Skip to main content
SpringerLink
Log in

Evaluation of individual cognitive remediation therapy (CRT) for the treatment of young people with anorexia nervosa

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Research suggests that there are cognitive inefficiencies underlying Anorexia Nervosa (AN), with CRT showing promise in improving these inefficiencies in adults. This area has yet to be explored in a younger population. The aim of this study was to evaluate the use of CRT for young people.

Methods

A within-subjects design was used to compare the performance of children and adolescents with AN on several neuropsychological measures administered before and after a course of CRT.

Results

Ninety-two female participants diagnosed with AN aged between 11 and 17 (M = 14.8, SD = 1.6), all receiving treatment at a specialist inpatient unit. The assessment consisted of the Rey–Osterrieth Complex Figure test (ROCFT), the Behaviour Rating Inventory of Executive Function–Self-Report (BRIEF-SR), and the D-KEFS Colour-Word Interference Test (CWT). Repeated-measures t tests were used to analyse the ROCFT and BRIEF-SR data. There was a significant improvement in Central Coherence Index (p < .001), Immediate Recall (p < .001), Shift (p < .001) Cognitive Shift (p = 002), Behavioural shift (p < .001), Emotional Control (p < .001), Working Memory (p = .001), Plan/Organize (p < .001), Monitor (p = .001) BRI (p < .001), MI (p = .001), and GEC (p < .001). On the D-KEFS CWT, a repeated-measure Wilcoxon signed-rank test revealed a significant improvement in Error Rate (p = .019) and a repeated-measures t test revealed a significant improvement in time taken (p < .001).

Conclusions

Results suggest that CRT for children and adolescents with AN could strengthen specific cognitive domains.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Washington

    Book  Google Scholar 

  2. Hoek HW (2006) Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry 19:389–394

    Article  PubMed  Google Scholar 

  3. Lang K, Lopez C, Stahl D, Tchanturia K, Treasure J (2014) Central coherence in eating disorders: an updated systematic review and meta-analysis. World J Biol Psychiatry 15:586–598

    Article  PubMed  Google Scholar 

  4. Tchanturia K, Davies H, Roberts M, Harison M, Nakazato M, Schmidt U, Treasure J, Morris R (2012) Poor cognitive flexibility in eating disorders: examining the evidence using the wisconsin card sorting task. PLoS One 7:e28331. doi:10.1371/journal.pone.0028331

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Tchanturia K, Harrison A, Davies H, Roberts M, Oldershaw A, Nakazato M, Stahl D, Morris R, Schmidt U, Treasure J (2011) Cognitive flexibility and clinical severity in eating disorders. PLoS One 6:e20462. doi:10.1371/journal.pone.0020462

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wu M, Brockmeyer T, Hartmann M, Skunde M, Herzog W, Friederich HC (2014) Set-shifting ability across the spectrum of eating disorders and in overweight and obesity: a systematic review and meta-analysis. Psychol Med 22:3365–3385. doi:10.1017/S0033291715000294

    Article  Google Scholar 

  7. Stedal K, Rose M, Frampton I, Landrø NI, Lask B (2012) The neuropsychological profile of children, adolescents, and young adults with anorexia nervosa. Arch Clin Neuropsychol 27:329–337. doi:10.1093/arclin/acs032

    Article  PubMed  Google Scholar 

  8. Tenconi E, Santonastaso P, Degortes D, Bosello R, Titton F, Mapelli D, Favaro A (2010) Set-shifting abilities, central coherence, and handedness in anorexia nervosa patients, their unaffected siblings and healthy controls: exploring putative endophenotypes. World J Biol Psychiatry 11:813–823

    Article  PubMed  Google Scholar 

  9. Lask B, Frampton I (2011) Eating disorders and the brain. John Wiley & Son, Chichester, West Sussex

    Book  Google Scholar 

  10. Lang K, Tchanturia K (2014) A systematic review of central coherence in young people with Anorexia Nervosa. J Child Adolesc Behav 2:140. doi:10.4172/jcalb.1000140

    Article  Google Scholar 

  11. Lang K, Stahl D, Espie J, Treasure J, Tchanturia K (2014) Set shifting in children and adolescents with anorexia nervosa: an exploratory systematic review and meta-analysis. Int J Eat Disord 47:394–399. doi:10.1002/eat.22235

    Article  PubMed  Google Scholar 

  12. Lang K, Lloyd S, Khondoker M, Simic M, Treasure J, Tchanturia K (2015) Do children and adolescents with anorexia nervosa display an inefficient cognitive processing style? PLoS One 10:e0131724. doi:10.1371/journal.pone.0131724

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Rose M, Frampton I, Lask B (2014) Central coherence, organizational strategy, and visuospatial memory in children and adolescents with anorexia nervosa. Appl Neuropsychol Child 3:284–296. doi:10.1080/21622965.2013.775064

    Article  PubMed  Google Scholar 

  14. Kjaersdam Telléus G, Jepsen JR, Bentz M, Christiansen E, Jensen SO, Fagerlund B, Thomsen PH (2015) Cognitive profile of children and adolescents with anorexia nervosa. Eur Eat Disord Rev 23:34–42. doi:10.1002/erv.2337

    Article  PubMed  Google Scholar 

  15. Wykes T, van der Gaag M (2001) Is it time to develop a new cognitive therapy for psychosis—Cognitive remediation therapy (CRT)? Clin Psychol Rev 21:1227–1256

    Article  CAS  PubMed  Google Scholar 

  16. McGurk SR, Twamley EW, Sitzer DL, McHugo GJ (2007) A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry 164:1791–1802. doi:10.1176/appi.ajp.2007.07060906

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tchanturia K (2014) Cognitive Remediation Therapy (CRT) for eating and weight disorders. Routledge, Hove, East Sussex

    Book  Google Scholar 

  18. Davies H, Tchanturia K (2005) Cognitive remediation therapy as an intervention for acute anorexia nervosa: a case report. Eur Eat Disord Rev 13:311–316. doi:10.1002/erv.655

    Article  Google Scholar 

  19. Tchanturia K, Whitney J, Treasure J (2006) Can cognitive exercises help treat anorexia nervosa? A case report. Eat Weight Disord 11:e112–e117

    Article  CAS  PubMed  Google Scholar 

  20. Tchanturia K, Davies H, Lopez C, Schmidt U, Treasure J, Wykes T (2008) Neuropsychological task performance before and after cognitive remediation in anorexia nervosa: a pilot case-series. Psychol Med 38:1371–1373. doi:10.1017/S0033291708003796

    Article  PubMed  Google Scholar 

  21. Tchanturia K, Lounes N, Holttum S (2014) Cognitive remediation in anorexia nervosa and related conditions: a systematic review. Eur Eat Disord Rev 22:454–462. doi:10.1002/erv.2326

    Article  PubMed  Google Scholar 

  22. Tchanturia K, Lloyd S, Lang K (2013) Cognitive remediation therapy for anorexia nervosa: current evidence and future research directions. Int J Eat Disord 46:492–496. doi:10.1002/eat.22106

    Article  PubMed  Google Scholar 

  23. Wood L, Al-Khairulla H, Lask B (2011) Group cognitive remediation therapy for adolescents with anorexia nervosa. Clin Child Psychol Psychiatry 16:225–231. doi:10.1177/1359104511404750

    Article  PubMed  Google Scholar 

  24. Pretorius N, Dimmer M, Power E, Eisler I, Simic M, Tchanturia K (2012) Evaluation of a cognitive remediation therapy group for adolescents with anorexia nervosa: pilot study. Eur Eat Disord Rev 20:321–325. doi:10.1002/erv.2176

    Article  PubMed  Google Scholar 

  25. Dahlgren CL, Lask B, Landrø NI, Rø Ø (2014) Patient and parental self-reports of executive functioning in a sample of young female adolescents with anorexia nervosa before and after cognitive remediation therapy. Eur Eat Disord Rev 22:45–52. doi:10.1002/erv.2265

    Article  PubMed  Google Scholar 

  26. Gioia GA, Isquith PK, Guy SC, Kenworthy L (2000) Behavior rating inventory of executive function: professional manual. Psychological Assessment Resources Inc, USA

    Google Scholar 

  27. van Noort BM, Kraus MK, Pfeiffer E, Lehmkuhl U, Kappel V (2016) Neuropsychological and behavioural short-term effects of cognitive remediation therapy in adolescents with anorexia nervosa: a pilot study. Eur Eat Disord Rev. 24:69–74. doi:10.1002/erv.2383

    Article  PubMed  Google Scholar 

  28. Osterrieth PA (1944) Le teste du copie d’une figure complexe. Arch de Psychol 38:206–356

    Google Scholar 

  29. Delis DC, Kaplan E, Kramer JH (2001) Delis-Kaplan executive function system (D-KEFS). The Psychological Corporation, San Antonio

    Google Scholar 

  30. Rose M, Davis J, Frampton I, Lask B (2011) The Ravello profile: development of a global standard neuropsychological assessment for young people with anorexia nervosa. Clin Child Psychol Psychiatry 16:195–202. doi:10.1177/1359104511401191

    Article  Google Scholar 

  31. Tchanturia K, Davies H, Reeder C, Wykes T (2010) Cognitive remediation therapy for anorexia nervosa. http://media.wix.com/ugd/2e1018_f71866481f9f44e5a342fb068b891a8c.pdf. Accessed 23 Sept 2016

  32. Lindvall C, Owen I, Lask B (2011) Cognitive remediation therapy for children and adolescents with anorexia nervosa—the CRT resource pack. Olso University Hospital, Ulleål, HF. http://www.oslouniversitetssykehus.no/SiteCollectionDocuments/Fagfolk/Forskning%20og%20utvikling/RASP/1.-7.%20The%20CRT%20Recource%20Pack.pdf. Accessed 23 Sept 2016

  33. Giombini L, Turton R, Turco M, Nesbitt S, Lask B (2016) The use of cognitive remediation therapy on a child adolescent eating disorder unit: patients and therapists perspectives. Clin Child Psychol Psychiatry. doi:10.1177/1359104516657859

    Article  PubMed  Google Scholar 

  34. Booth R (2006) Local-global processing and cognitive style in autism spectrum disorders and typical development. Institute of Psychiatry, King’s College London, London. https://kclpure.kcl.ac.uk/portal/files/2935437/433168.pdf. Accessed 23 Sept 2016

  35. Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire. Int J Eat Disord 16:363–370

    CAS  PubMed  Google Scholar 

  36. Fairburn CG (2008) Cognitive behavior therapy and eating disorders. Guilford Press, New York

    Google Scholar 

  37. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the state-trait anxiety scale. Consulting Psychologists Press, Palo Alto

    Google Scholar 

  38. Junior MARSIPAN Guidelines (2012) Management of really sick inpatients with anorexia nervosa. Royal College of Psychiatrists, London. http://www.rcpsych.ac.uk/files/pdfversion/CR168nov14.pdf. Accessed 23 Sept 2016

  39. Treasure J, Schmidt U (2013) The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord 1:13. doi:10.1186/2050-2974-1-13

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lozano-Serra E, Andrés-Perpiña S, Lázaro-García L, Castro-Fornieles J (2014) Adolescent anorexia nervosa: cognitive performance after weight recovery. J Psychosom Res 76(1):6–11. doi:10.1016/j.jpsychores.2013.10.009 PMID 24360134

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Prof. Bryan Lask for introducing CRT in our service and the support and guidance he provided.

Author information

Authors and Affiliations

  1. Rhodes Wood Hospital, Partnerships In Care, Sheperd’s Way, Brookmans Park, Hatfield, London, AL96NN, UK

    Lucia Giombini, Jennifer Moynihan, Matteo Turco & Sophie Nesbitt

Authors
  1. Lucia Giombini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Moynihan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matteo Turco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sophie Nesbitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucia Giombini.

Ethics declarations

Disclosure of potential conflicts of interest

All authors declare that they have no conflict of interest.

Ethical approval

For this study, formal ethical approval is not required, as the therapy and assessments were a part of the standard treatment programme. The assessments were conducted to inform the content of the Cognitive Remediation Therapy sessions and to provide feedback to the patients.

Informed consent

Informed consent was obtained from all parents or guardians and individual participants included in the study at the admission.

Additional information

L. Giombini and J. Moynihan indicate co-first authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giombini, L., Moynihan, J., Turco, M. et al. Evaluation of individual cognitive remediation therapy (CRT) for the treatment of young people with anorexia nervosa. Eat Weight Disord 22, 667–673 (2017). https://doi.org/10.1007/s40519-016-0322-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-016-0322-4

Keywords

Search

Navigation