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Giombini L, Nesbitt S, Kusosa R, Hinallas K, Fabian C, Easter A, Tchanturia K. Young people and parents' views towards individual cognitive remediation therapy-qualitative findings from a feasibility randomised controlled trial. Eat Weight Disord 2022; 27:2237-2244. [PMID: 35037189 DOI: 10.1007/s40519-021-01346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Cognitive Remediation Therapy (CRT) has been used mostly in adults. Randomised Controlled Trials (RCTs) in anorexia nervosa (AN) have shown that CRT enhances cognitive flexibility, abstract thinking and is associated with quality-of-life improvement. More research is needed in younger populations. METHODS A single-centre feasibility RCT with young people (YP) with AN was conducted in an inpatient setting. A secondary aim of this study was to explore patient satisfaction and parents' views towards CRT to inform further development and implementation of CRT in YP. YP were asked to complete a therapy feedback questionnaire and write a letter with their views on CRT. Parents were asked to complete a questionnaire exploring their perceptions of CRT. Data were analysed using inductive thematic and deductive content analysis. RESULTS Both YP and parents valued CRT. Its engaging and pragmatic nature and its focus on thinking styles were perceived as a novel aspect. Parents expressed the need to be involved in the sessions to be able to continue to support their children at home. CONCLUSIONS This study confirms previous qualitative findings. Should a fully powered RCT be conducted, it would be important to take into account these findings to further adapt the content of the CRT sessions to the YP needs and to consider their parents' involvement in the sessions, which could also increase the likelihood of parents' engagement in providing their feedback. LEVEL OF EVIDENCE Level I: Evidence obtained from one randomized controlled trial.
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Affiliation(s)
- Lucia Giombini
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK.
- Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, PO59 King's College London, London, SE58AF, UK.
| | - Sophie Nesbitt
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Rutendo Kusosa
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Katerina Hinallas
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Cleo Fabian
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kate Tchanturia
- Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, PO59 King's College London, London, SE58AF, UK
- Department of Psychology, Illia University Tbilisi Georgia, Tbilisi, Georgia
- South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK
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Herbrich-Bowe L, Bentz LK, Correll CU, Kappel V, van Noort BM. Randomized controlled trial of cognitive remediation therapy in adolescent inpatients with anorexia nervosa: Neuropsychological outcomes. EUROPEAN EATING DISORDERS REVIEW 2022; 30:772-786. [PMID: 35607258 DOI: 10.1002/erv.2921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/21/2022] [Accepted: 05/08/2022] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Laura Herbrich-Bowe
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany
| | - Lea K Bentz
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany
| | - Christoph U Correll
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany.,Department of Psychiatry, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Viola Kappel
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany
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Giombini L, Nesbitt S, Kusosa R, Fabian C, Sharia T, Easter A, Tchanturia K. Neuropsychological and clinical findings of Cognitive Remediation Therapy feasibility randomised controlled trial in young people with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 30:50-60. [PMID: 34821431 DOI: 10.1002/erv.2874] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Randomised controlled trial (RCT) in adults with anorexia nervosa (AN) showed that Cognitive Remediation Therapy (CRT) enhances cognitive flexibility, abstract thinking and quality-of-life. Despite inconsistent findings, CRT has the potential as an adjunct treatment for young people (YP) with AN. A feasibility RCT was conducted in an inpatient setting. The study will also consider the effect of CRT in YP with AN and autistic symptoms. METHODS Participants were randomly allocated to the Immediate or Delayed condition to receive individual CRT sessions, in addition to standard treatment. A repeated measures design was conducted. RESULTS Eighty participants were recruited. The neuropsychological measures were feasible for evaluating individual CRT in YP. Significant improvements in set-shifting and central coherence were found, with no main effect between immediate and delayed condition. Significant interactions were found between the condition, and autism spectrum condition (ASC) and No-ASC subgroup, with significant positive impact of CRT on set-shifting in the No-ASC subgroup. There was some evidence that for the No-ASC subgroup, CRT was more effective if delivered at the start of the treatment; and for the ASC subgroup, that CRT was more effective if delivered at the later stage of treatment. CONCLUSIONS These findings suggest that the overall positive effect of CRT in set-shifting and central coherence alongside standard treatment. They also indicate the importance of screening for the presence of ASC which could require tailored CRT.
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Affiliation(s)
- Lucia Giombini
- Rhodes Wood Hospital, Elysium Healthcare, London, UK.,Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, PO59 King's College London, London, UK
| | | | | | - Cleo Fabian
- Rhodes Wood Hospital, Elysium Healthcare, London, UK
| | - Teo Sharia
- Department of Mathematics, Royal Holloway University of London, Egham, Surrey, UK
| | - Abigail Easter
- Department of Women and Children's Health, Faculty of Life Sciences & Medicine, School of Life Course Science, King's College London, London, UK
| | - Kate Tchanturia
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, PO59 King's College London, London, UK.,Department of Psychology, Illia University Tbilisi, Tbilisi, Georgia.,South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK
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Coelho JS, Suen J, Marshall S, Burns A, Lam PY, Geller J. Parental experiences with their child's eating disorder treatment journey. J Eat Disord 2021; 9:92. [PMID: 34315529 PMCID: PMC8314586 DOI: 10.1186/s40337-021-00449-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/18/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Parents are integral in the treatment of pediatric eating disorders. The current study was conducted to further understand the barriers and facilitators that parents experience in accessing specialized, tertiary level eating disorder treatment for children and adolescents. The goals of the study were to understand the processes leading to diagnosis and treatment, perceived barriers and facilitators to accessing care, and parents' experiences over the course of their child's eating disorder treatment. METHODS Ten parents whose children were admitted to a Canadian tertiary level specialized pediatric eating disorders program took part in an exit interview upon their child's completion of treatment in the program. In-depth semi-structured interviews were combined with a visual timeline. Interpretive induction was performed to generate high-level concepts that emerged from the interviews. RESULTS Five high-level concepts were identified: (1) delays in identifying eating disorder symptoms, (2) challenges in accessing eating disorder services, (3) the right treatment at the right time, (4) emotional impact on parents, and (5) parental expertise and involvement. CONCLUSIONS Several barriers were identified by parents that interfered with treatment, including system-related challenges when accessing specialized eating disorder treatment, concerns about a lack of appropriate mental health support for their child, and difficulties with transitioning between community and tertiary level care. Negative emotions, including guilt and self-blame, were common early in the treatment journey. Themes of parental involvement throughout treatment, and parents taking charge of their child's recovery, emerged across interviews. The results of this study suggest the importance of early identification of eating disorder symptoms, facilitating smoother transitions between levels of care (e.g., community services and hospital-based eating disorder care), and improving clinical decision-making to ensure children and adolescents with eating disorders receive the most appropriate treatment based on their clinical presentation.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H 3N1, Canada. .,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Janet Suen
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H 3N1, Canada
| | - Sheila Marshall
- School of Social Work, University of British Columbia, Vancouver, BC, Canada.,Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Alex Burns
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H 3N1, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H 3N1, Canada.,Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Eating Disorders Program, St. Paul's Hospital, Vancouver, BC, Canada
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