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      Cognitive Remediation Therapy for Adolescents with Anorexia Nervosa—Treatment Satisfaction and the Perception of Change

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          Abstract

          Cognitive remediation therapy (CRT) has recently been developed for children and adolescents with anorexia nervosa (AN). It focuses on decreasing rigid cognitions and behaviors, as well as increasing central coherence. Overall, CRT has been proven feasible for young individuals with AN, but little is known regarding the specifics of its feasibility, and the perception of change associated with the intervention. Consequently, the aim of the current study was to explore service users’ perspective on CRT with a specific focus on treatment delivery, treatment content, and perceived change. Twenty adolescents (age 13–18) with AN participated in a 10-session course of CRT. A 20-item treatment evaluation questionnaire was administered at the end of treatment, focusing on four aspects of the intervention: (1) general attitudes towards treatment, (2) treatment specifics, (3) the perception of change and (4) the patient-therapist relation. The main findings suggest high levels of treatment satisfaction, but somewhat limited perceptions of change. The current study is one of the most detailed accounts of adolescents’ perspective on CRT published on eating disorders, and highlights several important aspects of the treatment viewed through the eye of the receiver.

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            A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.

            The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments. Resumen: Objetivo: La alianza terapéutica entre paciente y terapeuta ha demostrado ser una relación con resultados psicoterapéuticos favorables en el tratamiento de los trastornos de la conducta alimentaria (TCA). Sin embargo, quedan preguntas acerca de la inter-relación entre alianza temprana, mejoría temprana de síntomas y resultados del tratamiento. Hicimos un meta-análisis de la relación entre estos constructos y los posibles moderadores de estas relaciones en los tratamientos psicosociales para TCA. Método: Veintiún estudios reunieron los criterios de inclusión y aportaron suficientes datos suplementarios. Resultados: los resultados revelaron un efecto de la talla pequeño a moderado, ฆยs = 0.13 a 0.22 (p < .05), encontrando que la mejoría temprana de los síntomas estuvo relacionada con la subsecuente calidad de la alianza y las calificaciones de la alianza también estuvieron relacionadas con la subsecuente reducción de los síntomas. La relación entre alianza temprana y resultados de tratamiento fue parcialmente explicada por la temprana mejoría de los síntomas. Con relación a los moderadores, la alianza temprana mostró débiles asociaciones con el resultado en terapias con un fuerte componente conductual relativo a terapias no conductuales. Sin embargo, la alianza mostró más fuerte relación con los resultados para pacientes más jóvenes (versus mayores), por encima y sobre la varianza compartida con la temprana mejoría de síntomas. Discusión: En resumen, la reducción temprana de los síntomas refuerza la alianza terapéutica y los resultados del tratamiento en TCA, pero la alianza temprana puede requerir atención específica para pacientes jóvenes y para aquellos que no reciben tratamientos basados en una orientación conductual.
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              Decision making, central coherence and set-shifting: a comparison between Binge Eating Disorder, Anorexia Nervosa and Healthy Controls

              Background Several studies have investigated the cognitive profile in patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN); on the contrary few studies have evaluated it in patients with Binge Eating Disorder (BED). The purpose of this study was to compare decision making, central coherence and set-shifting between BED and AN patients. Methods A battery of neuropsychological tests including the Iowa Gambling Task (IGT), the Rey-Osterrieth Complex Figure Test (RCFT), the Wisconsin Card Sorting Test (WCST), the Trial Making Task (TMT) and the Hayling Sentence Completion Task (HSCT) were administered in a sample of 135 women (45 AN, 45 BED, 45 Healthy Controls [HC]). Furthermore, Beck Depression Inventory (BDI) was administered to evaluate depressive symptoms. Years of education, age, Body Mass Index (BMI) and depression severity were considered as covariates in statistical analyses. Results BED and AN patients showed high rates of cognitive impairment compared to HC on the domains investigated; furthermore, the cognitive profile of BED patients was characterised by poorer decision making and cognitive flexibility compared to patients with AN. Cognitive performance was strongly associated with depressive symptoms. Conclusions In the present sample, two different neurocognitive profiles emerged: a strong cognitive rigidity and a central coherence based on the details was predominant in patients with AN, while a lack of attention and difficulty in adapting to changes in a new situation seemed to better describe patients with BED. The knowledge of the different cognitive profiles of EDs patients may be important for the planning their psychotherapeutic intervention.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Behav Sci (Basel)
                Behav Sci (Basel)
                behavsci
                Behavioral Sciences
                MDPI
                2076-328X
                18 April 2017
                June 2017
                : 7
                : 2
                : 23
                Affiliations
                Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Postboks 4950 Nydalen, 0424 Oslo, Norway; post.psykiskhelse@ 123456oslo-universitetssykehus.no
                Author notes
                [* ]Correspondence: camilla.lindvall@ 123456dahlgren.no ; Tel.: +47-4729-1950
                Article
                behavsci-07-00023
                10.3390/bs7020023
                5485453
                28420211
                002c28ea-0847-42a6-8974-0a2e3dbc5f98
                © 2017 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 20 March 2017
                : 10 April 2017
                Categories
                Article

                anorexia nervosa,cognitive remediation therapy,eating disorders,treatment satisfaction,neuropsychology,rigidity,cognitive flexibility,central coherence

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