Individual Cognitive Remediation Therapy and Individual Emotion Skills Training for anorexia nervosa: a case series study in a paediatric ward

Abstract

Abstract Purpose: Anorexia Nervosa (AN) is a life-threatening eating disorder (ED), with the highest incidence in young people (YP) aged 15-19 years. The COVID-19 pandemic impacted on the increase of AN cases requiring hospitalisation. Cognitive Remediation Therapy (CRT) and Cognitive Remediation and Emotion Skills Training (CREST) are brief interventions aimed at enhancing cognitive and emotion processing skills. They are feasible for adult and YP with AN in inpatient settings, but their use has not been yet explored in paediatric wards. Methods: A case series study with uncontrolled repeated measures design was conducted in a paediatric ward. Eight participants received two individual one-hour long CRT and then CREST sessions a week for ten weeks. A repeated measures design, consisting of neuropsychological tests and psychometric self-report questionnaires, was conducted at three time-points. Results: Significant differences (T0 vs T1) were found in cognitive flexibility [“Animal Sorting” t(7)=-3.208; p=0.015; “Response Set” (t(7)=-3.910; p=0.006);“Learning to learn” (t(7)=-4.259; p=0.004)]; in central coherence [“Central Coherence Index” t(7)=-2.401; p=0.047]; in executive functions [“Design” (t(7)=-3.208; p=0.015), “Semantic” (t(7)=-3.660; p=0.008), “Phonological fluency” (t(7)=-4.020; p=0.005), short-term verbal memory (t(5)=-11.00; p=<0.001) and decision making task [(HDT) t(7)=-3.826; p=0.006]. Regarding the emotion processing, significant differences were found in emotion recognition [“Theory of mind t(7)=-2.376; p=0.049] ,and self-awareness [“Noticing” t(7)=-2.220;p=0.062, and “Emotional awareness” t(7)=-2.391; p=0.048].These improvements were maintained at six-month follow-up. Conclusions: Individual CRT in conjunction with individual CREST is a feasible intervention for YP with AN in a paediatric ward. Studies involving larger samples and control groups in paediatric wards are warranted.