Vol. 11: e??-e??, December 2006 CASE REPORT e1 Key words: Anorexia, cognitive rigidity, remediation, set shifting, flexibility training, ecological validity. Correspondence to: Dr. Kate Tchanturia, PhD, PO 59, EDU, Institute of Psychiatry, 16 De Crespigny Park, London SE5 8AF, U.K. E-mail: spjeket@iop.kcl.ac.uk Received: January 30, 2006 Accepted: March 10, 2006 Can cognitive exercises help treat anorexia nervosa? K. Tchanturia, J. Whitney, and J. Treasure King’s College University of London, Institute of Psychiatry, Eating Disorders, London, United Kingdom ABSTRACT. Cognitive remediation therapy (CRT) is used as an intervention for people with brain lesions and psychosis. This case report demonstrates the possible benefits of introduc- ing CRT into treatment packages for anorexia nervosa (AN). In our previous work, we report- ed that people with AN demonstrate inflexibility in cognitive set-shifting tasks. Weight gain alone does not improve the neuropsychological profile in set-shifting tasks. This case report illustrates how training programmes can address problems in cognitive rigidity. We acknowledge the limitations of case studies, however, this is a starting point in exploring the possibilities of introducing CRT as part of the treatment of AN. (Eating Weight Disord. 11: e?-e?, 2006). © 2006, Editrice Kurtis INTRODUCTION Anorexia nervosa (AN) is a complex, mul- tifactorial disease with high levels of dis- ability and mortality with high costs to the individual and society. Although the disease is characterized by pathological weight loss, simply gaining weight does not improve the psychopathol- ogy features related to thinking style. More research evidence is needed to clarify mod- els of information processing in AN, in other words, to address how people with AN think as opposed to what they think. We have shown that people with AN have difficulties in terms of set shifting and flexi- bility in their thinking style (1-3). Set shift- ing has been described as an inability to change past patterns of thinking and adapt to new requirements in the environment. In contrast with healthy individuals, individu- als with AN show broad set-shifting diffi- culties both during the acute phase of the illness and following weight restoration, as illustrated in our previous research using longitudinal data (1). The aim of this case report was to test a module designed to improve set shifting for a patient with AN. This module is part of cognitive remedia- tion therapy (CRT) (4, 5). Generally, CRT has been used for the treatment of psy- chosis and people with brain lesions. CRT programmes for psychosis have consisted of three major elements: memory, shifting and planning. The main focus for this case study was the shifting module, as research evidence has shown that people with AN demonstrate inflexibility in information processing and show increased attention to detail. Taking the relevant exercises from available resources (5, 6), we have tailored and added a number of exercises to our ‘flexibility’ module. Additional exercises that we have included are visual illusions, maps and a summarising task (e.g. letters summarised to bullet points or text mes- sages). We also emphasized the importance of ecological validity (i.e. real, every day life functioning) in our module by encouraging the patient to reflect on strategies and thinking styles at the end of every session and by giving them behavioural tasks to complete as homework. In our first case study (7), we found that a neuropsychological assessment with feed- back followed by a flexibility module was beneficial to a patient with AN. The set shifting tasks were selected to reflect the different aspect of information processing ranging from perceptual patterns to the processing of higher order concepts. These measures were taken before, after and at follow-up and it was found that the patient had improved on half of the tasks. This was an important finding, as in our previous longitudinal study on 22 patients with AN we found that set shifting perfor- mance did not improve with weight gain alone and treatment as usual (1). The main focus in the present case study was: firstly, to observe if set-shifting training was able to help a patient with AN increase her flexibili- ty of thinking, and secondly, to explore the ecological validity of the procedures by Ready for press Return by Fax to n° 02.48.20.12.19 Signature ...................................................................