Cognitive remediation therapy for patients with eating disorders: a qualitative study

Abstract

Transdiagnostic Cognitive Remediation Therapy (TCRT) is a new adaptation of cognitive remediation therapy for eating disorders (EDs) developed to address common cognitive difficulties across ED diagnoses (i.e., cognitive flexibility, central coherence, and impulsivity). This is the first evaluation of this novel treatment. The aim of this study was to explore acceptability and patients’ experience of TCRT. Thirteen patients diagnosed with restrictive or binge/purge subtypes of EDs and concurrent cognitive difficulties completed semi-structured qualitative interviews after receiving TCRT. Interview transcripts were analyzed using reflexive thematic analysis. The analysis resulted in four main themes: (1) Treatment fit (2), Treatment experience (3), Perceived outcomes, and (4) Future recommendations. Eleven of the thirteen patients evaluated the treatment positively, found the focus relevant and expressed how it contributed to new insights related to thinking style. Seven of the patients also described it as a starting point for making changes and using new strategies. Importantly, experiencing some challenges related to the cognitive difficulties addressed in the treatment seemed essential for engagement. Offering TCRT as an adjunctive treatment for patients with EDs and concurrent cognitive difficulties can be a way to engage patients in treatment, build therapeutic alliances and provide important awareness and strategies to handle challenges related to thinking style. This study is part of a larger randomized controlled trial, ClinicalTrials.gov Id: NCT03808467. Cognitive difficulties are thought to be one of several factors contributing to the development and maintenance of eating disorders (ED), but are rarely addressed in ED treatments. Cognitive remediation therapy (CRT) for EDs is a supplementary treatment originally developed for patients with anorexia nervosa (AN) that specifically targets cognitive difficulties. However, cognitive difficulties are found across ED diagnoses and not only in patients with AN. In this study, we have adapted CRT to address cognitive difficulties across ED diagnoses. The goal of this study was to explore patients’ experiences of this novel transdiagnostic CRT. We interviewed 13 individuals with various eating disorders after they had received the treatment. Eleven of the participants rated the treatment positively, expressed that it was engaging, offered something new and made them more aware of their thought processes. Seven participants also reported using new strategies to handle challenges related to cognitive difficulties. Importantly, one participant expressed that she did not experience cognitive difficulties and chose to drop out of the treatment, highlighting the importance of finding the treatment relevant to foster engagement.