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Cognitive remediation-enabled cognitive behaviour therapy for obesity: a case series

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Abstract

Purpose

Despite varied treatment effects, weight recidivism is common and typically associated with the abandonment of prescribed weight management strategies. Literature suggests that difficulty with weight management is associated with deficits in executive functioning, in particular cognitive flexibility and response inhibition, the neurocognitive processes that are involved in goal-directed behaviours, such as dietary adherence. These processes are overlooked by mainstream weight loss programmes. The aim of the study was to assess the effectiveness of a cognitive remediation-enabled cognitive behaviour therapy (CR-CBT) in addressing the neurocognitive, psychological and behavioural correlates of weight loss. It was hypothesised that CR-CBT would improve cognitive flexibility and response inhibition, reduce binge eating, aid weight loss and improve metabolic health.

Methods

Four adults with obesity (body mass index > 30 kg/m2) received 7 weeks of manualised CR-CBT and were assessed via a case series analysis at baseline, end of treatment and 3-month follow-up. Treatment included 3 weekly 90-min group-based behaviour weight loss sessions for 3 weeks, followed by twice-weekly 50-min individualised CR-CBT sessions for 4 weeks.

Results

Cognitive remediation-enabled cognitive behaviour therapy produced improvements in response inhibition and cognitive flexibility, and reductions in binge eating frequency, weight, and metabolic health readings between baseline and 3-month follow-up.

Conclusions

This is the first study to assess the effectiveness of CR-CBT in the treatment of obesity. Preliminary indications of treatment success are discussed with respect to study limitations. In light of these results, we recommend further investigation via a randomised control trial (RCT).

Level of evidence

Level IV, case series.

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Funding

No specific funding was provided for this project. Jayanthi Raman was supported by the UTS Seed Grant.

Author information

Authors and Affiliations

  1. University of Technology Sydney UTS, Level 4, Building 7, 15 Broadway, PO Box 123, Ultimo, NSW, 2007, Australia

    Mary Gilbert & Jayanthi Raman

  2. University of New South Wales, Level 3, Samuel Building, UNSW, Kensington, NSW, 2052, Australia

    Zhixian Sui

Authors
  1. Mary Gilbert
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  3. Zhixian Sui
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Corresponding author

Correspondence to Jayanthi Raman.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the Human Research Ethics Committee of the University of Technology Sydney (UTS) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was obtained from the UTS Human Research Ethics Committee prior to conducting this research.

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Informed consent was obtained from all individual participants included in the study.

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Appendices

Appendix 1: CR-CBT Treatment Plan

Cognitive remediation-enabled cognitive behavioural therapy (CR-CBT) manualised format

Session 1

CRT

1. Introduction to the programme

2. Psycho-education of CRT in weight management

3. Tasks relating to cognitive flexibility

CBT

1. Psychoeducation of CBT in weight management

2. Self-efficacy training

3. SMART goals

Session 2

CRT

1. Review home work

2. Recap

3. More tasks on cognitive flexibility

4. New ways of thinking—in-session training

5. Home work—self-monitoring

CBT

1. Review home work

2. Recap

3. Eating focused CBT—discussion

4. Behavioural experiments

5. Homework—beh experiment + continue self-monitoring

Session 3

CRT

1. Review home work

2. Recap

3. Tasks on cognitive flexibility, response inhibition and planning

4. Home work

CBT

1. CBT on impulse control

2. CBT on health behaviour change

3. In-session training

4. Homework—beh experiment and continue self-monitoring

Session 4

CRT

1. Review home work

2. Cognitive flexibility and response inhibition tasks—continued

3. Estimation tasks—in-session training

4. Planning and organisation—in-session training

5. Home work: estimation tasks in shopping behaviours

 

CBT

1. Review home work

2. Mindfulness in eating behaviours

3. Exposure and response prevention—Psycho-ed

4. Home work: on 2 and 3

Session 5

CRT

1. Review home work

2. Attention switching and Attention to detail tasks

3. Planning and organisation tasks

4. Cognitive flexibility tasks

5. New ways of thinking tasks

CBT

1. Review home work

2. Resisting and managing temptation—in-session training

3. Structured problem solving in eating behaviours—in-session training

4. Home work: on 2 and 3

Session 6

CRT

1. Review home work

2. Cognitive flexibility tasks

3. Response inhibition tasks

4. Advise participant to start preparing a letter to the therapist

CBT

1. Review home work

2. Overcoming unhelpful habits

3. Temptation management Cont’d

4. Homework tasks: on 1 and 2

Session 7

CRT

1. Goals—moving forward and strategies

CBT

1. Review home work

2. Recap on all CBT strategies taught so far with an emphasis on linking them with the CRT exercises taught so far: content and process

Session 8

CRT

1. Mind map

2. Read letter to the therapist

3. Recap programme content

4. Relapse prevention

CBT

1. Relapse prevention

2. Motivational therapy building self-efficacy—Guided discovery techniques

3. CBT goals—moving forward and strategies

Appendix 2: Individual participant cardiometabolic results

Individual C-reactive protein (CRP), triglycerides and high density lipoproteins—cholesterol readings at baseline, end of treatment (EoT) and 3-month follow-up

 

CRP (mg/L)

Tg (mmol/L)

HDL (mmol/L)

Baseline

Three-month follow-up

Baseline

Three-month follow-up

Baseline

Three-month follow-up

P1

2.5

1.5

1.2

1

1.7

1.2

P2

3.5

2.6

1.1

0.9

1.7

1.5

P3

2.5

0.9

1.2

0.9

1.7

1.6

P4

32.7

27.4

3.8

2.6

1.4

1.5

  1. P participant, BMI body mass index, BP blood pressure, Tg triglycerides, HDL high density lipoprotein cholesterol, CRP C-reactive protein, Binge Binge eating

Individual participant blood pressure (BP) readings at baseline end of treatment (EoT) and 3-month follow-up

 

BP (mmHg)

Baseline

EoT

Three-month follow-up

P1

157/103

138/90

134/82

P2

133/101

124/88

133/98

P3

181/126

127/100

137/101

P4

132/91

129/94

111/78

  1. P participant

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Gilbert, M., Raman, J. & Sui, Z. Cognitive remediation-enabled cognitive behaviour therapy for obesity: a case series. Eat Weight Disord 26, 103–114 (2021). https://doi.org/10.1007/s40519-019-00823-4

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