Cognitive remediation therapy (CRT) as a treatment enhancer of eating disorders and obsessive compulsive disorders: study protocol for a randomized controlled trial.
BACKGROUND
Anorexia nervosa (AN) and Obsessive Compulsive Disorder (OCD) are among the most incapacitating and costly of mental disorders. Cognitive Behaviour Therapy (CBT), medication, and combination regimens, to which in AN personalised guidance on weight control is added, are moderately successful, leaving room for more effective treatment algorithms. An underlying deficit which the two disorders share is cognitive inflexibility, a trait that is likely to impede treatment engagement and reduce patients' ability to benefit from treatment. Cognitive remediation therapy (CRT) is an easy-to-use intervention aimed at reducing cognitive inflexibility and thereby enhancing treatment outcome, which we aim to test in a controled study.


METHODS
In a randomized-controlled multicenter clinical trial 64 adult patients with AN and 64 with OCD are randomized to 10 bi-weekly sessions with either CRT or a control condition, after which Treatment As Usual (TAU) is started. All patients are evaluated during single-blind assessments at baseline, post-CRT/control intervention, and after 6 months. Indices of treatment effect are disorder-specific symptom severity, quality of life, and cost-effectivity. Also, moderators and mediators of treatment effects will be studied.


CONCLUSIONS
To our knowledge, this is the first randomized controlled trial using an control condition evaluating the efficacy and effectiveness of CRT as a treatment enhancer preceding TAU for AN, and the first study to investigate CRT in OCD, moreover taking cost-effectiveness of CRT in AN and OCD into account.


BACKGROUND
The Netherlands Trial Register NTR3865 . Registered 20 february 2013.
Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB, The Netherlands. b.van.passel@propersona.nl.|Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, The Netherlands. b.van.passel@propersona.nl.
Boris
B
van Passel
Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK, The Netherlands.
Unna
U
Danner
Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, Leiden, 2333 ZZ, The Netherlands.
Alexandra
A
Dingemans
Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, Leiden, 2333 ZZ, The Netherlands.|Department of Psychiatry, Leiden University Medical Centre, Einthovenweg 20, Leiden, 2333 ZC, The Netherlands.
Eric
E
van Furth
Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK, The Netherlands.|Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, The Netherlands.
Lot
L
Sternheim
Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK, The Netherlands.|Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, The Netherlands.
Annemarie
A
van Elburg
Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB, The Netherlands.|Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, The Netherlands.
Agnes
A
van Minnen
Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, The Netherlands.
Marcel
M
van den Hout
Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB, The Netherlands.|Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, The Netherlands.
Gert-Jan
GJ
Hendriks
Altrecht Academic Anxiety Centre, Nieuwe Houtenseweg 12, Utrecht, 3524 SH, The Netherlands.|Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, The Netherlands.
Daniëlle
D
Cath
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000628:therapy*; D002985:Clinical Protocols; D000072466:Cognitive Remediation; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome
Anorexia nervosa; Cognitive remediation; Obsessive compulsive disorder; Psychological treatment