Cognitive Remediation Therapy for Adolescents with Anorexia Nervosa—Treatment Satisfaction and the Perception of Change

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.

Obesity, Appetite, and the Prefrontal Cortex

“…In addition to tDCS and cognitive training, other interventions such as cognitive remediation therapy (CRT) and cognitive behavioral therapy (CBT), which have been utilized in the treatment for BED, provide further evidence of the DLPFC association with obesity. CRT is frequently employed in young individuals, used to prompt reflection on thinking styles to improve central coherence [77]. The literature suggests that CRT, tested in individuals with addiction, improves decision making capabilities and reduces the need for immediate rewards [78].…”

General and Eating Disorder Specific Flexibility: Development and Validation of the Eating Disorder Flexibility Index (EDFLIX) Questionnaire

“…Cognitive and behavioral inflexibility may manifest in aspects of the patients’ everyday life and lead to problems with general flexibility, but they may also manifest in terms of ED psychopathology, thereby resulting in problems with ED specific flexibility (Aloi et al, 2015; Dingemans et al, 2015). General inflexibility can manifest in rigid housekeeping or homework routines, but also in the social realm with interactions characterized by strict rules and regimes (Dahlgren and Stedal, 2017). Examples of ED specific inflexibility include strict rules around food preparation and eating, as well as ritualized weighing, body checking and exercise routines (Wu et al, 2014).…”

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

“…Existing literature demonstrates CRT for adults with AN can improve flexibility (Brockmeyer et al, 2014;Lock et al, 2013), reduce treatment drop-out (Herbrich et al, 2017;Tchanturia et al, 2013), and that it is perceived as being helpful by clinicians and patients alike (Dahlgren & Stedal, 2017;Easter & Tchanturia, 2011).…”

“…To date, the primary focus in CRT research in individuals with AN has been demonstrating the feasibility of interventions, acceptability of the intervention, and improvements in cognitive flexibility and central coherence; very few randomized controlled trials exist, particularly in an adolescent‐only sample (Dahlgren & Rø, 2014; Hagan et al, 2020). Existing literature demonstrates CRT for adults with AN can improve flexibility (Brockmeyer et al, 2014; Lock et al, 2013), reduce treatment drop‐out (Herbrich et al, 2017; Tchanturia et al, 2013), and that it is perceived as being helpful by clinicians and patients alike (Dahlgren & Stedal, 2017; Easter & Tchanturia, 2011).…”