Psychology Research and Behavior Management (Apr 2022)
Cognitive Behavioral and Cognitive Remediation Strategies for Managing Co-Occurring Anorexia Nervosa and Elevated Autism Spectrum Traits
Abstract
Emma Saure,1,2 Monica Ålgars,1,3,4 Marja Laasonen,5 Anu Raevuori6,7 1Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; 2BABA Center and Department of Clinical Neurophysiology, Children’s Hospital, Helsinki, Finland; 3Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland; 4Department of Psychology, Åbo Akademi University, Turku, Finland; 5Logopedics, School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland; 6Department Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland; 7Clinicum, Department of Public Health, University of Helsinki, Helsinki, FinlandCorrespondence: Emma Saure, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, Helsinki, FI-00014, Finland, Tel +358443035828, Email [email protected]: Anorexia nervosa (AN) is a potentially severe eating disorder whose core characteristics include energy intake restriction leading to low body weight. Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social interaction and communication as well as repetitive, stereotyped behavior and interests. Both high ASD traits and diagnosed ASD are overrepresented among individuals with AN, and AN and ASD appear to share certain neurocognitive features. These features are associated with the severity of eating disorder symptoms and prolongation of AN. Thus, individuals with AN and high ASD traits or ASD may benefit less from traditional treatment when compared to those with low ASD traits. No previous reviews have summarized what is known about treatment adaptations for individuals with AN and high ASD traits or ASD. The purpose of this narrative review was to investigate the feasibility of cognitive remediation therapy (CRT), cognitive remediation and emotional skill training (CREST), and cognitive behavioral therapy (CBT), and give an overview of treatment modifications for individuals with AN and co-occurring ASD or high ASD traits. We found nine studies that fulfilled our inclusion criteria. The combined results suggest that individuals with AN and high ASD traits or ASD benefit less from CRT, CREST, and CBT than those with AN and low ASD traits. However, CRT and CREST administered in individual format may be associated with improved cognitive flexibility, motivation for change, and decreased alexithymia among adults with AN and high ASD traits or ASD. Individuals with comorbid AN and ASD themselves highlight the importance of treatment adaptations that take the characteristics of ASD into account. In the future, controlled studies of the treatment strategies for individuals with AN and ASD/high ASD traits are needed in order to improve the outcome of individuals with this challenging comorbidity.Keywords: anorexia nervosa, feeding and eating disorders, autism spectrum disorder, treatment, cognitive remediation, cognitive behavioral therapy
