Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Int J Eat Disord. 2014 Jan;47(1):24-31. doi: 10.1002/eat.22206. Epub 2013 Oct 28.
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.
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.
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.
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.
认知灵活性效率低下被认为是与神经性厌食症（AN）的发展和维持有关的神经认知特征标志物。认知矫正治疗（CRT）是一种针对这种认知方式的特定治疗方法。本研究旨在调查针对 AN 的特定 CRT 的可行性和疗效（通过估计效应大小），并与非特异性认知训练进行比较。
进行了一项前瞻性、随机对照、优势性试验。40 名接受常规治疗（TAU）的 AN 女性患者被随机分为 CRT 组或非特异性神经认知治疗（NNT）组作为附加治疗。两种治疗条件均包含 30 次计算机辅助（21 次）和面对面（9 次）训练，持续 3 周。CRT 专门针对认知灵活性，NNT 由旨在改善注意力和记忆力的任务组成。主要结局是在神经心理学治疗后评估认知转换能力的表现。
对 25 名完成治疗的参与者的数据进行了分析。在治疗结束时，CRT 组的参与者在认知转换方面的表现优于 NNT 组（p = 0.027；组间效应大小 d = 0.62）。两组参与者均表现出高度的治疗接受度。
本研究证实了 CRT 治疗 AN 的可行性，并提供了使用 CRT 治疗 AN 可实现的效应大小的初步估计。此外，目前的研究结果证实，针对 AN 的神经认知训练应针对该患者群体的特定认知缺陷进行调整。
