Cognitive Remediation Therapy for Anorexia Nervosa

Stanford University, Stanford CA

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Abstract

[unreadable] DESCRIPTION (provided by applicant): Anorexia Nervosa (AN) is a serious mental disorder with a prevalence rate of about 1%, a mortality rate of about 10%, and is as costly to treat as schizophrenia. No psychological or psychopharmacological treatments are known to be effective for adults with AN in part because existing studies have had difficulty retaining subjects in treatment. One potentially modifiable reason that has been suggested to assist with this problem is to address the specific cognitive impairments (inflexibility, set shifting, and weak central coherence) associated with AN through cognitive remediation therapy (CRT) prior to initiating a more specific treatment such as CBT. Evidence from the literature in schizophrenia, obsessive-compulsive disorder and traumatic brain injury indicate that CRT is an effective strategy for teaching new cognitive skills. Preliminary data suggest that CRT is both acceptable and feasible for adult AN subjects; however it has not yet been studied when added to a potentially effective psychotherapy such as cognitive behavioral therapy (CBT).The specific aims of this initial study are: Aim 1: To compare the relative efficacy of manualized CRT followed by manualized CBT-AN to manualized CBT-AN alone to retain subjects in treatment. We predict that those who receive CRT plus CBT-AN will have greater retention rates as assessed by survival curves between the treatment arms. Secondary outcomes will include changes in BMI and eating disorder psychopathology. Aim 2:To compare the relative efficacy of CRT versus CBT-AN in changing neurocognitive impairments in AN. Aim 3: To explore (post- hoc) moderators and mediators of treatment uptake, retention and outcome. To accomplish these aims, the following study is proposed: 46 subjects (ages 18 and above) meeting DSM IV criteria for AN and medically stable for outpatient treatment will be randomized to either CBT-AN (28 sessions) for 6 months or CRT (8 sessions) followed by CBT-AN for (20 sessions) for 6 months, with 23 subjects in each group. Assessments will occur at three time points: baseline, 8 weeks (end of treatment for CRT) and at 6 months follow-up. The primary outcome of the study will be time to drop out from treatment. Secondary outcomes will include changes in executive functioning (subtests of the Delis-Kaplan Executive Functioning System (D-KEFS)), the quality of the patient therapist relationship (HRQ), changes in Eating Disorder Examination (EDE) scores, and weight gain. [unreadable] [unreadable] [unreadable]