Evaluation of a Cognitive Remediation Therapy Group for Adolescents with Anorexia Nervosa: Pilot Study
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Abstract Objective Cognitive remediation therapy (CRT) has been used with adults with anorexia nervosa (AN) in individual and group formats; however, evaluation of CRT with adolescents in this population is very limited. Method Seven CRT groups were carried out with a total of 30 adolescents with AN. Adolescents' cognitive flexibility and motivation was assessed before and after the group, and they completed qualitative questionnaires after the group to determine their perceptions. Results There was a small effect size in self‐reported cognitive flexibility post group. Adolescents found the group interesting and useful; however, some wanted more support with application to real life. Discussion Cognitive remediation therapy has the potential to be used with adolescents with AN. More research is needed to determine if CRT is beneficial for young people with AN. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.Keywords:
Anorexia nervosa
Cognitive remediation therapy
Cognitive flexibility
Group psychotherapy
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BACKGROUND: Anorexia nervosa (AN) is a severe mental illness. Drug treatments are not effective and there is no established first choice psychological treatment for adults with AN. Neuropsychological studies have shown that patients with AN have difficulties in cognitive flexibility: these laboratory based findings have been used to develop a clinical intervention based on Cognitive Remediation Therapy (CRT) which aims to use cognitive exercises to strengthen thinking skills.AIMS: 1) To conduct a preliminary investigation of CRT in patients with AN 2) to explore whether cognitive training improves performance in set shifting tasks 3) to explore whether CRT exercises are appropriate and acceptable to AN patients 4) to use the data to improve a CRT module for AN patients.METHODS: Intervention was comprised of ten 45 minute sessions of CRT. Four patients with AN were assessed before and after the ten sessions using five set shifting tests and clinical assessments. At the end, each patient wrote a letter providing feedback on the intervention.RESULTS: Post intervention, three of the five set shifting assessments showed a moderate to large effect size in performance and two showed a large effect size in performance, both indicative of improved flexibility. Patients were aware of an improvement in their cognitive flexibility qualitative feedback was generally positive towards CRT.DISCUSSION: This preliminary study suggests that CRT changed performance on flexibility tasks and may be beneficial for acute, treatment resistant patients with AN. Feedback gathered from this small case series has enabled modification of the intervention for a future larger study, for example, by linking exercises with real life behavioural tasks and including exercises that encourage global thinking.CONCLUSION: This exploratory study has produced encouraging data supporting the use of CRT in patients with AN: it has also provided insight into how the module should be tailored to maximise its effectiveness for people with acute AN. PMID: 17550611
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Introduction The term executive functions (EFs) includes a set of cognitive processes such as planning, working memory, attention, problem solving, inhibition, mental flexibility, multi-tasking, and initiation and monitoring of actions. EFs are the higher order control processes to guide behaviour. Some studies on the relationship between EFs and autism spectrum disorder (ASD) showed deficit in the cognitive flexibility and speed processing, particularly with Asperger syndrome. Recently, Merchán-Naranjo et al. [1] supported that children's and adolescents with autism without intellectual disability are insufficient in at least 5 domains: attention, working memory, cognitive flexibility, inhibitory control and problem-solving. Aims Our work is aimed at verifying if the presence of a dysexecutive syndrome significantly impacts on the adaptive functioning of people with high functioning autism. Methods A group of young adults with ASD were administered traditional neuropsychological assessment, specific assessment, focusing on the planning strategies for solving problems (Test Tower of London), abstraction and categorization (Wisconsin Card Sorting Test), and the Dysexecutive Questionnaires. Results The results showed the presence of a specific deficit in the executive functioning in an average cognitive functioning. Conclusions Integrate the standard cognitive screening with a specific EFs assessment resulted to be very useful for the clinician to realize neuropsychological and psychotherapeutic individualized treatment. Disclosure of interest The authors have not supplied their declaration of competing interest.
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Anorexia nervosa (AN) is a severe mental illness. Drug treatments are not effective and there is no established first choice psychological treatment for adults with AN. Neuropsychological studies have shown that patients with AN have difficulties in cognitive flexibility: these laboratory based findings have been used to develop a clinical intervention based on Cognitive Remediation Therapy (CRT) which aims to use cognitive exercises to strengthen thinking skills.
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Anorexia nervosa (AN) has consistently been found to be associated with poor cognitive flexibility and central coherence. These two cognitive functions have been considered important maintenance factors in AN and are addressed by specific treatment approaches such as cognitive remediation therapy. While there is clear empirical evidence that difficulties in such cognitive functions are related to impaired daily functioning in schizophrenia and bipolar disorder, this potential association has received only little attention in AN research so far. Therefore, the aim of this study was to examine potential relationships between weak cognitive flexibility, central coherence, and poor quality of life (QoL) in AN.Cognitive flexibility and central coherence were measured by both neuropsychological (i.e., performance based) and self-report measures alongside with self-reported QoL in a sample of 138 adult patients with AN.Self-report but not performance based measures of cognitive flexibility and central coherence were associated with QoL. Weaker cognitive flexibility and central coherence were correlated with poorer QoL. These associations were independent of comorbid depression. The link between weak central coherence and poor QoL was particularly strong in patients with the restricting subtype of AN. The link between cognitive flexibility and QoL, however, was independent of AN subtype.Weak cognitive flexibility and central coherence are associated with low QoL in AN, especially in patients with the restrictive subtype. However, this relationship is dependent on the method of measurement, where self-report measures seem to be more relevant than performance based measures.
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Cognitive remediation therapy (CRT) aims to strengthen weak cognitive flexibility and central coherence in adult and adolescent anorexia nervosa (AN). Currently, there are no studies in adolescents with AN that control for learning effects because of re-testing while evaluating CRT.Twenty in- and outpatients with AN aged 12 to 18 years received CRT. Assessment took place directly before and after the intervention. Performance was compared to 20 age-, gender-, IQ-, and test-retest interval matched healthy controls, which did not receive CRT.AN patients showed an improvement in flexibility on neuropsychological assessment directly after CRT, whereas HC did not improve over time. Self-report assessment of flexibility, as well as central coherence, did not show significant improvement after CRT.Results suggest that CRT may be beneficial for enhancing flexibility in adolescents with AN. However, randomized controlled studies are essential to determine the actual efficacy of this intervention.
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Anorexia nervosa (AN) is characterized by severe malnutrition as well as inefficiencies in neurocognitive functioning, which are believed to contribute to the maintenance of disordered eating. The aim of this study was to examine the impact of individual cognitive remediation therapy (CRT) on neurocognition in AN.A total of 145 adult women from an eating disorders inpatient program took part in the present study. All participants were given individual CRT in addition to treatment as usual. Neurocognitive processes were assessed at baseline and at the end of treatment using task-based and self-report measures. The task-based measures included the Rey-Osterrieth Complex Figure test and the Brixton test, which were used to assess central coherence and set-shifting. The Detail and Flexibility Questionnaire was used to examine patients self-reported detail focus and cognitive flexibility.Participants showed significant improvement in task-based measures of neurocognition following CRT. There were no significant changes in self-report measures.These findings suggest that CRT may be an effective intervention targeting inefficiencies in neurocognition in AN. Future studies may benefit from assessing neural changes associated with these improvements and conducting randomized controlled trials to replicate these findings.
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Abstract: Several dermatologic abnormalities have been described In anorexia nervosa, but only rare associations have been made with pernlosis. We recently saw two teenage girls and one woman with anorexia nervosa who had symptoms of perniosis. We suggest that altered ther moregulation and a hyperreactive peripheral vascular response to cold in anorexia nervosa may predispose these patients to permiosis.
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