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Meneguzzo P, Bonello E, Tenconi E, Todisco P. Enhancing emotional abilities in anorexia nervosa treatment: A rolling-group cognitive remediation and emotional skills training protocol. EUROPEAN EATING DISORDERS REVIEW 2024; 32:1026-1037. [PMID: 38837559 DOI: 10.1002/erv.3113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/07/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Anorexia nervosa (AN) is characterised by limited remission rates and emotional dimensions are often neglected. Cognitive remediation and emotional skills training (CREST) protocol aims to address cognitive and emotional factors. This study evaluates the feasibility and effectiveness of a modified rolling-group CREST protocol in an inpatient setting. METHODS Quasi-experimental design evaluated CREST protocol in a rehabilitation programme. A total of 116 females diagnosed with AN were included, of whom 63 were included in the CREST protocol and 53 in the standard rehabilitation treatment. Various standardized measures were employed to assess psychopathology. Data collection occurred longitudinally, before and after CREST implementation. RESULTS No significant differences emerged between groups regarding changes in specific eating psychopathology. CREST group exhibited significant improvements in emotion regulation (p = 0.002) and social skills (p = 0.014), besides a reduction in alexithymia (p < 0.001) and cognitive rigidity (p = 0.013). Empathic features remained stable. Participants reported positive perceptions of the CREST intervention. DISCUSSION The study highlights the potential benefits of integrating emotional training within multidisciplinary intensive treatment for AN. Results emphasise the importance of treatment protocol with more affective and hot-cognition-related interventions, beyond weight-related psychopathology. Implementing a rolling-group CREST protocol in an inpatient setting showed promise in enhancing the emotional abilities of AN patients.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita" - Neomesia, Arcugnano (Vicenza), Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita" - Neomesia, Arcugnano (Vicenza), Italy
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Marchesi G, Cammisuli DM, Semonella M, Castelnuovo G, Pietrabissa G. The Efficacy of Cognitive Remediation Therapy for Anorexia Nervosa: A Systematic Review of Systematic Reviews. Brain Sci 2024; 14:118. [PMID: 38391693 PMCID: PMC10886621 DOI: 10.3390/brainsci14020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is an intervention specifically focused on addressing cognitive difficulties associated with the eating disorder. This systematic review of systematic reviews and meta-analysis aimed to provide a summary of the existing literature examining the efficacy of CRT in improving the neuropsychological, psychological, and clinical parameters of patients with AN. METHODS Systematic reviews and meta-analyses were sought in electronic databases, encompassing studies that explored the impact of CRT on AN. Three eligible reviews were identified based on the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was employed to evaluate the methodological quality of the reviews, and all included reviews demonstrated satisfactory methodological quality with an R-AMSTAR score of ≥22. Relevant information was extracted from each review and qualitatively compiled. RESULTS Findings suggest that CRT can help people increase their awareness of cognitive styles and information processing and have a positive effect on patients' responses to treatment. CONCLUSIONS Further research is required to better understand its impact on other relevant outcomes, including psychological variables, to optimize the treatment's benefits.
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Affiliation(s)
- Gloria Marchesi
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | | | | | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 20149 Milan, Italy
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3
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Pugh M, Bibby-Jones AM, Coyle-Stewart A, Hayward M. Relating Therapy for Distressing Voices in the Context of Anorexia Nervosa: A Case Series. J Nerv Ment Dis 2023; 211:784-790. [PMID: 37782520 DOI: 10.1097/nmd.0000000000001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
ABSTRACT Voice hearing experiences are commonly reported by patients with anorexia nervosa (AN) and are associated with negative outcomes. The "eating disorder voice" (EDV) can be understood within relational frameworks. Relating therapy (RT) has offered encouraging outcomes when targeted at voice hearing experiences transdiagnostically but has not been evaluated in the context of AN. This study aimed to offer a preliminary and mixed methods exploration of RT for the EDV. RT was delivered to three participants with a diagnosis of AN who were distressed by an EDV. Weight, negative impact of voices, and eating disorder cognitions were assessed at baseline, posttherapy and at brief follow-up. Participant experiences were explored through exit interviews. Therapy was completed by all participants. Weight gain was reported by two participants and maintained at brief follow-up. Positive changes were not reported on other measures. Qualitative data were suggestive of positive experiences that facilitated assertive responding.
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Affiliation(s)
- Matthew Pugh
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Anna-Marie Bibby-Jones
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Millview, Hove, UK
| | | | - Mark Hayward
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Millview, Hove, UK
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Meneguzzo P, Tenconi E, Todisco P, Favaro A. Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit. EUROPEAN EATING DISORDERS REVIEW 2021; 29:770-782. [PMID: 34118097 PMCID: PMC8453548 DOI: 10.1002/erv.2848] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022]
Abstract
Objective Cognitive remediation therapy (CRT) has been proposed as an add‐on treatment approach that could increase the engagement in treatment of anorexia nervosa (AN) patients and reduce maintaining factors, but prior studies have evaluated CRT in individual and group settings, difficult protocols for rehabilitation settings. Our aim is to evaluate the CRT rolling protocol implementation in an inpatient specialised unit. Methods A historical longitudinal controlled study was designed to include 31 AN patients for the CRT program, and 28 AN patients treated as usual. The CRT rolling group was implemented in a multidisciplinary inpatient rehabilitation ward with both adolescent and adult patients and an 8‐weeks protocol. To evaluate the treatment implementation effect, different self‐administered questionnaires were used. Results The study found greater improvements of the CRT group in clinical symptomatology (p = 0.039), flexibility (p = 0.003), self‐confidence about the ability to change (p < 0.001), and less short‐term focus (p < 0.001), with no differences between restrictive and binge‐purging patients. Conclusion This study demonstrates that CRT rolling group protocol is feasible in an inpatient treatment setting and may improve a rehabilitation program's outcome. Our results have shown how CRT can influence cognitive styles considered AN maintenance factors, positively affecting both restrictive and binge‐purge type. Cognitive remediation therapy (CRT) could be implemented in an inpatient setting with a rolling protocol CRT improves flexibility, drive to change, and therapy engagement No differences between restrictive or binge/purge subgroups Both adolescent and adult patients improved their cognitive styles
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy.,Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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Keegan E, Tchanturia K, Wade TD. Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2021; 54:229-243. [PMID: 33305366 DOI: 10.1002/eat.23430] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. METHOD We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. RESULTS People with anorexia nervosa (Hedge's g = -0.53, 95% CIs: -0.80, -0.27, p < .001) and bulimia nervosa (Hedge's g = -0.70, 95% CIs: -1.14, -0.25, p = .002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = -0.38, 95% CIs: -0.50, -0.26, p < .001) and bulimia nervosa (Hedge's g = -0.55, 95% CIs: -0.81, -0.29, p < .001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. DISCUSSION Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.
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Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | | | - Tracey D Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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Plemeniti Tololeski B, Suhodolčan Grabner A, Kumperscak HG. Adolescents With Autism Spectrum Disorder and Anorexia Nervosa Comorbidity: Common Features and Treatment Possibilities With Cognitive Remediation Therapy and Oxytocin. Front Psychiatry 2021; 12:686030. [PMID: 34413796 PMCID: PMC8369034 DOI: 10.3389/fpsyt.2021.686030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Autistic traits or autism spectrum disorder (ASD) can be found in 4% to 52% of anorexic patients, which makes the treatment of these patients very challenging. In this review, possible ways to treat ASD and anorexia nervosa (AN) comorbidity in children and adolescents are summarized. Over recent years, the focus has shifted from searching for the evidence of connections between these two disorders, which have started with Gillberg's study in 1983, to searching for more effective and holistic treatment of this comorbidity. The latter is known to contribute to more severe courses and worse prognosis, which is probably related to the obstacles in both diagnosing and treating. Since AN usually starts in early adolescence and high-functioning ASD children seem to begin struggling with increased pressure in adolescence, while various comorbidities can occur, it is important to improve the treatment of this comorbidity in young patients and to tailor it specifically in terms of diagnosing. In this paper, a literature review is conducted on common features and promising treatment possibilities. We describe cognitive remediation therapy and the promising pharmacotherapeutic candidate oxytocin with a special focus on adolescents.
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Affiliation(s)
- Barbara Plemeniti Tololeski
- Centre for Mental Health, Unit for Adolescent Psychiatry, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Hojka Gregoric Kumperscak
- Department for Child and Adolescent Psychiatry, University Medical Centre, Maribor, Slovenia.,Faculty for Medicine, University of Maribor, Maribor, Slovenia
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Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions. Harv Rev Psychiatry 2018; 26:250-263. [PMID: 30188337 PMCID: PMC6129986 DOI: 10.1097/hrp.0000000000000170] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Interoception, or the process of sensing, interpreting, and integrating internal bodily signals, has increasingly been the subject of scientific research over the past decade but is still not well known in clinical practice. The aim of this article is to review clinical treatment interventions that use interoception, to synthesize the current research knowledge, and to identify the gaps where future research is needed. We conducted a comprehensive literature search on randomized, controlled trials that both include interoception in treatment interventions for individuals with psychiatric disorders and measure aspects of interoception using self-report measures. Out of 14 randomized, controlled trials identified, 7 found that interventions with interoception were effective in ameliorating symptoms. These studies included individuals with anxiety disorders, eating disorders, psychosomatic disorders, and addictive disorders. All of the intervention studies with positive clinical outcomes also demonstrated changes on interoceptive measures; however, these measures were often related to specific illness symptoms. Interoception may be a mechanism of action in improving clinical symptomatology, though studies incorporating general, symptom-independent interoceptive measures remain scarce. To further our understanding of the role interoception has in psychiatric disorders and their treatment, more studies integrating interoceptive measures are needed, along with a clearer definition of interoceptive terms used.
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Okuda T, Asano K, Numata N, Hirano Y, Yamamoto T, Tanaka M, Matsuzawa D, Shimizu E, Iyo M, Nakazato M. Feasibility of cognitive remediation therapy for adults with autism spectrum disorders: a single-group pilot study. Neuropsychiatr Dis Treat 2017; 13:2185-2191. [PMID: 28860776 PMCID: PMC5565247 DOI: 10.2147/ndt.s141555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Set-shifting (SS) difficulties and weak central coherence (CC) are commonly associated with autism spectrum disorders (ASD). Cognitive remediation therapy (CRT) aims to improve such cognitive processing; however, there are no reports on CRT for patients with ASD. This pilot study aimed to provide preliminary evidence to support the use of CRT for individuals with ASD and provide data to inform future studies. PARTICIPANTS AND METHODS Nineteen individuals with ASD were recruited and administered a series of neuropsychological and questionnaire measures to examine cognitive function and clinical outcomes such as anxiety and depression. Participants received CRT, and cognitive function and clinical variables were re-evaluated at postintervention and after 3 months. RESULTS The participants demonstrated significant improvement in CC and anxiety at postintervention, which was maintained at 3-month follow-up. Although SS scores had improved with a large effect size, this was not statistically significant. CONCLUSION CRT improved CC and anxiety scores for individuals with ASD, suggesting that CRT is an effective treatment for individuals with ASD.
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Affiliation(s)
- Tomoko Okuda
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Department of Psychiatry, Chibaken Saiseikai Narashino Hospital, Narashino
| | - Kenichi Asano
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Research Center for Child Mental Development, Chiba University
| | - Noriko Numata
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University
| | - Yoshiyuki Hirano
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Research Center for Child Mental Development, Chiba University
| | | | - Mari Tanaka
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University
| | - Daisuke Matsuzawa
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University
| | - Eiji Shimizu
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Research Center for Child Mental Development, Chiba University
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University
| | - Masaomi Iyo
- Center for Forensic Mental Health, Chiba University
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michiko Nakazato
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Research Center for Child Mental Development, Chiba University
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
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Tchanturia K, Giombini L, Leppanen J, Kinnaird E. Evidence for Cognitive Remediation Therapy in Young People with Anorexia Nervosa: Systematic Review and Meta-analysis of the Literature. EUROPEAN EATING DISORDERS REVIEW 2017; 25:227-236. [DOI: 10.1002/erv.2522] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
- South London and Maudsley NHS Foundation Trust; London UK
- Illia State University; Tbilisi Georgia
| | - Lucia Giombini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
- Rhodes Wood Hospital; Elysium Healthcare; London UK
| | - Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
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Buelow MT, Barnhart WR. Test–Retest Reliability of Common Behavioral Decision Making Tasks. Arch Clin Neuropsychol 2017; 33:125-129. [DOI: 10.1093/arclin/acx038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 04/05/2017] [Indexed: 01/21/2023] Open
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Herbrich L, van Noort B, Pfeiffer E, Lehmkuhl U, Winter S, Kappel V. Follow-up Assessment of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2017; 25:104-113. [DOI: 10.1002/erv.2501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/18/2016] [Accepted: 12/02/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Laura Herbrich
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Betteke van Noort
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Ernst Pfeiffer
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Ulrike Lehmkuhl
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Sibylle Winter
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Viola Kappel
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
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Benefits of group cognitive remediation therapy in anorexia nervosa: case series. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2016; 30:42-9. [PMID: 26943839 PMCID: PMC4799273 DOI: 10.1007/s40211-016-0177-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/19/2016] [Indexed: 12/30/2022]
Abstract
Background Cognitive remediation therapy (CRT) is a treatment targeting cognitive difficulties in psychiatric disorders. CRT has been used with patients with severe anorexia nervosa (AN) in individual and group formats. Research of group CRT in AN is limited. Methods Evaluation of a series of CRT groups delivered in inpatient and intensive daycare services was performed. Participants’ self-reported cognitive flexibility and central coherence, as well as motivation to change were assessed pre- and post-group. Additionally, patients’ evaluative feedback was collected after completion of the group. Results There was a significant improvement in the patients’ self-reported cognitive flexibility and bigger picture thinking, as well as in their self-efficacy to change. The feedback questionnaires highlighted that patients found the sessions useful and reported confidence in using some of the skills and strategies they learnt in the group. Conclusion In line with evidence from small-scale reports, this larger scale case series study indicates that group CRT leads to increased flexibility and bigger picture thinking, as well as improved confidence in the ability to change for participants. CRT in a group format seems to be a practical and helpful intervention for patients with AN in intensive treatment programmes.
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Abstract
PURPOSE OF REVIEW This review compares the literature on cognitive remediation therapy (CRT) for eating disorders with findings in the field of schizophrenia, and discusses future directions for CRT for eating disorders. RECENT FINDINGS First studies using a randomized controlled trial design show the added value of CRT for eating disorders. Patients reported lessened symptoms and further improvements in quality of life and cognitive flexibility. Furthermore, the acceptability of the intervention was good and attrition rates for CRT itself were low. Research into the use of cognitive remediation for schizophrenia is extensive and the results on global cognition appeared to be robust at post-treatment and durable at follow-up, with small to medium effect sizes. Recent articles within the field of schizophrenia emphasize the necessity of intrinsic motivation to translate cognitive gains into actual changes in everyday life. SUMMARY A next step is to examine the impact of CRT for eating disorders on motivation. It is also important to focus on the transdiagnostic use of CRT, considering the overlap in cognitive inefficiencies between eating disorders. Another important step may be to develop effective personalized methods of CRT by taking into account individual differences in cognitive processes most relevant to improvement in outcome.
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Affiliation(s)
- Unna N Danner
- aAltrecht Eating Disorders Rintveld, Zeist bUtrecht Research Group Eating Disorders, Utrecht cCenter for Eating Disorders Ursula, Leiden, The Netherlands dDepartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, USA
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Martinez MA, Craighead LW. Toward Person(ality)-Centered Treatment: How Consideration of Personality and Individual Differences in Anorexia Nervosa May Improve Treatment Outcome. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2015. [DOI: 10.1111/cpsp.12111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abbate-Daga G, Buzzichelli S, Marzola E, Aloi M, Amianto F, Fassino S. Does depression matter in neuropsychological performances in anorexia nervosa? A descriptive review. Int J Eat Disord 2015; 48:736-45. [PMID: 26032280 DOI: 10.1002/eat.22399] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 12/16/2014] [Accepted: 02/12/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This review aims to examine the impact of depressive symptoms on the assessment of cognitive flexibility, central coherence, and decision-making in individuals with anorexia nervosa (AN). METHOD An online search was carried out using PubMed and PsycInfo. Articles were selected for review if they were published in English between 1990 and 2014 and used the Wisconsin Card Sorting Test, the Trail Making Task parts A and B, the Brixton Test, the Rey-Osterrieth Complex Figure Test, and/or the Iowa Gambling Task. RESULTS Sixty-two studies were included. Thirty (48%) of the studies statistically assessed the association between depression and neurocognition in AN versus healthy controls. Where significant correlations were found, it became clear that the more serious the depression, the greater the neuropsychological impairment. Only six (10%) studies examined whether increased depressive symptoms were able to eliminate the differences between individuals with AN and healthy controls, and one study found that depressive symptoms did eliminate group differences in cognitive flexibility and decision-making. DISCUSSION Only a subgroup of articles on neuropsychology in AN adjusted for depression. However, given the role of depression that some articles suggest, future studies should pay closer attention to the evaluation of this potential confounder.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Aloi
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.,Ambulatory for Clinical Research and Treatment of Eating Disorders, Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
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Giner-Bartolomé C, Fagundo AB, Sánchez I, Jiménez-Murcia S, Santamaría JJ, Ladouceur R, Menchón JM, Fernández-Aranda F. Can an intervention based on a serious videogame prior to cognitive behavioral therapy be helpful in bulimia nervosa? A clinical case study. Front Psychol 2015; 6:982. [PMID: 26236261 PMCID: PMC4500862 DOI: 10.3389/fpsyg.2015.00982] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity. DESIGN Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an "A-B-A-C-A" single case experimental design. Impulsivity levels were assessed with the Conner's Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. RESULTS After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention. DISCUSSION This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN.
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Affiliation(s)
- Cristina Giner-Bartolomé
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | - Ana B Fagundo
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain
| | - Juan J Santamaría
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | | | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain ; Ciber Salud Mental, Instituto de Salud Carlos III , Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain
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Talbot A, Hay P, Buckett G, Touyz S. Cognitive deficits as an endophenotype for anorexia nervosa: an accepted fact or a need for re-examination? Int J Eat Disord 2015; 48:15-25. [PMID: 25046823 DOI: 10.1002/eat.22332] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate whether impaired set shifting and weak central coherence represent state or trait characteristics and, therefore, candidate endophenotypes of anorexia nervosa (AN). METHOD Forty-nine individuals with lifetime AN (24 acutely unwell, 10 weight recovered, and 15 fully recovered) and 43 healthy controls completed the Wisconsin Card Sorting Test (WCST), the Matching Familiar Figures Test, and the Rey Complex Figure Task measuring cognitive flexibility, local processing, and global processing, respectively. Participants also completed questionnaires assessing eating disorder, anxiety and depressive symptoms, obsessional traits, interpersonal functioning, and quality of life. Body mass index was calculated from height and weight measurements. RESULTS Participants with lifetime AN demonstrated poorer set shifting ability than healthy controls as evidenced by a greater number of perseverative errors on the WCST. When participants were grouped according to illness status, only those in the two recovered groups demonstrated poorer set shifting ability than healthy controls while patients with acute AN performed comparably to all other groups. There were no significant differences between groups on measures of local and global processing. No relationship was found between specific clinical features of AN and cognitive performance. DISCUSSION The results of this study are consistent with a global trend toward set shifting difficulties in patients with AN but do not support weak central coherence as a candidate endophenotype for AN. These findings have clinical implications in terms of treatment selection and planning, particularly in relation to the use of cognitive remediation therapy with patients with AN.
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Affiliation(s)
- Amy Talbot
- The Redleaf Practice, Wahroonga, New South Wales, Australia; Department of Psychology, University of Sydney, New South Wales, Australia
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Abbate-Daga G, Buzzichelli S, Marzola E, Amianto F, Fassino S. Clinical investigation of set-shifting subtypes in anorexia nervosa. Psychiatry Res 2014; 219:592-7. [PMID: 25017616 DOI: 10.1016/j.psychres.2014.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 11/17/2022]
Abstract
While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
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19
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Exposure-Based Family Therapy (FBT-E): An Open Case Series of a New Treatment for Anorexia Nervosa. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tchanturia K, Lounes N, Holttum S. Cognitive remediation in anorexia nervosa and related conditions: a systematic review. EUROPEAN EATING DISORDERS REVIEW 2014; 22:454-62. [PMID: 25277720 DOI: 10.1002/erv.2326] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/07/2022]
Abstract
Research evidence for cognitive remediation therapy's (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK; South London and Maudsley NHS Trust Eating Disorders National Service, UK; Illia University Tbilisi, Georgia
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Dahlgren CL, Lask B, Landrø NI, Rø Ø. Developing and evaluating cognitive remediation therapy (CRT) for adolescents with anorexia nervosa: a feasibility study. Clin Child Psychol Psychiatry 2014; 19:476-87. [PMID: 23761592 DOI: 10.1177/1359104513489980] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive Remediation Therapy (CRT) aims at improving neuropsychological weaknesses and associated thinking styles in patients with anorexia nervosa (AN). It has only recently been developed for adolescents with AN, and evidence of its applicability for this particular patient group is limited. This study aimed to test the feasibility of individually tailored and delivered CRT for young females with AN. METHODS A sample of 20 in- and outpatients (13-18 years) with AN participated in once- or twice weekly individual CRT sessions. The CRT materials used were available in a "CRT Resource Pack." Feasibility was assessed with regards to the recruitment process, the delivery of the intervention, the materials used and clinical experiences. RESULTS Overall results indicate that the intervention was feasible with regards to (a) the recruitment of both in- and outpatients, (b) individual tailoring and delivery, (c) the CRT materials adapted to suit young females with AN, and (d) the acceptability for clinicians involved in the study. There were no voluntary dropouts, with 19 of 20 patients completing the entire course of treatment. CONCLUSIONS The findings have implications for the refinement of CRT for the youngest AN population, and strengthens our understanding of the core components in the development and evaluation of novel interventions targeting AN. This study will help inform the design of a subsequent randomized controlled trial.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK Care UK, London, UK
| | - Nils-Inge Landrø
- Center for the Study of Human Cognition, Department of Psychology, University of Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
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22
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Lindvall Dahlgren C, Rø O. A systematic review of cognitive remediation therapy for anorexia nervosa - development, current state and implications for future research and clinical practice. J Eat Disord 2014; 2:26. [PMID: 25254110 PMCID: PMC4173002 DOI: 10.1186/s40337-014-0026-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/27/2014] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To systematically review studies of cognitive remediation therapy (CRT) for anorexia nervosa (AN), and to discuss findings with references to clinical practice and future research. METHOD The literature was reviewed using the PubMed, Web of Science and PsycINFO search terms "cognitive remediation therapy" AND "anorexia nervosa". Papers published online between 2005 and 2013 were selected on the basis of three inclusion criteria: 1) studies of any design focusing on CRT for AN, 2) papers that were written in English or had an available published English translation, and 3) papers published in peer reviewed journals. RESULTS A total of 45 papers were identified of which 21 were recognized as being relevant for the review. Relevant papers were divided into three different categories 1) single case reports, 2) case series and 3) randomised controlled trials (RCTs). Single case studies and case series yielded strong evidence of feasibility and acceptability of CRT for AN despite great variety in sample compositions. Four RCTs demonstrate that CRT has the potential of enhancing the effectiveness of current treatments, reduce attrition, increase cognitive set-shifting abilities and quality of life, as well as reduce eating disorder psychopathology. DISCUSSION The number of CRT studies published is growing rapidly, in particular RCTs. Further research is needed to define the primary aim of delivering CRT to patients with eating disorders, and to establish how to best measure the effect of the intervention. Moreover, researchers and clinicians should focus on identifying and assessing specific versus non-specific CRT contributions, and explore long-term effects of the intervention. It is imperative that adolescent RCTs are conducted to evaluate how CRT may be effective as a treatment for this young patient group.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway ; Department of Psychiatry, Centre for Research on Eating Disorders at Oxford (CREDO), University of Oxford, Warneford Hospital, Oxford, UK
| | - Oyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway ; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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23
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Brockmeyer T, Ingenerf K, Walther S, Wild B, Hartmann M, Herzog W, Bents H, Friederich HC. Training cognitive flexibility in patients with anorexia nervosa: a pilot randomized controlled trial of cognitive remediation therapy. Int J Eat Disord 2014; 47:24-31. [PMID: 24166941 DOI: 10.1002/eat.22206] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/04/2013] [Accepted: 09/14/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Inefficient cognitive flexibility is considered a neurocognitive trait marker involved in the development and maintenance of anorexia nervosa (AN). Cognitive Remediation Therapy (CRT) is a specific treatment targeting this cognitive style. The aim of this study was to investigate the feasibility and efficacy (by estimating the effect size) of specifically tailored CRT for AN, compared to non-specific cognitive training. METHOD A prospective, randomized controlled, superiority pilot trial was conducted. Forty women with AN receiving treatment as usual (TAU) were randomized to receive either CRT or non-specific neurocognitive therapy (NNT) as an add-on. Both conditions comprised 30 sessions of computer-assisted (21 sessions) and face-to-face (9 sessions) training over a 3-week period. CRT focused specifically on cognitive flexibility. NNT was comprised of tasks designed to improve attention and memory. The primary outcome was performance on a neuropsychological post-treatment assessment of cognitive set-shifting. RESULTS Data available from 25 treatment completers were analyzed. Participants in the CRT condition outperformed participants in the NNT condition in cognitive set-shifting at the end of the treatment (p = 0.027; between-groups effect size d = 0.62). Participants in both conditions showed high treatment acceptance. DISCUSSION This study confirms the feasibility of CRT for AN, and provides a first estimate of the effect size that can be achieved using CRT for AN. Furthermore, the present findings corroborate that neurocognitive training for AN should be tailored to the specific cognitive inefficiencies of this patient group.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Abbate-Daga G, Amianto F, Delsedime N, De-Bacco C, Fassino S. Resistance to treatment and change in anorexia nervosa [corrected]: a clinical overview. BMC Psychiatry 2013; 13:294. [PMID: 24199620 PMCID: PMC3879222 DOI: 10.1186/1471-244x-13-294] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 10/25/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. In fact, many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN--with an in-depth investigation of resistance-related psychological factors.A literature search was conducted on PubMed and PsychINFO; English-language articles published between 1990 and 2013 investigating the phenomenon of resistance to treatment in AN have been considered. DISCUSSION The selected papers have been then grouped into four main thematic areas: denial of illness; motivation to change; maintaining factors and treatment outcome; and therapeutic relationship. Eating symptomatology was found to only partially explain resistance to treatment. The role of duration of illness has been questioned whilst some maintaining factors seemed promising in providing a useful framework for this phenomenon. Emotive and relational aspects have been investigated on their role in resistance as well as therapists' countertransference. SUMMARY Remarkably there has been little research done on resistance to treatment in the ED field, in spite of its clinical relevance. Motivation, insight and subjective meaning of the illness can be useful tools to manage the resistance phenomenon when coupled with a wider approach. The latter enables the therapists to be aware of their role in the therapeutic alliance through countertransference aspects and to consider the EDs as disorders of the development of both personality and self, entailing severe impairments as regards identity and relationships.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Nadia Delsedime
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Carlotta De-Bacco
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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Abstract
PURPOSE OF REVIEW This review summarizes recent evidence on psychological treatments for eating disorders. RECENT FINDINGS Eating disorders are serious psychiatric conditions requiring evidence-based intervention. Treatments have been evaluated within each eating disorder diagnosis and across diagnoses. For adults with anorexia nervosa, no one specialist treatment has been shown to be superior. Cognitive behavioral therapy and interpersonal psychotherapy remain the most established treatments for bulimia nervosa and binge eating disorder, with stepped-care approaches showing promise and new behavioral treatments under study. Enhanced cognitive behavioral therapy has improved symptoms in adults and youth. Maudsley family-based therapy is the most established treatment for youth with anorexia nervosa and may be efficacious for youth with bulimia nervosa. Interpersonal psychotherapy for the prevention of excess weight gain may be efficacious for reducing loss of control eating and weight gain in overweight youth. SUMMARY Significant advances in treatments have been made, including evaluation of long-term outcomes, novel approaches, and tailored extension for specific patient profiles. However, widespread access to effective eating disorder treatments remains limited. Increasing the potency and expanding the implementation of psychological treatments beyond research settings into clinical practice has strong potential to increase access to care, thereby reducing the burden of eating disorders.
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Affiliation(s)
- Andrea E. Kass
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel P. Kolko
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Dahlgren CL, Lask B, Landrø NI, Rø Ø. Patient and Parental Self-reports of Executive Functioning in a Sample of Young Female Adolescents with Anorexia Nervosa Before and After Cognitive Remediation Therapy. EUROPEAN EATING DISORDERS REVIEW 2013; 22:45-52. [DOI: 10.1002/erv.2265] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/03/2013] [Accepted: 09/23/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health; Great Ormond Street Hospital for Children, NHS Trust; London UK
- Care UK; London UK
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology; University of Oslo; Oslo Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
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Amianto F, Daga GA, Bertorello A, Fassino S. Exploring personality clusters among parents of ED subjects. Relationship with parents' psychopathology, attachment, and family dynamics. Compr Psychiatry 2013; 54:797-811. [PMID: 23602391 DOI: 10.1016/j.comppsych.2013.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 02/16/2013] [Accepted: 03/04/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Eating disorders are some of the most difficult mental disorders to treat and manage. Family interacts with genetic dispositions and other pathogenic factors, and may influence the outburst, development and outcome of EDs. The present study explores with a cluster analysis the personality traits of parents of ED subjects. METHODS One-hundred-eight mothers and 104 fathers were tested with Temperament Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), State-Trait Anger Expression Inventory (STAX), Family Assessment Device (FAD), Attachment Style Questionnaire (ASQ), Symptom Questionnaire (SQ), Psychological Well-Being scales (PWB). The cluster distribution of parents based on personality traits was explored. Parents' clusters TCI scores were compared as regards personality, psychopathology, attachment and family features. Cross distribution of temperament and character clusters in mothers and fathers, among couples and ED diagnoses of the daughters was explored. RESULTS Two clusters of mothers and fathers were identified with temperament clustering. Character traits led to two mothers and three fathers clusters. Mothers temperament cluster 1 (MTC1) correspond to a explosive/adventurous profile, MTC2 to a cautious/passive-dependent profile. Fathers temperament cluster 1 (FTC1) was explosive/methodic, FTC2 was independent/methodic. Character clustering distinguished very immature mothers (MCC1) and majority (65%) of character mature mothers with low self-transcendence (MCC2). A third of fathers was severely immature (FCC1), a third impaired as regards relationships (poor cooperativeness and self-transcendence; FCC2), and one third character mature fathers with low self-transcendence (FCC3). Each cluster evidences specific psychopathology and attachment characteristics. FTC1 was more frequently associated with character immaturity. No significant clusters' cross correlation was found in parental couples. CONCLUSION Parents' clusters analyze in depth the univocal picture of prototypical mothers and fathers of EDs. Parents not disturbed as regards personality traits are not exceptions. Since EDs are multifactor disorders family dynamics related to parents' personality may be very relevant or even marginal in their pathogenesis. Conversely, parenting may be negatively influenced by relatively marginal personality malfunctions of parents. The clustering approach to the complexity of personality-related dynamics of ED families improves the picture of ED parents. Psychoeducational, counseling and psychotherapeutic family interventions should consider the specific underlying personality of parents.
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Affiliation(s)
- Federico Amianto
- Department of Neuroscience, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Turin.
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Dahlgren CL, Lask B, Landrø NI, Rø Ø. Neuropsychological functioning in adolescents with anorexia nervosa before and after cognitive remediation therapy: a feasibility trial. Int J Eat Disord 2013; 46:576-81. [PMID: 23828636 DOI: 10.1002/eat.22155] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate neuropsychological functioning in adolescents with anorexia nervosa (AN) before and after receiving cognitive remediation therapy (CRT). METHOD Twenty young females with AN participated in an individually-delivered CRT treatment program. Neuropsychological and psychiatric assessments were administered before and after treatment. Weight, depression, anxiety, duration of illness, and level of eating disorder psychopathology were considered as covariates in statistical analyses. RESULTS Significant changes in weight, depression, visio-spatial memory, perceptual disembedding abilities, and verbal fluency were observed. Changes in weight had a significant effect on improvements in visuo-spatial memory and verbal fluency. Results also revealed a significant effect of depressive symptoms on perceptual disembedding abilities. DISCUSSION The results suggest improvements on a number of neuropsychological functions during the course of CRT. Future studies should explore the use of additional assessment instruments, and include control groups to assess the effectiveness of the intervention.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital Ullevål HF, Norway
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