Table 1 Characteristics of included studies

To illustrate how CRT can be used to stimulate mental activities and improve thinking skills.

Improvement in cognitive set-shifting.

To demonstrate the potential benefits of CRT through a case-report.

The authors propose cognitive flexibility training as a pre-treatment intervention for treatment resistant inpatient cases.

To demonstrate how CRT has been adapted for AN through a case-report.

Increase in BMI, tasks were a bit repetitive but the patient was able to develop new flexible strategies for implementation in real-life settings.

Aim of study

Results

Explore the effect of CRT in set-shifting and investigates in acceptability for AN patients.

Improved cognitive flexibility and positive feedback for CRT.

To examine patients’ experience of participating in CRT.

Positive that the intervention did not focus on food, helpful in reducing perfectionism and rigidity. More difficulty in tasks wanted, and help to implement newly learned skills.

To explore neuropsychological task performance before and after CRT.

Improvements in cognitive performance on the Brixton & CatBat tasks. No sign improvements in other neuropsychological tasks. Significant decrease in depression.

To report CRT development and acceptability in a group format (2 male participants).

Statistically significant gains in self-reports of ability to change. CRT was found to be acceptable, useful and positive by both patient and group facilitators.

To evaluate the benefit of CRT in terms of changes in self-reported perfectionism and patient feedback.

Initially confusing but mentally stimulating. Increased awareness of ones own thinking style. Both higher and lower degrees of perfectionism post CRT.

To describe group CRT for adolescents.

Patients found CRT fun and playful, helped develop a positive therapeutic relationship. Negative feedback involved tasks being boring, too easy tasks, repetitive, some negative group dynamics affected the group work.

To examine how CRT has been implemented in the daily life of the patients through therapist feedback letters.

Feedback letters were positive and motivational, and highlighted challenges in metacognitive ability and in transferring in therapy skills to every day life for the patients.

To measure the effect of CRT on cognitive flexibility.

Improved neuropsychological performance. Significant improvement on impulse regulation, interoceptive awareness reflexive skills and awareness.

Evaluation of group CRT for adolescents with AN through self-reported flexibility and motivation.

No significant changes in flexibility and motivation to get better. Patient feedback: “interesting”, “fun”, “not too demanding”, “helpful”, but also “dull” and “repetitive”. Patients wanted more variation in exercises.

To explore the feasibility and acceptability of group CRT for inpatients with AN.

Group-based CRT could be well incorporated into the therapeutic program at the eating disorders unit, and was well received by the participants.

To assess the feasibility of CRT for children and adolescents with AN.

Results indicate feasibility for young patients with AN with regards to recruitment, materials, individual tailoring and delivery, and clinician feasibility.

To assess neuropsychological functioning pre and post CRT.

Significant changes in weight, depression, visio-spatial memory, global information processing and verbal fluency. Changes in weight had a significant effect on improvements in visio-spatial memory and verbal fluency.

To explore self-reports and parental ratings of executive function before and after CRT.

Decrease in patient BRIEF shift subscale post CRT. Parent reports revealed significant lower scores on shift-, emotional control- and working memory subscales, and on two composite indices.

To assess feasibility of CRT in family settings.

CRT is useful when applied in families, and authors suggest a subsequent formal evaluation of this mode of delivery.

Aim of study

Results

To evaluate the feasibility of using CRT to reduce attrition in RCT’s for AN.

CRT is acceptable and feasible for use in RCTs. It may also reduce short-term attrition.

To investigate feasibility and efficacy of specifically tailored CRT, compared to NNT.

Participants receiving CRT outperformed participants in the NNT condition in cognitive set-shifting. Both groups showed high treatment acceptance.

To evaluate AN-EXRP as an adjunctive strategy to improve eating behaviour during weight restoration.

AN-EXRP is associated with better caloric intake than CRT when assessed through laboratory meals.

To investigate the effectiveness of CRT in a randomised controlled trial comparing treatment as usual (TAU) and TAU plus CRT.

CRT plus TAU was superior in terms of ED-related quality of life and ED psychopathology. CRT appears to be promising in enhancing effectiveness of concurrent treatment.