Cognitive rehabilitation therapy, also called ‘cognitive remedy’ therapy, is a treatment that was created for people resistant to treatments, generally hospitalized and suffering from severe and chronic anorexia. It is an intervention that can be used both as a pre-treatment program and as an additional module to cognitive-behavioral psychotherapies.
The purpose of the treatment is to help the patient acquire a series of strategies that facilitate the acquisition of greater flexibility of thought (and therefore combat the rigidity that characterizes the disorder) and the adoption of a more “global” style of thinking. ”(Versus the tendency to excessive attention to detail).
The assumptions on which the program is based consist of the idea that the brain, thought and information processing are not given once and for all, but that they are able to change in the course of life if subjected to specific “training” or “gymnastics”. It is a science-based program where research-based findings have been brought into clinical practice with patients.
It is a slightly different approach from classic psychotherapeutic interventions, which mainly addresses ‘how’ the patient thinks and not the contents of the thought (what the person thinks). No emphasis is placed on the food symptoms manifested by the person (body weight, fasting, caloric restriction, physical hyperactivity, bulimic crises, …), but the focus is on thought processes through the use of simple and specific cognitive exercises that they have nothing to do with nutrition and weight. This generally reduces patient resistance by improving adherence to therapy (compliance). It is an intervention that consists of mental exercises aimed at improving cognitive strategies, thinking skills, and the processing of information through a structured and limited time program.
The motto that well describes the objectives of the program is: “I think it is difficult to think about how to get out of my problem because I think the problem is my way of thinking”.
The cognitive remedy is an intervention that:
- It consists of mental exercises aimed at improving cognitive strategies, thinking skills and ways of processing information through practice;
- Promotes reflection on styles of thinking;
- Encourage metacognition (thinking about thinking);
- It helps to explore new thinking strategies in everyday life.
The purpose of the program is to improve in particular cognitive flexibility and “central coherence” which is the ability to integrate individual details into a whole with meaning and the ability not to “get lost” in the details (see the forest and not trees only).
The original program consists of 10 sessions of 30-40 minutes each lasting about 5 weeks. The first sessions are dedicated to building a relationship of trust and collaboration between therapist and patient in order to create a working alliance. The rationale and methods of treatment are explained to the patient. It begins with the experiences of everyday life. Then we move on to the implementation of simple exercises aimed at improving cognitive rigidity and central coherence. In sessions 5-8 we focus on daily life and the need to transfer what has been learned to behaviors in real life through the implementation of new behaviors. Finally, in the last two sessions we talk and exchange the letter of greetings prepared by the therapist and patient.
Numerous studies in the literature have confirmed the efficacy in reducing the inflexibility and attention to detail of the cognitive remedy intervention in anorexia nervosa .
