Neuropsychological rehabilitation specific to anorexia nervosa: A critical review of the literature on executive functioning symptomatology and cognitive remediation treatment applications tailored to this patient population

Abstract

Engaging, maintaining, and treating patients with anorexia nervosa (AN) remains a significant challenge for clinicians, hypothesized explanations for which are thought to involve specific executive functioning impairments. The neuropsychological treatment paradigm Cognitive Remediation Therapy (CRT) represents the translation of neurocognitive research into practice, and is thought to remediate neuropsychological symptoms and associated maladaptive cognitive processes. Additionally, the etiological model of AN related to executive functioning provides a conceptual framework for this novel approach to treatment. This study identifies and examines such a model, in addition to CRT protocols. Methodology involved a comprehensive synthesis and critical analysis of the literature pertaining to these domains. A variety of promising findings attributed to CRT are discussed, including an increase in participant BMI, improved neuropsychological performance, reduced perseveration, increased capacity for global processing, decreased eating disorder and depressive symptomatology, increased motivation, and confidence in patients’ ability to change and begin subsequent therapies. Numerous important methodological limitations are also elucidated, as many studies utilized small sample sizes resulting in low statistical power and poor generalizability, neglected to identify or consider demographic and cultural variables, failed to assess general intelligence or reference the normative data used, did not identify or discuss potential cohort or practice effects, provided limited details influencing studies’ reproducibility, and introduced a variety of biases. Nevertheless, this groundwork illuminated promising results in the treatment of a diagnostically complex and challenging disorder. Accordingly, a number of suggested future directions and clinical applications are elaborated upon.