Shifting Perspectives

Because anorexia begins in adolescence, early intervention is key to prevent a longer course of the disorder. To date, there is only one intervention with substantial evidence-based support for treating anorexia in adolescents: Family Based Treatment (FBT). While effective, FBT does not work for everyone, and we want to see if we can increase its effectiveness.

Studies in individuals with anorexia indicate that they have relative inefficiencies in cognitive flexibility (e.g., have a difficult time switching gears or topics) and may struggle with big picture thinking. In addition, they can exhibit reduced behavioral flexibility (e.g., extreme perfectionism, perseveration, difficulties in learning new behaviors) that researchers believe reflects this underlying neurocognitive inefficiency.

Cognitive Remediation Therapy (CRT) is an adjunctive treatment that has been used to improve cognitive processes in individuals with a variety of psychiatric conditions. When used with individuals with anorexia, CRT focuses on improving flexibility and big picture thinking. We believe that adding CRT to treatment could help to mitigate the impact of malnutrition on developing executive functioning and eventually help adolescents to be more flexible faster than what we would see in FBT alone. This may increase the effectiveness of treatment.

Adolescents ages 12-18 who currently have anorexia and their parents are eligible to participate in this study. Participants must be medically stable for outpatient treatment and fluent in English. Parents must be willing to engage in treatment. Families cannot engage in any other treatment over the course of the study (i.e., no individual treatment for the adolescent). Families are randomly assigned to either 15 sessions of FBT or 15 sessions of FBT + nine sessions of CRT. All treatment takes place over a six-month period and is delivered via telehealth. There are four in-person assessments.

The Shifting Perspectives Study is funded by the National Institutes of Mental Health.