title: Training cognitive flexibility in patients with anorexia nervosa: a pilot randomized controlled trial of cognitive remediation therapy.
abstract: OBJECTIVE
  Inefficient cognitive flexibility is considered a neurocognitive trait marker involved in the development and maintenance of anorexia nervosa (AN). Cognitive Remediation Therapy (CRT) is a specific treatment targeting this cognitive style. The aim of this study was to investigate the feasibility and efficacy (by estimating the effect size) of specifically tailored CRT for AN, compared to non-specific cognitive training.
  
  
  METHODS
  A prospective, randomized controlled, superiority pilot trial was conducted. Forty women with AN receiving treatment as usual (TAU) were randomized to receive either CRT or non-specific neurocognitive therapy (NNT) as an add-on. Both conditions comprised 30 sessions of computer-assisted (21 sessions) and face-to-face (9 sessions) training over a 3-week period. CRT focused specifically on cognitive flexibility. NNT was comprised of tasks designed to improve attention and memory. The primary outcome was performance on a neuropsychological post-treatment assessment of cognitive set-shifting.
  
  
  RESULTS
  Data available from 25 treatment completers were analyzed. Participants in the CRT condition outperformed participants in the NNT condition in cognitive set-shifting at the end of the treatment (p = 0.027; between-groups effect size d = 0.62). Participants in both conditions showed high treatment acceptance.
  
  
  CONCLUSIONS
  This study confirms the feasibility of CRT for AN, and provides a first estimate of the effect size that can be achieved using CRT for AN. Furthermore, the present findings corroborate that neurocognitive training for AN should be tailored to the specific cognitive inefficiencies of this patient group.
authors.affiliation: Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Brockmeyer
authors.forename: Katrin
authors.initials: K
authors.lastname: Ingenerf
authors.forename: Stephan
authors.initials: S
authors.lastname: Walther
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
authors.forename: Mechthild
authors.initials: M
authors.lastname: Hartmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.forename: Hinrich
authors.initials: H
authors.lastname: Bents
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Friederich
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology* / Q000628:therapy*; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007406:Interview, Psychological; D009483:Neuropsychological Tests; D010865:Pilot Projects; D011446:Prospective Studies; D012073:Remedial Teaching / Q000379:methods; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: anorexia nervosa; cognitive flexibility; cognitive remediation; cognitive set-shifting