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Introduction

Unlike many mental illnesses, pharmacological treatments are not effective for eating disorders and neuropsychological studies have shown that individuals with anorexia nervosa have difficulties in cognitive flexibility (Tchanturia, Davies & Campbell, 2007). In addition, treating individuals with eating disorders can be challenging secondary to a high resistance to treatment. Effective treatment may need to be executed in a different manner, in which may begin by targeting negative thought processes and inflexibility rather than targeting the psychological eating symptoms. The objective of cognitive remediation therapy (CRT) is to apply repetitive practice, personal reflection and guided discovery to improve and strengthen thinking styles (Tchanturia, Davies & Campbell, 2007).

Theory

The goals of cognitive remediation therapy include exercising connections in the brain to improve function, encouraging individuals to reflect on their thinking styles, and providing them with motivation and confidence to make changes (Tchanturia, Davies & Campbell, 2007). These goals align with the concept behind cognitive behavioral therapy (CBT). When evaluating an individual using a CBT approach, clinicians look at barriers to occupational performance which in cognitive remediation therapy, the barrier is cognitive deficits. When looking at an individual’s progress, CBT reflects on their feelings  and thoughts regarding their self efficacy which directly relates to the goals of cognitive remediation to help individuals acknowledge their thinking styles while giving them motivation and confidence to change.

Evidence

Recent evidence has provided both quantitative and qualitative data on CRT, demonstrating low dropout rates, significant increase in the individual’s performance related to cognitive tasks, improvement in self reports on cognitive strategies and an overall positive feedback about CRT. Further evidence also demonstrates long-term benefits of CRT and validates its compatibility as a form of treatment in group formats among either adolescents or adults (Genders & Tchanturia, 2010).

Case Study

Luisa is a 27 year old married woman who lives in New York City. She is a personal assistant to a world renowned fashion magazine editor which consists of a fast paced, high demand environment and constant overtime hours. Luisa is very passionate of her job position and of all the benefits she reaps that include traveling the world and attending fashion shows. She has considered herself to be very rigid and compulsive but it has worsened over the years to the point where she becomes so overwhelmed that she will cease all activity. She has recently been diagnosed with Anorexia Nervosa and is concerned with her time management and planning skills in the workplace. Luisa struggles to shift from one activity to the next, and on some day stays fixated on one task. Her boss has brought up concerns about her time management issues, and would like to see her more productive. After interviewing and establishing rapport with the client, she is concerned with losing her job and becoming unemployed due to her lack of ability to keep up with work task and demands.

Intervention Plan

Problem Statement

Due to inflexibility to attain to work task, client is unable to perform job demands efficiently.

Long Term Goals

1. Client will complete 6 out of the 6 tasks, on her to-do list, by the end of the day in order to engage in work responsibilities by 4 weeks.
2. Client will independently create a monthly calendar, with a list of responsibilities, to engage in work tasks by 4 weeks.

Short Term Goals

1. Client will create a weekly schedule with a list of responsibilities, approved by her boss, to engage in work task by 2 weeks.
2. Client will complete 3 out of the 6 task, on her to-do list, by the middle of the day in order to engage in work responsibilities by 4 weeks.
3. Client will complete 4/4 morning task activities by lunchtime to improve time management skills by 2 weeks.

Intervention Format

Individual

Setting

Luisa will meet with the occupational therapist individually for 60 minutes 2x a week.

Supplies

None

Agenda

Luisa’s second treatment session includes:

• Warm up: Create her own schedule for the session in which she will follow (5 mins)
• Explain Map task activity (10 mins)
  • Map task activity demands: (4 tasks total in 45 mins)
    • Pick up dry cleaning, buy the following items: paper-clips, staples, and ink cartridge.
    • Pick up coffee at Dunkin Donuts for her co-workers
    • Drop off packages at the UPS store

Documentation

S: “I’m concerned that I will lose my job if i don’t get better with managing my responsibilities.”

O: Client was able to complete 2 out of the 4 task. She picked up the dry cleaning, and dropped off the packages within 40 minutes. Client was unable to pick up coffee for her co-workers nor was she able to pick up office supplies due to lack of time. Upon reaching to the office, client complained of feeling overwhelmed and stressed.

A: Client demonstrated poor time-management skills by not planning prior to starting map task activity. Client did not organize the responsibilities listed in order of least to complex task demonstrating lack of planning and decision making skills. Client’s stress level at the end of the session indicates lack of emotional control, therefore client will benefit from improving planning and time management skills to prevent further stress. Client shows difficulty with the map task activity and therefore client should enhance her skills in creating and organizing her to-do list before executing task.

P: Next session, client will work on organizing and sequencing her to-do list prior to beginning any of the items listed.

References

Davies, H., & Tchanturia, K. (2005). Cognitive remediation therapy as an intervention for acute anorexia nervosa: A case report. European Eating Disorders Review, 13(5), 311-316.

Genders, R., & Tchanturia, K. (2010). Cognitive remediation therapy (CRT) for anorexia in group format: a pilot study. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 15(4), e234-e239.

Tchanturia, K., Davies, H., & Campbell, I. C. (2007). Cognitive remediation therapy for patients with anorexia nervosa: preliminary findings. Annals of General Psychiatry, 6(1), 14.