Cognitive Remediation Therapy in Anorexia Nervosa
Condition: Teenager; Young Adult; Hospitalized; Anorexia Nervosa (DSM-IV Revised Criteria)
MeSH terms: Anorexia; Anorexia Nervosa
Study type: Interventional

Summary: 
      "Clinicians from the Maudsley (IoP, London, UK) have specifically tailored a cognitive
      remediation therapy (CRT) for treating Anorexia Nervosa (AN). It is an intensive manualised
      training cognitive therapy which addresses the difficulties in flexibility and holistic
      processing that have been incriminated in AN. CRT has been found to improve AN's
      neuropsychological functioning and short term outcome. To our knowledge, no French speaking
      country has tested its effectiveness. Moreover, the question whether it is efficient for both
      anorexic restrictive and anorexic binge-purging patients remains unanswered.

      The aim of the present study is to determine if CRT in AN adolescents and young adults has a
      favourable impact on cognitive functioning and clinical status. We will also explore whether
      the impact of CRT is similar in both anorexic restrictive and binge-purging subtypes. There
      will also be an Historical Control Group of patients, sixty, who received traditional medical
      interventions in a specialized inpatient unit for eating disorders (i.e., EVHAN study)."
    

Detailed description: 
      "Several studies have documented that patients with Anorexia Nervosa (AN) display a trait of
      cognitive inflexibility (e;g., poor set-shifting performances on the Trail Making Task B),
      i.e. an inability to move flexibly back and forth between tasks, operations, or mental sets
      which allows for the adaptation of behaviour in response to changing demands within the
      environment. This cognitive inflexibility can be observed both during the acute phase of the
      illness and after weight restoration, and has been found to predict negative treatment
      outcomes. 'Weak central coherence' is another skill which is particularly problematic in AN.
      It refers to a cognitive style in which information remains fragmented as opposed to
      integrated, with processing occurring at the level of 'detail' as opposed to 'whole'. AN
      patients exhibit this detail focussed information-processing style (e.g., as measured by the
      Embedded Figures Test). To treat these difficulties, clinicians from the Institute of
      Psychiatry (London, UK) have specifically tailored a treatment for AN. Cognitive remediation
      therapy (CRT) is an intensive training cognitive therapy that encourages people to reflect on
      and try to modify the way they think, with a particular focus on improving cognitive
      flexibility. It is a manualised therapist-led intervention consisting of multiple versions of
      a variety of tasks and mental exercises that address the difficulties in flexibility and
      holistic processing. CRT is a 10-sessions long program that has been found to improve AN's
      neuropsychological functioning and short term outcome. To our knowledge, no French speaking
      country has tested its effectiveness. Moreover, the question whether it is efficient for both
      anorexic restrictive and anorexic binge-purging patients remains unanswered.

      To address these issues, we designed a multicenter randomized clinical trial on the
      effectiveness of CRT in AN adolescents and young adults.

      Main hypothesis: AN patients treated with CRT present a better clinical status than those
      treated by a control therapy.

      Recruitment and Procedure: 120 female adolescents or young adults [15-40 years old] AN (60
      Anorexic Restrictive; 60 Anorexic Binge-Purging) will be recruited among the patients of
      specialized ED care units of three hospitals: PAUL BROUSSE, INSTITUT MUTUALISTE MONTSOURIS,
      COCHIN-MAISON DE SOLENN. In each group of AN subtype, the patients will be randomly allocated
      to one of the two treatment arms: CRT or Sham Therapy (ST). Each therapy is manualised and
      includes 10 sessions over a period of 5 weeks (2 sessions/week). All the patients will be
      assessed just prior the beginning and after the end of the CRT/ST, at 6 months and 1 year of
      follow-up."
    

Intervention name(s): Cognitive Remediation Therapy; Sham Therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Cognitive remediation therapy (CRT) is an intensive training cognitive therapy that encourages people to reflect on and try to modify the way they think, with a particular focus on improving cognitive flexibility. It is a manualised therapist-led intervention consisting of multiple versions of a variety of tasks and mental exercises that address the difficulties in flexibility and holistic processing. CRT is an individual 10-sessions long program (2 sessions per week).; The Sham therapy (ST) has been designed to match the CRT format: an individual manualised therapist-led 10-sessions long program (2 sessions per week). ST sessions have been designed so as to avoid set-shifting and central coherence training. Rather, ST is a manualised sham intervention consisting of multiple exercises on 3 domains: soft physical activity, emotional expression recognition and interpersonal functioning.
Other intervention name(s): CRT; ST
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Anorexia Nervosa; Cognitive remediation therapy; Randomized clinical trial