The importance of improving cognitive flexibility in adolescents with anorexia nervosa: The case for Cognitive Remediation Therapy

Objective: Inefficiencies in executive functioning (EF), more specifically cognitive flexibility and an overly detailed processing style are frequently observed in adult individuals with Anorexia Nervosa (AN); however, they are not regularly observed in youth with AN. Executive functioning is still developing during adolescence, when AN typically onsets. We highlight the importance of cognitive flexibility and the role that it can play in illness maintenance and treatment. Cognitive remediation therapy (CRT) has been suggested as an adjunctive treatment approach that targets EF; yet CRT is often criticized for its perceived ineffectiveness in promoting weight restoration or directly reducing eating disorder symptoms. Method: The current article broadly reviews findings on executive functioning inefficiencies in individuals with AN. Next, we discuss the purpose and role of CRT in the treatment of AN. We highlight key critiques of the use of CRT and pose questions for future research. Results: CRT has been shown to improve targeted EF skills for various psychiatric disorders. In adolescents with AN, we may need to refocus our conceptual framework for using CRT as an adjunctive treatment. Instead of focusing on ameliorating eating disorder symptoms and directly improving weight gain, CRT may have an indirect impact on remission by influencing maintenance factors and improving global functioning. Discussion: More research needs to be done to understand the role of EF in AN and the role of CRT in treating AN and other eating disorders.