Cognitive remediation therapy for eating disorder
Danner, Dingemans, & Steinglass (2015)
Current opinion in psychiatry

Introduction

Cognitive remediation therapy (CRT) is a behavioural-based training intervention that aims to improve cognitive processes with the goal of durable improvement in functional outcomes.

What is cognitive remediation therapy and how does it work?

Cognitive remediation may be administered in different forms. All forms use the technique of specific and explicit training of strategies and use the use of various transfer techniques to functional improvements.

For anorexia nervosa, a manual for CRT has been proposed to focus specifically on improving cognitive flexibility by training set shifting abilities and central coherence strength. The intervention combines simple brain exercises, with reflection on thinking styles and strategies. It translates these processes to everyday life.

RCT does not directly emphasize core features of eating disorders, or emotional processes or the content of thoughts.

Patients with anorexia nervosa manifest inefficient set-shifting abilities and have a superior local processing, but inefficient global processing. These cognitive inefficiencies might relate to the inflexible behaviours and thoughts observed in anorexia nervosa patients.

Cognitive remediation therapy is theorized to capitalize on neuroplasticity. Through repetition of cognitive exercise changes in underlying neural pathways can occur. With improvement in cognitive exercises, individuals are thought to experience self-efficacy. Confidence in the capacity to achieve change is believed to be important in allowing CRT successes to generalize to life functioning.

Motivation

Improvement of neuropsychological impairments alone will not improve functional outcome. There is often ambivalence about treatment in individuals with eating disorders.

CRT provides opportunities of success in treatment.

Intrinsic motivation is inherent satisfaction derived from behaviours independent of their external consequence. Extrinsic motivation is driven by some external gain or avoidance of loss or punishment.

Functional improvement requires practice of newly learned skills, and therefore intrinsic motivation is necessary to translate cognitive gains into changes in everyday life.

Intrinsic motivation is dynamic and can be enhanced by encouraging personal goal setting, delivering treatment in group settings to create a supportive learning environment, using instructional techniques that provide a meaningful context, as well as feedback during learning activities, and by emphasising the malleability of cognitive problems.

An aim of a program to enhance intrinsic motivation is to become an independent learner, able to continue the learning process outside the program in educational and social settings.

CRT is delivered in an emphatic reflective style, with a focus on the ease with which tasks are done. This aims to motivate individuals through positive feedback.

Future of cognitive remediation therapy

One proposed rational for using CRT is that through improved cognitive functioning and enhancement the perceived ability to change, patients will become more motivated for psychological treatment following CRT. It might be that CRT is best suited to a subset of patients with specific cognitive problems, since not all patients with eating disorders have similar cognitive efficiencies or suffer from cognitive inefficiencies to the same extent.