Group cognitive remediation therapy for children and adolescents in intensive day-patient treatment for anorexia nervosa: a feasibility study.

BACKGROUND: Cognitive Remediation Therapy (CRT) is an adjunct treatment targeting set-shifting (SS) and weak central coherence (CC) thought to play a role in maintaining anorexia nervosa (AN). This study aimed to test the feasibility of brief group CRT for young people with AN in a day-patient setting using neuropsychological assessment of SS and CC. It also explored the benefit for young people with Autism Spectrum Disorder (ASD) features. METHODS: Twenty female day-patients (12-18 years) with AN or Atypical AN completed neuropsychological assessment of SS (using the Wisconsin Card Sorting Task and the Brixton Spatial Anticipation Test) and of CC (using the Rey Osterrieth Complex Figures Task) pre and post 4 sessions of group CRT. Baseline ASD features and weight change pre and post were measured. Feasibility was assessed regarding the recruitment process, intervention feedback, suitability of neuropsychological assessment measures, and effect sizes. RESULTS: Study uptake was 95%, intervention retention was 91%, and group CRT was rated as acceptable. Medium to large effect size improvements were found across measures of SS (dz = 0.44 to dz = 0.90) and medium size improvements found in CC (dz = 0.59). Young people with ASD features showed smaller to similar size improvements in SS and larger improvements in CC. There was a moderate (not significant) correlation with level of weight restoration. CONCLUSIONS: Important study parameters have been estimated in order to plan a future definitive trial of brief group CRT in a day-patient setting using neuropsychological assessment. These findings also have implications for the use of brief group CRT in young people with ASD features.

Cognitive behavioral therapy for childhood anxiety disorders: What happens to comorbid mood and behavioral disorders? A systematic review.

BACKGROUND: High rates of comorbidity among children and adolescents with anxiety disorders are widely documented. To date the question of what happens to comorbid disorders upon treatment of the primary anxiety disorder has received little attention and the optimal treatment strategy for cases with comorbidity remains to be determined. OBJECTIVES: This review examines the literature on the impact of disorder-specific CBT on comorbid mood and behavioral disorders in young people with a primary anxiety disorder. SEARCH METHODS: PsycINFO, EMBASE, MEDLINE and the Cochrane Library were systematically searched using predefined selection criteria. Two reviewers independently assessed the relevance of studies, obtained data using a data extraction form and undertook methodological quality analysis. RESULTS: Ten studies (1647 children in total) were included in the review. All studies demonstrated positive outcomes for CBT focused on the primary anxiety disorder on untargeted comorbid mood and/or externalising disorders. CONCLUSIONS: Findings suggest CBT focused on the primary anxiety disorder successfully reduces comorbid mood and/or behavioral diagnoses and symptoms of these co-occurring clinical diagnoses. Therefore, the implementation of disorder-specific CBT for the primary disorder is a valid alternative to transdiagnostic interventions and is recommended in cases of comorbidity in children and adolescents with a primary anxiety disorder.

The Relationship between Competence and Patient Outcome with Low-Intensity Cognitive Behavioural Interventions.

BACKGROUND: Little is understood about the relationship between therapist competence and the outcomes of patients treated for common mental health disorders. Furthermore, the evidence is yet to extend to competence in the delivery of low-intensity cognitive behavioural interventions. Understanding this relationship is essential to the dissemination and implementation of low-intensity cognitive behavioural interventions. AIMS: The aim of this study was to explore the relationship between Psychological Well-being Practitioner (PWP) competence and patient outcome within the framework of the British government's Improving Access to Psychological Therapies (IAPT) initiative. METHOD: Forty-seven PWPs treating 3688 patients participated. Relationships between PWP scores on three observed standardized clinical examinations and reliable change in patients' symptoms of anxiety and depression were explored at two time points: during the year-long training phase, and over a 12-month follow-up. RESULTS: Results indicated that patients treated by qualified PWPs achieved superior outcomes than those treated by trainees. Little support was found for a general association between practitioner competence in delivering low-intensity cognitive behavioural interventions and patient outcome, either during or post-training; however, significantly more patients of the most competent PWPs demonstrated reliable improvement in their symptoms of anxiety and depression than would be expected by chance alone and fewer deteriorated compared with those treated by the least competent PWPs. CONCLUSION: Results were indicative of a complex, non-linear relationship, with patient outcome affected by PWP status (trainee or qualified) and by competence at its extremes. The implications of these results for the dissemination and implementation of low-intensity cognitive behavioural interventions are discussed.