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Meta-Analysis
. 2020 Apr:37:101391.
doi: 10.1016/j.eatbeh.2020.101391. Epub 2020 May 3.

A preliminary systematic review and meta-analysis of randomized-controlled trials of cognitive remediation therapy for anorexia nervosa

Kelsey E Hagan  1 , Kara A Christensen  2 , Kelsie T Forbush  2
Affiliations
Meta-Analysis

A preliminary systematic review and meta-analysis of randomized-controlled trials of cognitive remediation therapy for anorexia nervosa

Kelsey E Hagan et al. Eat Behav. 2020 Apr.

Abstract

Cognitive remediation therapy (CRT) for anorexia nervosa (AN) was developed as an adjuvant treatment to target set-shifting and central coherence inefficiencies important in AN and to ultimately improve clinical outcomes of those with AN. The primary aim of this preliminary systematic review and meta-analysis was to determine the effect of CRT for AN relative to control treatments in randomized-controlled trials (RCTs) on neuropsychological inefficiencies at end-of-treatment. Secondary aims were to assess the effect of CRT for AN on dropout, eating-disorder-related, and other psychological outcomes at end-of-treatment. Systematic review and meta-analytic procedures were conducted in accordance with PRISMA Guidelines. RCTs evaluating CRT for AN compared to a control treatment were identified via ProQuest, PsycINFO, PubMed, and SCOPUS. Seven RCTs and one quasi-RCT of CRT for AN were included. RCT quality ratings ranged from fair (n = 3) to good (n = 4). Random-effects meta-analysis was conducted using Hedge's g. Study heterogeneity was assessed using I2 and publication bias was assessed with Begg's adjusted-rank correlation and the trim-and-fill method. CRT was not associated with improvement in central coherence compared to control treatments at end-of-treatment (g = 0.25, 95% CI = -0.35, 0.85, k = 3). Set-shifting outcomes were mixed due to heterogeneity of set-shifting measures across studies. CRT may prevent dropout; yet, more studies are needed to draw conclusions. CRT did not confer advantage over control treatments for eating-disorder-related and other psychological outcomes at end-of-treatment. Future RCTs of CRT for AN should use precise measures to assess constructs (particularly for set shifting), increase sample size, and implement longitudinal follow-up. (Word Count: 247 words).

Keywords: Anorexia nervosa; Cognitive remediation therapy; Meta-analysis; Randomized-controlled trials; Systematic review.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
PRISMA flow chart of study selection guidelines.
Fig. 2.
Fig. 2.
Central coherence forest plot.
Fig. 3.
Fig. 3.
Body mass index forest plot.
Fig. 4.
Fig. 4.
EDE global scores forest plot.
Fig. 5.
Fig. 5.
Depressive symptoms forest plot.
See this image and copyright information in PMC

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