A New Therapy Helps Those With Anorexia

By Zachary Siegel 06/24/15

Progress is being made in the notoriously difficult to treat eating disorder.

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A recent study involving a group of adults who struggle with anorexia nervosa (AN) yielded promising results in treating the complex eating disorder.

Published last March in the journal BMC Psychiatry, the study consisted of a therapeutic intervention called cognitive remediation and emotion skills training (CREST) in a group of 37 in-patient adults.

Originally piloted in 2011, CREST is a newer method of psychoeducation and skills-based therapy specifically developed to treat anorexia nervosa. “It aims to target rigid and detail-focused thinking styles, but places greater emphasis on the development of emotion recognition skills (in ourselves and others), and the management and expression of emotion in AN,” writes the researchers who conducted the study.

Game-like activities and cognitive tasks that encourage reflection are an essential aspect of the therapy. For example, little balls with emotional expressions are presented and conversations about what it is like to be sad, happy or curious occur.

The researchers note that this style of discussion provokes greater reflection than the standard open-ended questions. People with anorexia often display low-emotional intelligence, so such activities may help them reflect on their emotions.

Before and after the CREST intervention, patients filled out self-report measures such as the Revised Social Anhedonia Scale (RSAS) and the Toronto Alexithymia Scale (TAS). The RSAS targets “the reduced ability to experience social pleasure” and the TAS assesses “difficulties in identifying feelings (e.g., 'I am often confused about what emotion I am feeling').” A secondary outcome was motivation, for instance, one’s ability to change.

After 10 sessions of CREST, scores on both primary measures, social anhedonia and alexithymia, decreased significantly with ample effect sizes, meaning that people did not score lower due purely to chance. Lower scores indicate feeling less social discomfort on the RSAS and lower scores on the TAS indicate that one can better recognize emotions.

Recent research in the field of eating disorders has found that people with AN experience rigid thinking styles, difficulty understanding emotions, and difficulty communicating emotions, among other cognitive problems. Because CREST encourages new types of social interaction and reflection for individuals with eating disorders, this therapy is gaining some traction in the treatment field.

Though further studies like a randomized trial with a larger sample size are in order, the writers of this study argue a “CREST intervention can influence social anhedonia, the ability to recognize one's own emotions, and confidence in one's ability to change.” Attending to these problems that often occur in people with severe nutritional issues is showing to be of great value in treating and understanding a serious and sometimes deadly condition.

You can read the full study here.

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.