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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 multitasking 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 coherencea term describing a preoccupation with specific detail and inattention to the “bigger picture,” central coherence is effectively addressed using CRT exercises at eating disorder 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 to use 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.

What Is Cognitive Behavioral Therapy?

From our blog: Cognitive Behavioral Therapy (CBT) was originally developed for treating mental health disorders like depression and bipolar disorder, and it has been proven to be equally effective for the treatment of eating disorders. In simplest terms, CBT is a kind of talk therapy that promotes mindfulness and objectivity through a Socratic dialectic process. This type of therapy is often used because it can help people quickly identify and learn to cope with challenges in their lives. According to the American Psychological Association, here are the core principles of CBT:

  • Problems or conditions are based, at least in part, on unhelpful or negative thinking patterns. Identifying and sharing thoughts about an individual’s problems is a major part of CBT.
  • Problems or conditions are based, at least in part, on patterns of negative behavior. It’s necessary to reshape ways of thinking that will eventually change behavior.
  • CBT provides better ways of thinking, and ultimately of coping. This can lead to the successful treatment of everything from depression and anxiety to a variety of eating disorders.
  • The core of CBT is helping an individual identify which of their thought patterns are disordered or distorted, remaining objective and non-judgmental about them. Eventually, these thoughts can be replaced with more positive ones. CBT experts will work with individuals to help them discover ways to treat their condition that is catered to their specific needs. CBT is effective for people with a wide variety of mental health disorders, and there is generally no risk involved, although the process, even with a gentle therapist can be difficult at first.

Taking the First Steps Toward Psychiatric Treatment for Anorexia Nervosa

Psychiatric care for any mental health disorder is a complex process. It’s even more so with anorexia nervosa, which is dangerous to both mental and physical health. It is often comorbid with other mental health disorders like depression and anxiety and greatly increases the risk factor for self-harm and suicidal ideation. With this in mind, psychiatric care for anorexia nervosa is not as simple as looking up a therapist on Google (although that’s a good place to start).

The first step is a psychological assessment, however. Whether it’s yourself o a loved one that needs help receiving treatment for anorexia nervosa, the best thing to do is to talk to your therapist, if you already have one, or select a qualified therapist from your insurance plan. They may not be able to provide the full curriculum of care, but they can help make a referral to someone who can Please note that if the potential patient is in serious physical distress due to the symptoms of anorexia nervosa, or is currently at risk for self-harm or suicide, you should call 911 first to ensure their safety.

From that point, a diagnosis can be made. Your therapist may refer you to a psychiatrist or they may point you to an eating disorder treatment facility. In either case, they will help the patient decide whether to enroll in residential, day treatment, or outpatient treatment. Each of these may include CRT as part of the program, and virtually all plans include CBT. Treatment centers will work on rehabilitating the patient’s relationship with food, body image, and nutrition over the course of weeks or months. It’s a long and complex process, but an essential one for people suffering from anorexia nervosa.

So, If you or a loved one is struggling with anorexia nervosa or another eating disorder, act as soon as you can. A happier, healthier life in recovery is possible – but the earlier treatment begins, the smoother the process generally goes. Reach out today for assistance.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.