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Cognitive Remediation Therapy for Eating Disorders: Development, Refinement and Future Directions

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Behavioral Neurobiology of Eating Disorders

Part of the book series: Current Topics in Behavioral Neurosciences ((CTBN,volume 6))

Abstract

In this chapter, we aim to address some basic conceptual and practical questions about cognitive remediation therapy (CRT) for eating disorders. We begin by providing an overall historical, conceptual, and theoretical framework for CRT. Next, we discuss the specific indications for how and why CRT might be useful for eating disorders based on existing neuropsychological research evidence. We also provide an overview of the types of tasks and stimuli used in CRT and a general protocol for a manualized version of CRT. In addition, modifications of the adult CRT manual for use with adolescents as well as preliminary acceptability of the approach with this younger age group are described. We also propose various ways to integrate CRT in a variety of inpatient and outpatient programmes. Finally, a discussion of potential future directions in research using the tools of neurocognitive assessment, imaging and treatment research is provided.

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References

  • Almasy L, Gur R et al (2008) A genome screen for quantitative trait loci influencing schizophrenia and neurocognitive phenotypes. Am J Psychiatry 165:1185–1192

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC

    Google Scholar 

  • Arnsten A, Shansky R (2004) Adolescence: vulnerable period for stress-induced prefrontal cortical function? Introduction to part IV. Ann NY Acad Sci 1021:143–147

    Article  PubMed  Google Scholar 

  • Baldock E, Tchanturia K (2007) Translating laboratory research into practice: foundations, functions, and future of cognitive remediation therapy for anorexia nervosa. Therapy 4:1–8

    Article  Google Scholar 

  • Buyske S, Bates M et al (2006) Cognitive traits link to human chromosomal regions. Behav Genet 36:65–76

    Article  PubMed  Google Scholar 

  • Carter C, Stewart D et al (2001) Eating disorder examinatin questionnaire: norms for young adolescent girls. Behav Res Ther 39:625–632

    Article  CAS  PubMed  Google Scholar 

  • Casey B, Jones R et al (2008) The adolescent brain. Ann NY Acad Sci 1124:111–126

    Article  CAS  PubMed  Google Scholar 

  • Cavedini P, Bassi T, Ubbiali A, Casolari A, Giordani S, Zorzi C, Bellodi L (2004) Neuropsychological investigation of decision-making in anorexia nervosa. Psychiatry Research 127:259–266

    Article  PubMed  Google Scholar 

  • Chamberlain S, FIneberg N et al (2007) Impaired cognitive flexibility and motor inhibition in unaffected first-degree relatives of patients with obsessive-compulsive disorder. Am J Psychiatry 164:335–338

    Article  PubMed  Google Scholar 

  • Chan R, Shum D, Toulopoulou T, Chen E (2008) Assessment of executive functions: review of instruments and identification of critical issues. Arch Clin Neurospychol 23:201–216

    Article  Google Scholar 

  • Chui H, Christensen B et al (2008) Cognitive function and brain structure in females with a history of adolescent-onset anorexia nervosa. Pediatrics 122:e426–e437

    Article  PubMed  Google Scholar 

  • Cooper Z, Fairburn CG (1987) The eating disorder examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 6:1–8

    Article  Google Scholar 

  • Cooper Z, Cooper PJ et al (1989) The validity of the eating disorder examination and its subscales. Br J Psychiatry 154:807–812

    Article  CAS  PubMed  Google Scholar 

  • Das J (1999) A neo-Lurian approach to assessment and remediation. Neuropsychol Rev 9(2):107–116

    Article  CAS  PubMed  Google Scholar 

  • Davies M, Tchanturia K (2005) Cognitive remediation therapy as an intervention for acute anorexia nervosa: a case report. Eur Eat Disord Rev 13:311–316

    Article  Google Scholar 

  • Delis D, Kaplan E et al (2001) Examiner’s manual: Delis-Kaplan executive functioning systems (D-KEFS). Psychological Corporation, San Antonio, TX

    Google Scholar 

  • Eack SM, Hogarty GE, Cho RY, Prasad KM, Greenwald DP, Hogarty SS, Keshavan MS (2010) Neuroprotective Effects of Cognitive Enhancement Therapy Against Gray Matter Loss in Early Schizophrenia Results From a 2-Year Randomized Controlled Trial. Arch Gen Psychiatry 67(7):674–82

    Article  PubMed  Google Scholar 

  • Eslinger P, Oliveri M (2002) Approaching interventions clinically and scientifically. In: Eslinger PJ (ed) Neuropsychological interventions – clinical research and practice. Guildford University Press, New York

    Google Scholar 

  • Fairburn CG, Cooper I (1993) The eating disorder examination. In: Fairburn CG, Wilson GT (eds) Binge eating: nature, assessment, and treatment, 12th edn. Guilford Press, New York

    Google Scholar 

  • Fossella J, Bishop S et al (2003) Exploring genetic influences on cognition: emerging strategies for target validation and treatment optimization. Curr Drug Targets CNS Neurol Disord 2:357–362

    Article  CAS  PubMed  Google Scholar 

  • Friedman N, Miyake A et al (2008) Individual differences in executive functions are almost entirely genetic in origin. J Exp Psychol Gen 137:201–225

    Article  PubMed  Google Scholar 

  • Genders R, Tchanturia K (2010) Cogntitive remediation in group format: a pilot study. J Weight Eat Disord (in press)

    Google Scholar 

  • Genders R, Davies H, StLouis L, Kyriacou O, Hambrook D, Tchanturia K (2008) Long-term benefits of CRT for anorexia. British Journal of Healthcare Management 14(12):15–19

    Google Scholar 

  • Gilbert S, Bird G et al (2008) Atypical recruitment of medical prefrontal cortex in autism spectrum disorders: an fMRI study of two executive function tasks. Neuropsychologia 46:2281–2291

    Article  PubMed  Google Scholar 

  • Gillberg I, Råstam M, Wentz E, Gillberg C (2007) Cognitive and executive functions in anorexia nervosa ten years after onset of eating disorder. J Clin Exp Neuropsychol 29(2):170–178

    Article  PubMed  Google Scholar 

  • Goldberg T, Weinberger D (2004) Genes and parsing of cognitive processes. Trends Cogn Sci 8:325–335

    Article  PubMed  Google Scholar 

  • Gosso MF, de Geus EJ, van Belzen MJ et al (2006) The SNAP-25 gene is associated with cognitive ability: evidence from a family-based study in two independent Dutch cohorts. Mol Psychiatry 11:878–886

    Article  CAS  PubMed  Google Scholar 

  • Halmi KA, Agras WS et al (2005) Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Arch Gen Psychiatry 62:776–781

    Article  PubMed  Google Scholar 

  • Hoek HW, van Hoeken D (2003) Review of prevalence and incidence of eating disorders. Int J Eat Disord 34:383–396

    Article  PubMed  Google Scholar 

  • Holliday J, Tchanturia K et al (2005) Is impaired set-shifting an endophenotype of anorexia nervosa? Am J Psychiatry 162:2269–2275

    Article  PubMed  Google Scholar 

  • Kaye W, Fudge J, Paulus M (2009) New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci 10:573–584

    Article  CAS  PubMed  Google Scholar 

  • Keski-Rahkonen A, Hoek H et al (2007) Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 164:1259–165

    Article  PubMed  Google Scholar 

  • Lauer CJ (2002) Neuropsychological findings in eating disorders. In: D'haenen H, den Boer JA, Westenberg H, Willner P (eds) Biological psychiatry. Wiley, Swansey, UK, pp 1167–1172

    Chapter  Google Scholar 

  • Lock JD, Fitzpatrick KK (2009) Anorexia nervosa. Br Med J Clin Evid 01(1011):1–19

    Google Scholar 

  • Lopez C, Tchanturia K, Stahl D, Treasure J (2008) Central coherence in eating disorders: a systematic review. Psychol Med 38(10):1393–1404

    Article  CAS  PubMed  Google Scholar 

  • Losh M, Adolphs R et al (2009) Neuropsychological profile of autism and the broad phenotype. Arch Gen Psychiatry 66:518–526

    Article  PubMed  Google Scholar 

  • Lucas AR, Beard CM et al (1991) 50-year trends in the incidence of anorexia nervosa in Rochester, Minn: a population-based study. Am J Psychiatry 148:917–929

    CAS  PubMed  Google Scholar 

  • Lucas AR, Crowson C et al (1999) The ups and downs of anorexia nervosa. Int J Eat Disord 26:397–405

    Article  CAS  PubMed  Google Scholar 

  • Luna B, Sweeney J (2004) The emergence of collaborative brain function. Ann NY Acad Sci 1021:296–309

    Article  PubMed  Google Scholar 

  • Marsh R, Maia T et al (2009a) Functional disturbances within frontostriatal circuits across multiple childhood psychopathologies. Am J Psychiatry 166:664–674

    Article  PubMed  Google Scholar 

  • Marsh R, Steinglass J et al (2009b) Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa. Arch Gen Psychiatry 66:51–63

    Article  PubMed  Google Scholar 

  • McGurk S, Twamley E, Sitzer D, McHugo G, Mueser K (2007) A meta analysis of cognitive remediation in schizophrenia. Am J Psychiatry 164:179–1802

    Article  Google Scholar 

  • Mcintosh VW, Jordan J et al (2005) Three psychotherapies for anorexia nervosa: a randomized, controlled trial. Am J Psychiatry 162:741–747

    Article  PubMed  Google Scholar 

  • Medalia A, Choi J (2009) Cognitive remediation in schizophrenia. Neuropsychol Rev 19:353–364

    Article  PubMed  Google Scholar 

  • NICE (2004) National clinical practice guideline: eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders. National Institute for Clinical Excellence, London

    Google Scholar 

  • Osterrieth P (1944) Test of copying a complex figures: contribution to the study of perception and memory. Arch Psychol 20:206–356

    Google Scholar 

  • Pike K, Walsh BT et al (2000) Cognitive-behavioral therapy in the relapse prevention of anorexia nervosa. Third International Congress of Neuropsychology, Kyoto

    Google Scholar 

  • Pike K, Walsh BT et al (2004) Cognitive-behavioral therapy in the posthospitalization treatment of anorexia nervosa. Am J Psychiatry 160:2046–2049

    Article  Google Scholar 

  • Resources PA (2003) Computerized Wisconsin Card Sort Task, (WCST), version 4

    Google Scholar 

  • Roberts M, Tchanturia K, Stahl D, Southgate L, Treasure J (2007) A systematic review and meta-analysis of set shifting ability in eating disorders. Psychol Med 37(8):1075–1084

    Article  PubMed  Google Scholar 

  • Roberts M, Tchanturia K, Treasure J (2010) Exploring the neurocognitive signature of poor set-shifting in anorexia and bulimia nervosa. J Psychiatr Res PMID:20398910

    Google Scholar 

  • Robinson I, Thompson J et al (2006) A meta-analysis of cognitive deficits in euthumic patients with bipolar disorder. J Affect Disord 93:105–115

    Article  PubMed  Google Scholar 

  • Rohling M, Faust M, Beverly B, Demakis G (2009) Effectiveness of cognitive rehabilitation following acquired brain injury: a meta – analytic re-examination of Cicerone et al. (2000–2005) systematic reviews. Neuropsychology 23:20–39

    Article  PubMed  Google Scholar 

  • Russell T, Schmidt U, Tchanturia K (2009) Aspects of social cognition in anorexia nervosa: Affective and cognitive theory of mind. Psychiatry Research 15; 168(3):181–5

    Google Scholar 

  • Sanders J, Johnson K et al (2008) A review of neuropsychological and neuroimagin research in autism spectrum disorders: attention, inhibition, and cognitive flexibility. Res Autism Spectr Disord 2:1–16

    Article  Google Scholar 

  • Schmidt U, Treasure J (2006) Anorexia nervosa: valued and visible. A cognitive interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol 45:343–366

    Article  PubMed  Google Scholar 

  • Serfaty M (1999) Cognitive therapy versus dietary counselling in the outpatient treatment of anorexia nervosa. Eur Eat Disord Rev 7:334–350

    Article  Google Scholar 

  • Siegle GJ, Ghinassi F, Thase ME (2007) Neurobehavioral therapies in the 21st century: summary of an emerging field and an extended example of cognitive control training for depression. Cognit Ther Res 31:235–262

    Article  Google Scholar 

  • Southgate L, Tchanturia K, Treasure J (2005) Building a model of the aetiology of eating disorders by translating experimental neuroscience into clinical practice. J Ment Health 14:553–566

    Article  Google Scholar 

  • Southgate L, Tchanturia K, Treasure J (2008) Information processing bias in anorexia nervosa. Psychiatry Res 160:221–227

    Article  PubMed  Google Scholar 

  • Southgate L, Tchanturia K et al (2009) Neuropsychology in eating disorders. In: Wood S, Allen N, Pantelis C (eds) Handbook of neuropsychology of mental illness. Cambridge University Press, Cambridge, pp 316–325

    Google Scholar 

  • Stevenson C, Whitmont S, Bornholt L, Livesey D, Stevenson R (2002) A cognitive remediation programme for adults with attention deficit hyperactivity disorder. Aust NZ J Psychiatry 36(5):610–616

    Article  Google Scholar 

  • Tchanturia K, Hambrook D (2009) Cognitive remediation. In: Grilo C, Mitchell J (eds) The treatment of eating disorders; Clinical handbook. Guilford Press, New York, pp 130–150

    Google Scholar 

  • Tchanturia K, Morris R, Surguladze S, Treasure J (2002) An examination of Perceptual and Cognitive Set Shifting Tasks in Acute Anorexia Nervosa and Following Recovery. Weight and Eating Disorders 7(4): 312–316

    CAS  Google Scholar 

  • Tchanturia K, Campbell I, Morris R, Treasure J (2005) Neuropsychological studies in AN. Int J Eat Disord, Special Issue Anorexia Nervosa 37:572–576

    Google Scholar 

  • Tchanturia K, Whitney J, Treasure J (2006) Can cognitive exercises help treat anorexia nervosa? A case report. Eat Weight Disord 11(4):112–117

    Google Scholar 

  • Tchanturia K, Davies H, Campbell I (2007) Cognitive Remediation for patients with anorexia nervosa: preliminary findings. Ann Gen Psychiatry 14:6–14

    Google Scholar 

  • 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(9):1371–1373

    Article  PubMed  Google Scholar 

  • Tokley M, Kemps E (2007) Preoccupation with detail contributes to poor abstraction in women with anorexia nervosa. J Clin Exp Neuropsychol 29:734–741

    Article  PubMed  Google Scholar 

  • Treasure JL, Todd G et al (1995) A pilot study of a randomized trial of cognitive-behavioral analytical therapy vs educational behavioral therapy for adult anorexia nervosa. Behav Res Ther 33:363–367

    Article  CAS  PubMed  Google Scholar 

  • Treasure J, Claudino A, Zucker N (2010) Eating disorders. Lancet 375:583–593

    Article  PubMed  Google Scholar 

  • Uher R, Treasure J (2005) Brain lesions and eating disorders. J Neurol Neurosurg Psychiatry 76(6):852–857, Review

    Article  CAS  PubMed  Google Scholar 

  • Van Son G, van Hoeken D et al (2006) Time trends in the incidence of eating disorders: a primary care study in the Netherlands. Int J Eat Disord 39:565–569

    Article  PubMed  Google Scholar 

  • Wechsler D (1997) WAIS-III Weschler adult intelligence scale, 3rd edn. Psychological Corporation, San Antonio, TX

    Google Scholar 

  • Whitney J, Easter A, Tchanturia K (2008) The patients experiences in cognitive exercise intervention for anorexia nervosa: Qualitative findings. International Journal of Eating Disorders 41(6):542–50

    Article  PubMed  Google Scholar 

  • Zastrow A, Kaiser S, Stippich C, Walther S, Herzog W, Tchanturia K, Belger A, Weisbrod M, Treasure J, Friederich H (2009) Neural correlates of impaired cognitive-behavioral flexibility in anorexia nervosa. Am J Psychiatry 166(5):608–616

    Article  PubMed  Google Scholar 

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Tchanturia, K., Lock, J. (2010). Cognitive Remediation Therapy for Eating Disorders: Development, Refinement and Future Directions. In: Adan, R., Kaye, W. (eds) Behavioral Neurobiology of Eating Disorders. Current Topics in Behavioral Neurosciences, vol 6. Springer, Berlin, Heidelberg. https://doi.org/10.1007/7854_2010_90

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