Department of Psychology, University at Albany, Albany, New York, USA.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA.
Int J Eat Disord. 2023 Jul;56(7):1449-1460. doi: 10.1002/eat.23942. Epub 2023 Mar 30.
Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and cost-effective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin.
We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n = 42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points.
We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain.
Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings.
Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological markers of the inflexible thinking style thought to be characteristic of anorexia nervosa and exercise dependence.
神经性厌食症（AN）会给个人带来严重的身心痛苦和公共卫生负担，而且目前的治疗方法能使不到一半的患者完全康复。合并运动依赖（ExD）在 AN 中很常见，且与更严重的症状严重程度和治疗结果相关。研究表明，认知灵活性是一种突出的执行功能效率低下，也是将 AN 和 ExD 联系起来的跨诊断病因和维持机制。本研究将评估辅助认知矫正治疗（CRT）的初步疗效，该方法已被证明可改善 AN 成人的认知功能，针对 AN 合并 ExD 个体的认知灵活性。作为一个探索性目标，本研究还通过建立两种拟议的生物标志物（心率变异性和唾液催产素）的实用性，解决目前缺乏快速且经济有效的认知灵活性评估方法的问题。
我们将对患有 AN 和 ExD 合并症的成年患者（n=42）进行一项单组、自身对照试验，将已建立的 CRT 方案作为常规住院或强化门诊治疗（TAU）的辅助手段进行远程治疗。评估包括自我报告、神经心理学和生物标志物测量，将在三个时间点进行。
我们预计 CRT 会跨诊断地提高认知灵活性，因此，与 TAU 一起，积极影响 AN 和 ExD 的强迫性和症状严重程度，包括体重增加。
研究结果将为开发更有效的针对 AN 和 ExD 的综合干预措施提供信息，这些干预措施针对的是共同的机制，并促进在临床和研究环境中作为跨诊断风险和维持因素的认知灵活性的常规评估。
神经性厌食症患者经常过度运动，导致有害后果，包括增加自杀行为。本研究检查了一种干预措施的初步疗效，该措施促进了有问题的饮食和运动患者的灵活和全面的思维方式，与常规治疗一起，减少有害的运动症状。本研究还检查了新的生物标志物，这些标志物表明了僵化思维方式，这种思维方式被认为是厌食症和运动依赖的特征。
