Cognitive remediation therapy
Cognitive remediation therapy (CRT), also called cognitive enhancement therapy (CET), is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved social functioning.
In patients with schizophrenia, atypical antipsychotic medications have increased the effectiveness of symptom management, but patients may remain socially or cognitively disabled. CET is recommended for patients with schizophrenia who are stable with low risk of relapse.
Also people with eating disorders such as anorexia nervosa are considered to be cognitively inflexible with their perspectives of food. In London, CRT was beneficial in the treatment of adults with anorexia nervosa, and in Poland among adolescents with anorexia nervosa. In the United States clinical trials are still being conducted by Stanford University in subjects over 16 as a conjunctive therapy with family based treatment.
CRT has also been shown to be useful in both children and adults with ADHD, as well as for cognitive deficits associated with major depressive disorder CRT has also been used in a subset of pediatric cancer survivors who experienced cognitive impairment due to the effects of cancer or cancer treatment on cognitive functioning. Clinical trials are slated to begin in 2010 in the United States by the National Institute of Health and the National Institute of Drug Abuse on the efficacy of cognitive remediation upon the cognitive deficits associated with drug abuse.
CRT is usually administered via use of a computer, with the tasks appearing on the monitor.
As a treatment for anorexia nervosa
For individuals with AN, CRT is an interactive treatment which combines practical exercises with discussions about their relevance to the patient’s everyday life. It addresses the process rather than the content of thinking, thus helping patients to develop a metacognitive awareness of their own thinking style. The treatment is hypothesized to work by strengthening and refining neural circuits, and by learning and transferring new cognitive strategies to appropriate situations. The aim is to identify and target the cognitive impairments specific to each patient, and to motivate the patient to engage in meta-cognitive processes i.e. to consider their cognitive/thinking styles and to explore alternative strategies, which in turn might lead to behavioral changes. By becoming aware of problematic cognitive styles, the patient can reflect on how these affect everyday life and learn to develop new strategies. The intervention was originally developed for adults with chronic AN  but during the last decade, there has been a substantial increase in studies exploring CRT for younger patients as well. Much of this work has been conducted at Oslo University Hospital, where a feasibility trial of CRT for adolescents with AN has been performed  and novel materials targeting young individuals with AN has been developed by Camilla Lindvall Dahlgren, Isabel Owen and Bryan Lask - the CRT Resource Pack (available free of charge at www.rasp.no).
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