Randomized controlled trial of cognitive remediation therapy in adolescent inpatients with anorexia nervosa: Neuropsychological outcomes

Abstract

Objective Neuropsychological dysfunction exists in anorexia nervosa (AN). Cognitive Remediation Therapy (CRT), mainly evaluated in adults with AN, targets these impairments. Methods Adolescent inpatients (age = 11–17 years) with AN were randomized to 5 weeks of either 10 sessions of individually delivered CRT or non‐specific cognitive‐training (NSCT). Co‐primary outcomes included cognitive domain ‘flexibility’ [composite score of Wisconsin Card Sorting Test (WSCT) and Trail Making Test (TMT‐4)] and ‘central coherence’ [composite score of Central Coherence Index (CCI) and Group Embedded Figures Test (GEFT)] at end of treatment (FU1). Secondary outcomes included individual test scores and self‐reported everyday‐life flexibility at FU1 and at 6‐months post‐treatment (FU2). Independent sample t‐tests, Pearson chi‐square‐tests and mixed models for repeated measures (MMRM) analyses were conducted. Results In 56 females (age = 15.1 ± 1.5 years), CRT was not superior to NSCT at FU1 regarding ‘flexibility’ (p = 0.768) or ‘central coherence’ (p = 0.354), nor at FU2 (p = 0.507; p = 0.624) (effect sizes = 0.02–0.26). Both groups improved over time in central coherence (CCI p = 0.001; GEFT p < 0.001), self‐reported flexibility (p = 0.002) and WCST (p = 0.18), but not TMT‐4 (p = 0.286). NSCT was superior to CRT regarding self‐reported planning/organisation ability at FU1 (p < 0.001) and FU2 (p = 0.003). Conclusions CRT was not superior to NSCT in adolescent inpatients with AN. More randomized controlled studies are needed.

Efficacy of educational interventions in adolescent population with feeding and eating disorders: a systematic review

“…Van Noort et al [ 27 ] performed a pre–post test evaluation in which an intervention group was compared with a healthy control. In the case of recent studies [ 28 , 29 ], two different interventions were compared in order to analyze which was more effective.…”

“…Although the interventions evaluated and implemented in the selected studies were heterogeneous in several aspects, in all of them, the theoretical basis, the place where the intervention was developed and its content were described. The interventions were carried out both in the hospital setting [ 25 , 26 , 28 , 32 ] and in outpatient [ 29 , 30 , 34 ] or mixed [ 27 ] settings, such as Day Hospital in FEDs [ 31 , 33 ].…”

“…The educational activity was conducted in groups in six of the studies [ 26 – 28 , 30 , 32 , 33 ] and one-on-one in four studies [ 25 , 29 , 31 , 34 ]. The educational intervention was developed simultaneously with the usual care in most of the studies.…”

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

“…Other studies examined the feasibility of using CRT with subgroups of adolescents with AN (e.g., obsessive compulsive traits [e.g., Lock et al, 2018] or autistic traits [e.g., Giombini et al, 2022]) or the timing of CRT (at the start or later in treatment; Giombini et al, 2022). The only published RCT on CRT in youth with AN ( N = 56) delivered individual CRT twice a week for 5 weeks during inpatient treatment and found no significant improvement in set‐shifting abilities, central coherence, and self‐reported behavioral flexibility (Herbrich‐Bowe et al, 2022). However, there is no consensus on the dose of CRT (length of sessions, number of sessions, frequency of sessions) needed to result in improvements in flexibility or central coherence.…”

“…None of the studies discussed whether or not they were conceptualizing CRT as having a rehabilitative, habilitative, or compensatory function. Overall, research investigating the effectiveness of CRT in adolescents is characterized by methodological limitations limiting the comparability of results (Hagan et al, 2020; Herbrich‐Bowe et al, 2022) and our ability to draw conclusions about the role of CRT in treating youth with AN.…”