Home Clinical Psychology & Psychotherapy Group Therapy Improves Cognitive Flexibility and Reduces Depression in Adolescents with Severe Anorexia Nervosa

Group Therapy Improves Cognitive Flexibility and Reduces Depression in Adolescents with Severe Anorexia Nervosa

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Researchers from Shinshu University Hospital and other Japanese institutions recently conducted a study that showed the significant advantages of group cognitive remediation therapy (CRT) for adolescents with severe and complex anorexia nervosa (AN) who required inpatient treatment. The study, published in the journal Clinical Child Psychology and Psychiatry, marks an important advancement in the treatment of AN in Japan, where such research is sparse.

Extreme calorie restriction, a strong fear of gaining weight, and a distorted body image are the hallmarks of the serious eating disorder anorexia nervosa. Despite existing treatment options, there remains a need for more effective interventions, especially for severe cases that necessitate inpatient care. Cognitive remediation therapy, designed to enhance cognitive flexibility through targeted exercises and activities, has shown promise as an adjunct treatment for AN.

Dr Rie Kuge and her team’s study sought to examine the efficacy of group CRT as an additional treatment for Japanese adolescents with severe AN. Specifically, the research sought to evaluate the neuropsychological and psychological outcomes of CRT before, immediately after, and during follow-up in a real-world clinical setting.

The study involved 31 adolescent girls, aged 13 to 18, diagnosed with severe AN according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. These participants received standard inpatient care, including physical monitoring, individual and family sessions, behavioural therapy, dietary advice, and psychoeducation. In addition, they participated in group CRT sessions four times a week, each lasting 40 minutes, over a period of time.

The CRT sessions included various tasks aimed at improving cognitive functions such as set-shifting and central coherence. Tasks ranged from illusion exercises to geometric figure activities, and sessions were designed to facilitate reflective discussions and practical applications in daily life. The effectiveness of CRT was assessed using a combination of neuropsychological tests, psychological scales, and participant feedback.

The results revealed significant improvements in several areas among the participants who completed the CRT programme. Notably, there were medium- to large effect improvements in set-shifting abilities and depressive symptoms. Additionally, participants showed enhanced central coherence, although the effect size for this improvement was medium.

The study’s findings indicated a high completion rate for the CRT sessions, with 94% of participants finishing the programme. This high rate of completion underscores the acceptability and feasibility of group CRT for adolescents with AN. The feedback from participants was overwhelmingly positive, with many adolescents reporting that the skills learned during CRT were applicable to their daily lives.

Participants reported a greater understanding of their own thinking styles and the thinking styles of others, which facilitated more flexible and adaptive cognitive patterns. They also highlighted the practical benefits of CRT in real-life situations, such as handling unplanned events, studying, and managing mealtime challenges.

The positive outcomes of this study suggest that group CRT can be a valuable component of treatment for adolescents with severe AN, particularly those requiring inpatient care. The ability of CRT to enhance cognitive flexibility and reduce depressive symptoms presents a promising avenue for improving the overall treatment efficacy for this population.

But the study also acknowledged certain limitations, such as the lack of a control group and the concurrent use of other treatments, making it difficult to isolate the effects of CRT alone. Future research should aim to include control groups and standardise follow-up periods to better assess the long-term benefits of CRT.

Furthermore, the researchers recommend expanding the sample size and conducting comparative studies to validate these findings and explore the potential of CRT in different settings and populations. Integrating CRT with other therapeutic approaches could also provide a more comprehensive treatment framework for adolescents struggling with AN.

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