Adapting a Cognitive Remediation Therapy Manual for Overeating Eating Disorders
Author
Jensen, Rebekka Bogadóttir
Term
4. term
Education
Publication year
2026
Abstract
This thesis explores how an existing Cognitive Remediation Therapy (CRT) manual can be adapted for individuals with overeating eating disorders in order to better target their specific cognitive difficulties. Overeating eating disorders (OED) are conceptualised as eating disorders in which overeating is a central feature, including anorexia nervosa binge/purge subtype, bulimia nervosa and binge eating disorder. The work builds on research showing that particular cognitive profiles—especially cognitive rigidity, reduced cognitive flexibility and weak inhibitory control—are linked to greater severity and chronicity in eating disorders. Using an iterative research strategy, the thesis first conducts a state-of-the-art literature review on the cognitive profile of OED and existing CRT interventions to identify key areas of deficit and suitable exercises. On this basis, an adapted CRT manual and workshop structure are developed to focus on set-shifting and inhibition through three core exercises (the d2 letter-cancellation task, the Tower of Hanoi, and the Konpira Fune cup-tapping task), supported by rhythm-based icebreakers and homework activities. The manual modifications are then explored in a pilot workshop with eight non-clinical participants who attend a CRT session and complete the Detail and Flexibility Questionnaire (DFlex), the Barratt Impulsiveness Scale (BIS-11), a motivational ruler, and a group feedback questionnaire. Data from surveys and field notes are used to assess the acceptability and practical utility of the adapted intervention and to refine the clarity, structure and presentation of materials. The findings suggest that the overall format and exercises are acceptable and usable: all participants reported enjoying the workshop, and the d2 task and cup-tapping exercise were especially described as enjoyable, engaging and thought-provoking, while feedback led to improvements in the readability and conciseness of the survey and workshop materials. The thesis concludes that a CRT manual targeting set-shifting and inhibitory deficits in overeating eating disorders can be developed and implemented in a way that participants experience as meaningful and manageable, while highlighting the need for further research, including a feasibility study of the full six-session manual in a clinical population.
Denne afhandling undersøger, hvordan et eksisterende manual til kognitiv remedieringsterapi (CRT) kan tilpasses personer med overspisende spiseforstyrrelser for bedre at målrette deres specifikke kognitive vanskeligheder. Overspisende spiseforstyrrelser (OED) forstås her som spiseforstyrrelser, hvor overspisning indgår som centralt symptom, herunder anoreksi med overspisning/udrensning, bulimi og binge eating disorder. Udgangspunktet er forskning, der peger på, at særlige kognitive profiler – især kognitiv rigiditet, nedsat fleksibilitet og svag hæmning af impulser – hænger sammen med øget sværhedsgrad og kronisk forløb ved spiseforstyrrelser. Med en iterativ forskningsstrategi gennemføres først et state-of-the-art litteraturreview af kognitive profiler ved OED og eksisterende CRT-indsatser, for at identificere centrale deficitområder og relevante øvelser. På denne baggrund udvikles et tilpasset CRT-manual og en workshopstruktur, der især adresserer set-shifting og inhibitionskontrol gennem tre hovedøvelser (d2-bogstavannulleringsopgave, Tower of Hanoi og Konpira Fune kop-rytmeøvelse) suppleret med rytmebaserede icebreakers og hjemmearbejde. Manualændringerne afprøves herefter i et eksplorativt pilotstudie med otte ikke-kliniske deltagere, der deltager i en CRT-workshop og udfylder måleinstrumenterne DFlex, BIS-11, en motivationsskala og et gruppe-feedbackskema. Data indsamles via spørgeskemaer og feltnoter og bruges til at vurdere anvendelighed og acceptabilitet samt til at justere formidling, struktur og materialer. Resultaterne tyder på, at det overordnede format og øvelserne opleves som acceptable og anvendelige: alle deltagere fandt workshoppen behagelig, og især d2-opgaven og kop-øvelsen blev beskrevet som sjove, engagerende og refleksionsskabende, mens surveys og materialer kunne forbedres ved større tydelighed og kortfattethed. Afhandlingen konkluderer, at et CRT-manual målrettet set-shifting og inhibitionsvanskeligheder ved overspisende spiseforstyrrelser kan udvikles og implementeres på en måde, der opleves meningsfuld og håndterbar af deltagerne, men at der er behov for yderligere forskning, herunder et egentlig feasibility-studie af det fulde 6-sessions manual i en klinisk population.
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