The Effectiveness of Cognitive Remediation Therapy in Patients with a Severe or Enduring Eating Disorder: A Randomized Controlled Trial

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.

Processing of novel stimuli as cognitive remediation therapy in patients with eating disorder / Procesamiento de estímulos novedosos como terapia de remediación cognitiva en pacientes con trastorno alimentario

“…Por ejemplo, Davies et al (2012) mostraron, luego de la TCR, una mejoría en diferentes medidas cognitivas, que incluyeron coherencia central y procesamiento emocional. En particular, se informa que la TRC ha logrado impulsar aspectos fundamentales de la introspección, la voluntad y la motivación para asumir cambios, con bajas tasas de deserción, buena alianza terapéutica y mejora en la calidad de vida (Dingemans et al, 2014;Tchanturia et al, 2008).…”

A systematic review of cognitive remediation therapy for anorexia nervosa ¿ development, current state and implications for future research and clinical practice

“…The authors are not aware of additional sample overlaps. One of the most recent studies explores transdiagnostic CRT without specifying ED diagnosis [57]. Out of the 21 studies reviewed, four reported results from RCTs, all which were published online in 2013 [57][58][59][60].…”

“…One of the most recent studies explores transdiagnostic CRT without specifying ED diagnosis [57]. Out of the 21 studies reviewed, four reported results from RCTs, all which were published online in 2013 [57][58][59][60]. Participants in the included studies were currently enrolled in either in-or outpatient treatment for their ED, and all received CRT as a conjunctive intervention.…”

“…NNT). In November 2013, two additional RCTs were published (online) [57,60]. The first, a small study conducted by Steinglass and colleagues [60], sought to evaluate the effect of Exposure and Response Prevention for AN (AN-EXRP) on eating behaviour during weight restoration, by comparing it to CRT.…”

Entrenamiento en remediación cognitiva y habilidades emocionales en formato grupal para pacientes con obesidad. Un estudio piloto

“…Esta intervención ha mostrado ser efi caz para mejorar la fl exibilidad cognitiva (Brockmeyer et al, 2013;Tchanturia, Lloyd, y Lang, 2013;Giombini, Moynihan, Turco, y Nesbitt, 2016), la coherencia central (Lock et al, 2013;Giombini et al, 2016), y la calidad de vida tras el tratamiento en pacientes con AN. Esta mejora se asocia a la reducción de la psicopatología alimentaria y la clínica de los pacientes (Lock et al, 2013;Dingemans et al, 2014). La CRT también se ha aplicado en pacientes con obesidad (CRT-O) (Raman, Hay, y Smith, 2014).…”