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Anorexia nervosa: how people think and how we address it in cognitive remediation therapy

Natalie Pretorius and Kate Tchanturia

Background: Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is a new working model for severely ill patients. It has been adapted from various resources, taking into account cognitive characteristics of patients with AN, such as difficulties in set-shifting and extreme attention to detail, as well as difficulties in engagement with treatment and in reflecting on their illness.

Aim: We aim to introduce the elements of a CRT intervention, which we have tailored for AN, and demonstrate it with a case report.

Methods: The patient presented completed ten, twice-weekly, 30-min sessions of a CRT intervention, which took into account strengths and weaknesses in information-processing styles and focused on the following components: helping patients to think about their thinking/strategies by undertaking simple cognitive tasks; reflecting how they relate to real life; exploring alternative strategies in cognitive tasks; applying new skills and strategies to real-life behaviors; acknowledging and summarizing what was learned during the intervention in the form of a letter.

Results: After completing CRT, the patient presented had developed awareness of her thinking processes, developed new, more flexible strategies, and found CRT to be useful as a pretreatment before commencing further psychological interventions.

Conclusion: CRT has the potential to increase the effectiveness of further psychological interventions for AN.