set-shifting subset of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The outcome variable was performance on the set-shifting aspect of the task. Pooled standardized mean differences (effect sizes) were calculated. RESULTS TMT, WCST, CatBat and Haptic tasks had sufficient sample sizes for meta-analysis. These four tasks yielded acceptable pooled standardized effect sizes (0.36; TMT -1.05; Haptic) with moderate variation within studies (as measured by confidence intervals). The Brixton task showed a small pooled mean difference, and displayed more variation between sample results. The effect size for CANTAB set shifting was 0.17. CONCLUSION Problems in set shifting as measured by a variety of neuropsychological tasks are present in people with eating disorders.
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Affiliation(s)
- Marion E Roberts
- Division of Psychological Medicine, Eating Disorders Research Unit, Department of Academic Psychiatry, King's College, Guy's Hospital, London, UK.
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Pretorius N, Tchanturia K. Anorexia nervosa: how people think and how we address it in cognitive remediation therapy. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/14750708.4.4.423] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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