What Is Cognitive Remediation Therapy and How Can It Help Teens and Adults with Anorexia Nervosa?

 One of the newer anorexia nervosa treatment methods is cognitive remediation therapy (CRT), an offshoot of cognitive behavioral therapy, originally developed for people with brain injuries. CRT has also been adapted to help patients deal with serious mental health issues like schizophrenia or bipolar disorder.

 Consisting of mental exercises intended to improve thinking skills and cognitive strategies, CRT sharpens neuronal pathways in the brain to improve the overall functioning of the brain. Certain brain networks are "activated" by CRT exercises which facilitate the involvement of lesser used brain areas to strengthen cognitive deficits shared by patients with anorexia nervosa.

Cognitive Symptomology in People with Anorexia Nervosa

Research shows that anorexia nervosa patients display two primary cognitive symptoms:

Reduced cognitive flexibility - cognitive flexibility is the ability of a person to change or shift their behavioral and mental strategies. Teens and adults receiving anorexia nervosa treatment present rigid thinking patterns controlling their eating habits and obsessive-compulsive rituals surrounding food and eating. Difficulty multi-tasking is another feature of cognitive inflexibility. Parents of teens with anorexia nervosa often report their teen becoming extremely upset when habits or routines are interrupted, even habits that do not involve eating and food.

Central coherence--a term describing a preoccupation with specific detail and inattention to the "bigger picture," central coherence is effectively addressed using CRT exercises at anorexia treatment centers. An example of how patients with anorexia nervosa become overly preoccupied with details is their obsession with food details, such as fat or calorie content. Instead of considering the nutritional benefits of food, they cannot focus on anything but the possibility of gaining weight if they eat a certain type of food.

During anorexia recovery, patients are taught using cognitive remediation therapy techniques to modify their thought processes instead of their thought content. While traditional anorexia nervosa treatment methods like cognitive behavioral therapy include addressing shape and weight concerns, CRT does not focus on deconstructing symptoms specific to anorexia nervosa. This is why CRT is almost always provided as an adjunct to other eating disorder therapies rather than a standalone treatment.

Neuropsychology and CRT

CRT involves a therapist introducing a variety of neuropsychological tasks to anorexia nervosa patients, such as puzzles, games and real-life activities designed to improve central coherence and cognitive flexibility issues. Examples of CRT activities include:
  • Changing routine behaviors that do not involve eating and food: If an individual always brushes their teeth before putting on their pajamas at night, the therapist may suggest they put their pajamas on first before brushing their teeth. While most of us could make this change easily, people with eating disorders find this kind of small change difficult to do.
  • Choosing different product brands: People receiving anorexia nervosa treatment often find it upsetting to purchase a different brand of bottled water or diet food. One of many CRT activities may involve buying different brands as a type of exposure therapy given to people with panic disorder.
  • Sitting in different places during meals: Teens with anorexia nervosa may insist on sitting in the same spot at every meal. Persuading them to sit in a different spot at the table can help improve cognitive deficits contributing to their eating disorder.
Ongoing research indicates that CRT is an acceptable adjunct therapeutic tool for most anorexia nervosa patients. Because CRT does not focus on emotionally strong content, it is seen as less threatening to patients in residential anorexia nervosa treatment centers who are early in anorexia recovery and unprepared to address extremely emotional issues and rigid behavioral patterns. In addition, CRT is seen as having real potential for enhancing the effectiveness of cognitive behavioral therapy and reducing eating disorder symptoms.
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