Young Adult Clinical Trial
Official title:
Cognitive Remediation Therapy Effectiveness in Anorexia Nervosa: a Multicenter Randomized Clinical Study
"Clinicians from the Maudsley (IoP, London, UK) have specifically tailored a cognitive
remediation therapy (CRT) for treating Anorexia Nervosa (AN). It is an intensive manualised
training cognitive therapy which addresses the difficulties in flexibility and holistic
processing that have been incriminated in AN. CRT has been found to improve AN's
neuropsychological functioning and short term outcome. To our knowledge, no French speaking
country has tested its effectiveness. Moreover, the question whether it is efficient for
both anorexic restrictive and anorexic binge-purging patients remains unanswered.
The aim of the present study is to determine if CRT in AN adolescents and young adults has a
favourable impact on cognitive functioning and clinical status. We will also explore whether
the impact of CRT is similar in both anorexic restrictive and binge-purging subtypes. There
will also be an Historical Control Group of patients, sixty, who received traditional
medical interventions in a specialized inpatient unit for eating disorders (i.e., EVHAN
study)."
"Several studies have documented that patients with Anorexia Nervosa (AN) display a trait of
cognitive inflexibility (e;g., poor set-shifting performances on the Trail Making Task B),
i.e. an inability to move flexibly back and forth between tasks, operations, or mental sets
which allows for the adaptation of behaviour in response to changing demands within the
environment. This cognitive inflexibility can be observed both during the acute phase of the
illness and after weight restoration, and has been found to predict negative treatment
outcomes. 'Weak central coherence' is another skill which is particularly problematic in AN.
It refers to a cognitive style in which information remains fragmented as opposed to
integrated, with processing occurring at the level of 'detail' as opposed to 'whole'. AN
patients exhibit this detail focussed information-processing style (e.g., as measured by the
Embedded Figures Test). To treat these difficulties, clinicians from the Institute of
Psychiatry (London, UK) have specifically tailored a treatment for AN. Cognitive remediation
therapy (CRT) is an intensive training cognitive therapy that encourages people to reflect
on and try to modify the way they think, with a particular focus on improving cognitive
flexibility. It is a manualised therapist-led intervention consisting of multiple versions
of a variety of tasks and mental exercises that address the difficulties in flexibility and
holistic processing. CRT is a 10-sessions long program that has been found to improve AN's
neuropsychological functioning and short term outcome. To our knowledge, no French speaking
country has tested its effectiveness. Moreover, the question whether it is efficient for
both anorexic restrictive and anorexic binge-purging patients remains unanswered.
To address these issues, we designed a multicenter randomized clinical trial on the
effectiveness of CRT in AN adolescents and young adults.
Main hypothesis: AN patients treated with CRT present a better clinical status than those
treated by a control therapy.
Recruitment and Procedure: 120 female adolescents or young adults [15-40 years old] AN (60
Anorexic Restrictive; 60 Anorexic Binge-Purging) will be recruited among the patients of
specialized ED care units of three hospitals: PAUL BROUSSE, INSTITUT MUTUALISTE MONTSOURIS,
COCHIN-MAISON DE SOLENN. In each group of AN subtype, the patients will be randomly
allocated to one of the two treatment arms: CRT or Sham Therapy (ST). Each therapy is
manualised and includes 10 sessions over a period of 5 weeks (2 sessions/week). All the
patients will be assessed just prior the beginning and after the end of the CRT/ST, at 6
months and 1 year of follow-up."
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