Adaptations of cognitive remediation therapy for adolescents with anorexia nervosa for delivery via telehealth

Abstract

Objective The COVID‐19 pandemic hastened a transition to treatment delivery via telehealth. While barriers still exist, the increased uptake of telehealth has the potential to increase access to mental health treatment for all diagnoses, including eating disorders. Delivery of evidence‐based treatment as well as adjunctive treatments, including those that are hard to find in‐person, have been modified to virtual format to increase accessibility and allow for continuity of care for adolescents with anorexia nervosa. Method We describe how to modify and deliver Cognitive Remediation Therapy for youth with anorexia nervosa (CRT‐AN) via a telehealth platform. Preliminary and practical guidance for best practice for both group and individual delivery is established. Results With minimal modifications, CRT‐AN can be delivered via telehealth for both individual and group delivery. More disengagement in group delivery was noted; however, overall application of the treatment via a remote platform was observed. Discussion As more treatment moves to a telehealth format, highlighting how an adjunctive treatment like CRT‐AN can combined with other treatments in a telehealth format has the potential to increase research in its implementation and furthermore increase its dissemination. Public Significance Cognitive Remediation Therapy for Anorexia Nervosa (CRT‐AN) requires significant manipulation of materials and supplementary human guidance. Suggestions for how to modify CRT‐AN for remote delivery via telehealth are provided. Modifications grew out of immediate changes made during the beginning of the COVID‐19 pandemic and can be used to inform changes therapists and programs can make to continue to or begin to use CRT‐AN in a remote fashion.

Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report

“…CRT has been validated for adult populations in both inpatient and outpatient settings, in both individual and group formats. Additionally, CRT has been shown to be suitable for delivery via telehealth (Orloff et al, 2023). Sessions will be audio recorded and a random subset will be coded for fidelity by trained research assistants to ensure manual adherence.…”

“…Additionally, the intervention will be delivered entirely virtually. CRT has been validated for virtual administration, and given the lasting virtual format of many AN programs, the virtual format will allow for implementation in those locations and may reach more individuals in need (Orloff et al, 2023). However, virtually administered interventions carry some downsides, including the need for additional equipment and potentially less accurate observable behavioral assessment (e.g., observing anxious leg movement).…”

The importance of improving cognitive flexibility in adolescents with anorexia nervosa: The case for cognitive remediation therapy

“…Of these elements, the two that affect the most change are having an active and trained therapist and the structured development of cognitive strategies (Vita et al, 2021). CRT is typically delivered in in‐person and individual formats, but it has been successfully used in group formats, in computer‐assisted formats (Eichen et al, 2017), and, more recently, via telehealth (Orloff et al, 2022).…”