ED - could training executive function improve treatment outcomes for eating disorders
10 important questions on ED - could training executive function improve treatment outcomes for eating disorders
ED: neurocognitive deficits in eating disorders
- many deficits in EF
- deficits in set-shifting (cognitive flexibility)
- deficits in central coherence
- working memory
- additionally, poor inhibitory control has been observed in BED
- these traits are probably causal instead of consequential
ED: Neurocognitive training for related conditions
- psychiatric illness is associated with dysfunction across prefrontal fronto-limbic and fronto-striatal neural systems
- these systems are associated with a diverse range of cognitive functioning including perception, cognition, social interactions, emotion, regulation, and motivation
- these functions can be trained
- more research necessary if training can extend to real life situations, and the only approach that has been tested with ED is cognitive remediation therapy (CRT)
ED: description of CRT
- is designed as an complementary therapy
- encouraging retention of primary therapy
- decreasing cognitive rigidity, and improving flexibility
- can be given in group or personal therapy
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ED: preliminary data
- mixed results, medium/large effect sizes in improvement of cognitive flexibility
- minimal support for the long-term transfer of such improvements
ED: limitations of existing research on CRT
- lack of control groups which raises concerns regarding confounds
- is the improvement only visible in the CRT task or also in the primary therapy/real life
- improvement in cognitive flexibility may also be attributable to weight gain
- is there a long-term effect of CRT?
ED: extending neurocognitive training paradigms for treatment of conditions related to ED
- extensive drill and practice exercises are the most effective in improving deficits in CRT
- computer based training can enhance CBT
- tests can be given by a computer
ED: cognitive flexibility training
- flexibility training may generate alternatives to rigid food and exercise rules
- according to MDD therapy, flexibility training is only effective in combination with psychotherapy
- a combination of computer training and clinician-guided therapy may have the most benefit
ED: inhibitory control training (ICT)
- food-cue-specific ICT paradigms have shown preliminary efficacy at reducing impulsive responses to visual cues for highly palatable foods
- training can also be used to used to increase inhibition for trigger items
- mixed results, other studies found no transfer effect, or an increase in impulsivity
- cue specific ICT has been show to facilitate weight loss
- long-term effects are unknown
- more research is necessary for BED and BN since thay operate under a egative affective state
ED: working memory training
- a deficit in the working memory may leave patients preoccupied with food or negative thoughts
- working memory training has shown to reduce behavioural impulsivity during decision making-tasks in individuals with stimulant dependence
- effective training paradigms for substance use are likely to be effective for EDs if appropriately for AN, BN
ED: Future directions
- impairments in EF are related to the development and maintenance of eating disorders
- CRT shows promise, but more research is needed
- the putative mediators (set-shifting central coherence) of CRT have yet tor be formally tested, CRT might be operating through a mechanism other than improving cognitive flexibility
- CRT and other training programs may be the most beneficial for those with more prominent deficits
- there is little knowledge over the dosis and duration of CRT and other cognitive trainings, but they must occur daily and for a long time
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