Cognitive remediation therapy

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Cognitive remediation is designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved psychosocial functioning.

Contents

Empirical support

Empirical support for cognitive remediation in traumatic brain injury and schizophrenia is documented by published randomized controlled trials and meta-analyses. [1] [2] [3] Effects on cognitive skill performance in schizophrenia are durable for months after the therapies are withdrawn, particularly in terms of executive functioning, working memory, and verbal memory. Importantly, neurocognitive gains have been linked to improvements in obtaining and working in competitive jobs. [2] [3]

In practice

Narrowly defined, CR is a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning. However, from the vantage point of the rehabilitation field, CR engages the participant in a learning activity to enhance the neurocognitive skills relevant to overall recovery goals. [4] CR programs vary in the extent to which they reflect these narrow or broader perspectives, and there is ongoing research to identify the active ingredients that result in a positive response to treatment. Data suggests that when cognitive remediation is provided to people with schizophrenia, it is most effective when given in the broader context of psychosocial rehabilitation. [2] [3] Recent attention has turned to incorporating motivational enhancements into the treatment of cognitive dysfunction for psychological disorders. [4] Meta-analyses on cognitive remediation [5] usually also consider interventions targeting social cognition and metacognition, such as social cognition and intervention training and metacognitive training.

For anorexia nervosa

For individuals with anorexia nervosa (AN), CRT is an interactive treatment which combines practical exercises with discussions about their relevance to the patient’s everyday life. Cognitive remediation therapy was adapted for anorexia nervosa by Professor Kate Tchanturia and colleagues at the Institute of Psychiatry, Psychology and Neuroscience to address the process rather than the content of thinking, thus helping patients to develop a metacognitive awareness of their own thinking style. [6] [7] [8] [9] [10] [11] The treatment is hypothesized to work by strengthening and refining neural circuits, and by learning and transferring new cognitive strategies to appropriate situations. The aim is to identify and target the cognitive impairments specific to each patient, and to motivate the patient to engage in meta-cognitive processes i.e. to consider their cognitive/thinking styles and to explore alternative strategies, which in turn might lead to behavioral changes. By becoming aware of problematic cognitive styles, the patient can reflect on how these affect everyday life and learn to develop new strategies. The intervention was originally developed for adults with chronic AN but it has been explored for younger patients as well. [12]

See also

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. Types of eating disorders include binge eating disorder, where the patient eats a large amount in a short period of time; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

<span class="mw-page-title-main">Neurocognition</span> Cognitive functions related to a brain region

Neurocognitive functions are cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain, ultimately served by the substrate of the brain's neurological matrix. Therefore, their understanding is closely linked to the practice of neuropsychology and cognitive neuroscience – two disciplines that broadly seek to understand how the structure and function of the brain relate to cognition and behaviour.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Neuropsychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychology factors. Within neuropsychiatry, the mind is considered "as an emergent property of the brain", whereas other behavioral and neurological specialties might consider the two as separate entities. Those disciplines are typically practiced separately.

The management of schizophrenia usually involves many aspects including psychological, pharmacological, social, educational, and employment-related interventions directed to recovery, and reducing the impact of schizophrenia on quality of life, social functioning, and longevity.

Alice Medalia is an American clinical neuropsychologist and international leader in the field of psychiatric rehabilitation. She is best known for her work treating cognitive deficits in people with psychiatric disorders. This subspecialty is known as cognitive remediation.

Maudsley family therapy also known as family-based treatment or Maudsley approach, is a family therapy for the treatment of anorexia nervosa devised by Christopher Dare and colleagues at the Maudsley Hospital in London. A comparison of family to individual therapy was conducted with eighty anorexia patients. The study showed family therapy to be the more effective approach in patients under 18 and within 3 years of the onset of their illness. Subsequent research confirmed the efficacy of family-based treatment for teens with anorexia nervosa. Family-based treatment has been adapted for bulimia nervosa and showed promising results in a randomized controlled trial comparing it to supportive individual therapy.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa tend to have a low self-image and an inaccurate perception of their body.

<span class="mw-page-title-main">Cognitive rehabilitation therapy</span>

Cognitive rehabilitation refers to a wide range of evidence-based interventions designed to improve cognitive functioning in brain-injured or otherwise cognitively impaired individuals to restore normal functioning, or to compensate for cognitive deficits. It entails an individualized program of specific skills training and practice plus metacognitive strategies. Metacognitive strategies include helping the patient increase self-awareness regarding problem-solving skills by learning how to monitor the effectiveness of these skills and self-correct when necessary.

<span class="mw-page-title-main">Til Wykes</span> Clinical psychologist

Professor Dame Til Wykes, Lady Davies is an English academic, author and editor.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Gerald Matthews. It is supported by scientific evidence from a large number of studies.

Metacognitive training (MCT) is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive–compulsive disorder and borderline over the years. It was developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of cognitive behavioral therapy, but focuses in particular on problematic thinking styles that are associated with the development and maintenance of positive symptoms, e.g. overconfidence in errors and jumping to conclusions. Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).

<span class="mw-page-title-main">Kate Tchanturia</span> English psychologist and eating disorders researcher

Kate Tchanturia is a British psychologist who is a professor of psychology in eating disorders at the Institute of Psychiatry, Psychology and Neuroscience, King's College London. She is also Consultant Psychologist at the South London and Maudsley NHS Foundation Trust for the National Eating Disorder Service, and president of the Eating Disorders Research Society. Her main research interests include cultural differences in illness presentations, cognitive profiles in eating disorders, and experimental work in emotion processing and translational research from experimental findings to real clinical practice. Tchanturia has a particular interest in women's mental health and has pioneered the PEACE pathway for autism and eating disorder comorbidity.

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

Body checking is a compulsive behaviour related but not exclusive to various forms of body dysmorphic disorders. It involves frequently collecting various information about one’s own body in terms of size, shape, appearance or weight. Frequent expressions of this form of behaviour entails for example mirror checking, trying to feel one’s own bones, pinching the abdomen, frequent body weight measurement and comparing your own body to that of others. Studies have shown that an increased rate of body checking correlates with an overall increased dissatisfaction with the own body.

Virginia Violet Williams McIntosh is a New Zealand clinical psychologist, and is a full professor at the University of Canterbury, specialising in improving therapy outcomes for disorders such as anorexia nervosa, bulimia nervosa, depression and anxiety.

References

  1. ↑ Cicerone, KD; Langenbahn, DM; Braden, C; et al. (2011). "Evidence-based cognitive rehabilitation: Updated review of the literature from 2003 through 2008". Archives of Physical Medicine and Rehabilitation. 92 (4): 519–530. doi:10.1016/j.apmr.2010.11.015. PMID   21440699.
  2. 1 2 3 McGurk, SR; Twamley, EW; Sitzer, DI; McHugo, GJ; Mueser, KT (2007). "A meta-analysis of cognitive remediation in schizophrenia". American Journal of Psychiatry. 164 (12): 1791–1802. doi:10.1176/appi.ajp.2007.07060906. PMC   3634703 . PMID   18056233.
  3. 1 2 3 Wykes, T; Huddy, V; Cellard, C; McGurk, SR; Czobor; P (2011). "A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes". American Journal of Psychiatry. 168 (5): 472–485. doi:10.1176/appi.ajp.2010.10060855. PMID   21406461.
  4. 1 2 Medalia, A; Saperstein, A (2011). "The role of motivation for treatment success". Schizophrenia Bulletin. 37 (suppl 2): S122–S128. doi:10.1093/schbul/sbr063. PMC   3160119 . PMID   21860041.
  5. ↑ Vita, Antonio; Barlati, Stefano; Ceraso, Anna; Nibbio, Gabriele; Ariu, Cassandra; Deste, Giacomo; Wykes, Til (2021-08-01). "Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia: A Systematic Review and Meta-analysis of Randomized Clinical Trials". JAMA Psychiatry. 78 (8): 848–858. doi:10.1001/jamapsychiatry.2021.0620. ISSN   2168-622X. PMC   8058696 . PMID   33877289.
  6. ↑ Davies, H., & Tchanturia, K. (2005). Cognitive remediation therapy as an intervention for acute anorexia nervosa: A case report. European Eating Disorders Review, 13(5), 311-316.
  7. ↑ Tchanturia, K., Davies, H., & Campbell, I. C. (2007). Cognitive remediation therapy for patients with anorexia nervosa: preliminary findings. Annals of General Psychiatry, 6(1), 14.
  8. ↑ Tchanturia, K. (2014). Cognitive Remediation Therapy (CRT) for Eating and Weight Disorders. Routledge.
  9. ↑ Tchanturia, K., Davies, H., Reeder, C., & Wykes, T. (2008). Cognitive remediation programme for anorexia nervosa: a manual for practitioners. London: NHS Foundation Trust.
  10. ↑ Lindvall, C., & Lask, B. Implications for Treatment. In B. Lask & I. Frampton (Eds.), Eating Disorders and the Brain (pp. 191-206). Oxford, UK: T Wiley/Blackwell, 2011. ISBN   9781119998433
  11. ↑ Owen, I., Lindvall Dahlgren, C., & Lask, B. Cognitive Remediation Therapy. In B. Lask & R. Bryant-Waugh (Eds.), Eating Disorders in Childhood and Adolescence. New York: Routledge, 2013. ISBN   9780415686402
  12. ↑ Tchanturia K; et al. (Nov 2014). "Cognitive remediation in anorexia nervosa and related conditions: a systematic review". Eur Eat Disord Rev. 22 (6): 454–62. doi:10.1002/erv.2326. PMID   25277720.

Cognitive Remediation to Improve Functional Outcome

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