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Objective: We aimed to evaluate longitudinal changes in set-shifting and central coherence in a predominantly adolescent cohort with anorexia nervosa (AN) and to explore whether these factors predict long-term eating disorder outcomes., Method: Ninety-two female patients with AN (mean age: 16.2, range: 13-21 years) completed neurocognitive tests (Rey Complex Figure Test, Adapted Version of the Wisconsin Card Sorting Test) before and after 12 months of psychotherapeutic treatment (n = 45 Maudsley AN Treatment, MANTRa; n = 47 standard psychotherapy; groups not randomised). Eating disorder severity was assessed at baseline, after 6, 12 and 18 months., Results: Central coherence (indicated by an increase in the Rey Figure Style Index) and set-shifting (indicated by a reduction in the percentage of perseverative errors) significantly improved over the course of treatment, with similar outcomes across groups. Lower central coherence was associated with higher eating disorder severity. Individuals with lower baseline set-shifting ability tended to have worse eating disorder outcomes in the long-term. However, this trend did not reach statistical significance in a multilevel linear mixed model., Conclusions: Neurocognitive difficulties in adolescents and young adults with AN can improve after treatment. Interventions specifically addressing flexibility in thinking and behaviour may contribute to treatment success., (© 2024 The Author(s). European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)