By Carrie Arnold, published on July 3, 2011 - last reviewed on November 20, 2015
When a person with an eating disorder sees an avocado, she doesn't think of its buttery flavor or a friend's killer guacamole—all she can focus on is its 300 calories. No matter how much she learns about nutrients and healthy fats, she can't think differently about the fruit.
Researchers at King's College London took advantage of the fact that people with eating disorders are cognitively inflexible. In their rituals and routines, in their approach to food, and even in finding alternate routes to work, they can't broaden or shift their perspectives. In this sense, anorexia patients look like schizophrenics: They tend to fixate on minutia and hold delusional beliefs. That inspired psychologist Kate Tchanturia to adapt for anorexics a new treatment for schizophrenia, cognitive remediation therapy (CRT).
CRT aims to correct the thinking styles that make people vulnerable to anorexia and keep them stuck in their disorder, explains James Lock, director of the Eating Disorders Program at Stanford. "The symptoms of anorexia are rigid, detailed dieting and exercise," he says.
A CRT patient completes tasks that develop the ability to shift and even broaden perspective. She also practices these skills on her own—taking a different route to work, for example. She's actually retraining the brain in low-stress situations, so that when she next encounters a ripe avocado she can appreciate its taste rather than fixate on its calories.
CRT isn't a stand-alone treatment for anorexia, says Lock—it's an add-on. The core symptoms of restrictive food intake and low weight still must be addressed through dietary modifications and therapy. But preliminary research indicates that CRT significantly improves patients' ability to change their behavior and is a nonthreatening way to begin the recovery process. —Carrie Arnold
The idea of using card games and puzzles as an eating disorder treatment may sound bizarre, yet it is CRT's simplicity and lack of focus on food and emotions that make it so successful. Here are a few of the drills clinicians use over the course of five or 10 sessions.
The Map Game
Find a route from Point A to Point B on a map. Now find another route. And another. Patients come to see there's more than one way to approach a problem.
The Letter Game
Read all the words in a list that begin with F. Midway through, start reading the ones that start with P. Practicing such switching helps patients think more flexibly.
The Summary Game
Read a short story or letter and then summarize it in one sentence. Patients learn to zoom out from the details.
The Visual Illusion Game
Study an illusion. See how the young woman's head is also an old woman's face? Patients practice perspective-taking, which helps them see their illness from loved ones' eyes.