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Couture S, Lecours S, Beaulieu-Pelletier G, Philippe FL, Strychar I. French adaptation of the eating disorder recovery self-efficacy questionnaire (EDRSQ): psychometric properties and conceptual overview. EUROPEAN EATING DISORDERS REVIEW 2010; 18:234-43. [PMID: 20196092 DOI: 10.1002/erv.996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
High prevalence of Eating Disorders (EDs) and poor treatment outcome rates have urged research in the assessment of EDs. Self-efficacy is a key motivational factor in the recovery from EDs. A self-report measure, the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), was recently developed to assess confidence in adopting healthy eating behaviours and in maintaining a realistic body image. The objectives of this study were to (a) translate the EDRSQ to French (EDRSQ-F), (b) assess the psychometric properties of this French version, and (c) establish normative data for a non-clinical sample. Participants were 203 undergraduate women. They completed the EDRSQ-F and measures of ED symptoms, depression and self-esteem. A confirmatory factor analysis (CFA) revealed a bi-factorial structure. Both scales demonstrated evidence of reliability and theoretically consistent evidence of construct validity. Findings support the validity of the EDRSQ-F and suggest it is a useful instrument for the assessment of EDs.
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52
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Zaitsoff SL, Taylor A. Factors related to motivation for change in adolescents with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2009; 17:227-33. [PMID: 19308946 DOI: 10.1002/erv.915] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the association between motivation for change and eating disorder symptom severity, the quality of the parent-adolescent relationship and depressive symptom severity in adolescents with eating disorders. METHOD Fifty-four female adolescents with eating disorders (mean age = 15.8 years, SD = 1.6) participated in this research prior to beginning outpatient treatment. Participants completed the Motivational Stages of Change for Adolescents Recovering from an Eating Disorder, the Eating Disorders Inventory-2, the Relations with Parents scale from the Behavioral Assessment System for Children and Adolescents Self-report and the Child Depression Inventory. RESULTS Greater motivation for change was associated with less body dissatisfaction, more adaptive parent-adolescent relationships and fewer depressive symptoms. The association between motivation for change and adolescents' perception of their relationship with their parents remained significant even after controlling for age, body dissatisfaction and depressive symptoms. CONCLUSION Involvement of families in treatment for adolescents with eating disorders may serve to enhance their motivation to recover.
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53
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Ackard DM, Croll JK, Richter S, Adlis S, Wonderlich A. A self-report instrument measuring readiness to change disordered eating behaviors: the Eating Disorders Stage of Change. Eat Weight Disord 2009; 14:e66-76. [PMID: 19934639 DOI: 10.1007/bf03327802] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the utility of the Eating Disorders Stage of Change (EDSOC), a behavior-specific readiness questionnaire. METHOD Patients (N=145) at a multidisciplinary eating disorder treatment facility in the United States completed the EDSOC and other questionnaires. RESULTS One-week test-retest reliability was strong across eating disorder diagnoses and age groups. Convergent validity was strongest when the behavior in question was congruent with the diagnosis (e.g., purging behaviors for bulimia nervosa diagnosis) and compared to the patient's own intention to complete treatment. Divergent validity was demonstrated against body mass index values and age. However, the EDSOC and Body Shape Questionnaire were inversely correlated, suggesting that increased body shape concerns are associated with decreased intention to change a behavior. CONCLUSION This preliminary cost-effective, behavior-specific measure demonstrates good psychometric properties and is appropriate for use with children and adults. Across diagnosis, the instrument should be used by looking at each single item instead of summing a total score across disparate eating disorder behaviors.
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Wade TD, Frayne A, Edwards SA, Robertson T, Gilchrist P. Motivational change in an inpatient anorexia nervosa population and implications for treatment. Aust N Z J Psychiatry 2009; 43:235-43. [PMID: 19221912 DOI: 10.1080/00048670802653356] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The relationship between motivation and recovery in anorexia nervosa has received increased attention in the research literature although few controlled investigations of increasing motivation in this population exist. Three questions were therefore examined in an inpatient anorexia nervosa population: (i) does baseline motivation predict change in eating pathology; (ii) does change in motivation predict change in eating pathology; and (iii) can we increase motivation to recover in this group? METHOD Inpatients (n=47) in a specialist weight disorder unit with a mean age of 21.85 years (SD=5.37) were randomly allocated to receive four sessions of motivational interviewing with a novice therapist in addition to treatment as usual (n=22) or treatment as usual alone (n=25). Assessment of eating pathology and motivation to recover was conducted on three occasions: at admission (baseline), and at 2- and 6 week follow up. Eating pathology was assessed using the Eating Disorder Examination and self-reported motivation was assessed using the Anorexia Nervosa Stages of Change Questionnaire and six Likert scales. RESULTS Higher baseline motivation across five of the seven measures predicted significant decreases in eating pathology, and increased Anorexia Nervosa Stages of Change Questionnaire scores between baseline and 2 week follow up predicted significant improvement in eating pathology between baseline and 6 week follow up. Significantly more patients were lost to follow up from the treatment as usual compared to the motivational interviewing group. More patients in the motivational interviewing condition moved from low readiness to change at baseline to high readiness to change at 2 and 6 week follow up. CONCLUSIONS Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that motivation can be improved in this population. Further investigations, however, of ways of improving motivation in this population need to be conducted, along with the impact of motivational changes on treatment outcome.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, SA, Australia.
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55
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Geller J, Cassin SE, Brown KE, Srikameswaran S. Factors associated with improvements in readiness for change: low vs. normal BMI eating disorders. Int J Eat Disord 2009; 42:40-6. [PMID: 18636540 DOI: 10.1002/eat.20574] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine factors associated with improvements in readiness for change as a function of body mass index (BMI) in individuals assessed for eating disorders treatment. METHOD Participants (n = 128) completed the Readiness and Motivation Interview (RMI) and measures of psychiatric and eating disorder symptoms, quality of life, and self-esteem at baseline and at 5-month follow-up. RESULTS Participants whose readiness for change showed improvements in psychiatric symptom severity, global self-esteem, and in the importance of friendships as a determinant of self-esteem. Only those with a normal baseline BMI (20 kg/m(2) or greater) improved in eating disorder symptoms and quality of life, and reported increased importance of personal development and decreased importance of shape and weight as determinants of self-esteem. CONCLUSION Correlates of readiness differed between low and normal BMI participants, suggesting that weight status may be an important variable to consider in preparing highly ambivalent individuals for treatment.
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Affiliation(s)
- Josie Geller
- Eating Disorders Program, St. Paul's Hospital, Vancouver, Canada.
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56
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Nordbø RHS, Gulliksen KS, Espeset EMS, Skårderud F, Geller J, Holte A. Expanding the concept of motivation to change: the content of patients' wish to recover from anorexia nervosa. Int J Eat Disord 2008; 41:635-42. [PMID: 18528876 DOI: 10.1002/eat.20547] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Motivational approaches to anorexia nervosa (AN) have mainly concerned motivational quality and quantity. We investigated the content of patients' wish to recover. METHOD Eighteen women, aged 18-39, with AN were interviewed in depth using a phenomenological study design. Interviews were tape-recorded, transcribed, and analyzed using the QSR-N*Vivo software program. RESULTS Four motivational content areas characterized informants' wishes to recover: "Sense of vitality" (e.g., joy, concentration, spontaneity, energy); "Sense of autonomy" (e.g., choosing to recover, new methods of mastery, self-determination); "Sense of insight" (e.g., awareness, seeing nuances, limitation of goals, self-knowledge); and "Negative consequences" (e.g., loss of future, costs to own children, feeling sick or thin, social costs, physical costs). CONCLUSION Our sample of AN patients' motivation to recover may be described using three dimensions: content, quality, and quantity, and may also include motives with no behavioral intention. Sustained therapeutic success may rest upon the therapist's ability to identify and ally with the patient's motives to recover.
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Affiliation(s)
- Ragnfrid H S Nordbø
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
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57
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Dean HY, Touyz SW, Rieger E, Thornton CE. Group motivational enhancement therapy as an adjunct to inpatient treatment for eating disorders: a preliminary study. EUROPEAN EATING DISORDERS REVIEW 2008; 16:256-67. [DOI: 10.1002/erv.851] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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58
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Bewell CV, Carter JC. Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa. Int J Eat Disord 2008; 41:368-71. [PMID: 18306345 DOI: 10.1002/eat.20513] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the present study was to determine if readiness to change eating and weight was predictive of anorexia nervosa (AN) inpatient treatment outcome, and whether it mediates the relationships between AN treatment outcome and other known predictors of outcome. METHOD Participants were 127 patients with AN who were consecutively admitted to an intensive in-patient treatment program. They completed the Eating Disorder Inventory at admission and a measure of readiness to change after 4 weeks of treatment. RESULTS Readiness to change significantly predicted treatment outcome, even after controlling for level of eating disorder symptomatology at admission and AN subtype. It was also found to fully mediate the relationship between eating disorder symptomatology at admission and later treatment outcome. CONCLUSION These findings suggest not only that readiness to make changes is an important indicator of future inpatient treatment outcome, but that it is the mechanism by which eating disorder symptomatology predicts success in a treatment program.
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Affiliation(s)
- Carmen V Bewell
- Department of Psychiatry, Toronto General Hospital, Toronto, Ontario, Canada
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59
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The Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ): change with treatment and prediction of outcome. Eat Behav 2008; 9:143-53. [PMID: 18329592 DOI: 10.1016/j.eatbeh.2007.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 05/19/2007] [Accepted: 07/04/2007] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to examine the predictive validity of the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), an empirically-derived self-report instrument that assesses confidence to eat without engaging in eating disordered behavior or experiencing undue emotional distress (Normative Eating Self-Efficacy) and confidence to maintain a realistic body image that is not dominated by pursuit of thinness (Body Image Self-Efficacy). Participants were 104 female inpatients with anorexia nervosa (AN), subthreshold AN, or underweight bulimia nervosa who were treated at a specialized eating disorder clinic and completed the EDRSQ and Eating Disorder Inventory-2 (EDI-2) Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales upon admission. A subset of patients completed the EDRSQ (n=81) and EDI-2 subscales (n=70) following inpatient treatment. Self-efficacy increased significantly during treatment. EDRSQ scores at admission were inversely related to length of hospital stay and posttreatment DT and BD subscales and positively related to partial hospital weight gain rate. The EDRSQ significantly predicted length of hospital stay and posttreatment BD above and beyond clinical indicators and eating disorder psychopathology at inpatient admission. Findings support the validity of the EDRSQ and suggest it is a useful predictor of short-term hospital treatment outcome in underweight eating disorder patients.
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60
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McHugh MD. Readiness for change and short-term outcomes of female adolescents in residential treatment for anorexia nervosa. Int J Eat Disord 2007; 40:602-12. [PMID: 17610253 DOI: 10.1002/eat.20425] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine if readiness for change (RFC) at admission predicted length of stay (LOS) and short-term outcomes among female adolescents in residential treatment for anorexia nervosa (AN). METHOD Using a prospective cohort design to collect data from participants (N = 65) at admission and discharge, Kaplan-Meier survival analysis and Cox regression tested whether RFC on admission predicted time in LOS to a favorable short-term outcome--a composite endpoint based on minimum criteria for weight gain, drive for thinness, depression, anxiety, and health-related quality of life (HRQOL). RESULTS Participants with low RFC had a mean survival time to a favorable short-term outcome of 59.4 days compared to 34.1 days for those with high RFC (log rank = 8.44, df = 1, p = .003). The probability of a favorable short-term outcome was 5.30 times greater for participants with high RFC. CONCLUSION Readiness for change is a useful predictor of a favorable short-term outcome and should be considered in the assessment profile of patients with AN.
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Affiliation(s)
- Matthew D McHugh
- The Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
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61
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Martinez E, Castro J, Bigorra A, Morer A, Calvo R, Vila M, Toro J, Rieger E. Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire. EUROPEAN EATING DISORDERS REVIEW 2007; 15:13-23. [PMID: 17676668 DOI: 10.1002/erv.725] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess motivation to change in adolescent patients with bulimia nervosa through the Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), an instrument adapted from the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) already validated in anorexic patients. METHOD Subjects were 30 bulimia nervosa patients (mean age = 16.3 years) who were receiving treatment at an eating disorders unit. The evaluation instruments were: the BNSOCQ, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI). The BNSOCQ was re-administered 1 week later to evaluate test-retest reliability. RESULTS The BNSOCQ demonstrated good internal consistency (Cronbach's alpha = 0.94) and one week test-retest reliability (Pearson's r = 0.93). Negative significant correlations were found between the BNSOCQ and several EDI-2 scales (Pearson's r between -0.51 and -0.84) and the BDI (r = -0.74). CONCLUSION The study provides initial support for the reliability and validity of the BNSOCQ as a self-report instrument for assessing motivation to change in adolescents with bulimia nervosa.
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Affiliation(s)
- Esteve Martinez
- Department of Child and Adolescent Psychiatry and Psychology Hospital Clínic Universitari of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Spain
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62
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Castro-Fornieles J, Casulà V, Saura B, Martínez E, Lazaro L, Vila M, Plana MT, Toro J. Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa. Int J Eat Disord 2007; 40:129-35. [PMID: 17080450 DOI: 10.1002/eat.20340] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyze variables that predict weight maintenance in adolescent anorexia nervosa. METHOD The Eating Attitudes Test, the Beck Depression Inventory, the Leyton Obsessional Inventory, the State and Trait Anxiety Inventory, and the Anorexia Nervosa Stages of Change Questionnaire were administered to 49 anorexia nervosa patients (mean age 14.3 years, SD 1.7) consecutively admitted to an eating disorder unit. They were evaluated at admission, at discharge, and after nine months follow-up. RESULTS At discharge, patients had improved in body mass index (p < .001), eating attitudes (p = .002), depressive symptomatology (p = .001), and motivation to change (p < .001). Patients with good weight maintenance at follow-up had higher body mass index (p = .017) at admission, lower abnormal eating attitudes (p = .035), depressive symptomatology (p = .026), and higher motivation to change (p = .004) at discharge. Logistic regression analysis showed a high motivation to change at discharge and a high body mass index at admission to be predictors of weight maintenance. CONCLUSION High motivation to change, low abnormal eating attitudes, depressive symptomatology at discharge, and high body mass index at admission are associated with weight maintenance in adolescent anorexia nervosa.
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Affiliation(s)
- Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Institute Clinic of Neurosciences, Hospital Clínic Universitari of Barcelona, Barcelona, Spain.
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63
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George L, Thornton C, Touyz SW, Waller G, Beumont* PJV. Motivational enhancement and schema-focused cognitive behaviour therapy in the treatment of chronic eating disorders. CLIN PSYCHOL-UK 2007. [DOI: 10.1080/13284200412331304054] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Louise George
- Peter Beumont Centre for Eating Disorders, Wesley Private Hospital , Sydney, New South Wales, Australia
| | - Chris Thornton
- Peter Beumont Centre for Eating Disorders, Wesley Private Hospital , Sydney, New South Wales, Australia
| | - Stephen W Touyz
- Peter Beumont Centre for Eating Disorders, Wesley Private Hospital , Sydney, New South Wales, Australia
- School of Psychology, University of Sydney , New South Wales, Australia
| | - Glenn Waller
- Department of Psychiatry, St. George's Hospital Medical School, University of London , United Kingdom
| | - Pierre JV Beumont*
- Department of Psychological Medicine, University of Sydney , New South Wales, Australia
- Wesley Private Hospital , Sydney, New South Wales, Australia
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64
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Marinilli Pinto A, Guarda AS, Heinberg LJ, Diclemente CC. Development of the eating disorder recovery self-efficacy questionnaire. Int J Eat Disord 2006; 39:376-84. [PMID: 16528731 DOI: 10.1002/eat.20256] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The purpose of the current investigation was to develop and validate the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), a self-report measure of self-efficacy to recover from an eating disorder. METHOD Participants were 116 female patients with anorexia nervosa, bulimia nervosa, or a subthreshold eating disorder treated at an eating disorder clinic. Patients completed the EDRSQ and measures of eating disorder symptoms and depression. RESULTS The EDRSQ contains two internally consistent factors, Normative Eating Self-Efficacy and Body Image Self-Efficacy. Moderate to large correlations between EDRSQ subscales and measures of eating disorder pathology support the convergent validity of the EDRSQ. The EDRSQ demonstrates theoretically consistent relations with constructs that are related to but distinct from self-efficacy. Discriminant validity is reflected in small correlations between EDRSQ subscales and measures of general psychological correlates of disordered eating. CONCLUSION The EDRSQ is a psychometrically sound measure to assess self-efficacy in patients with a range of eating disorder diagnoses.
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Affiliation(s)
- Angela Marinilli Pinto
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island 02903, USA.
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65
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Gale C, Holliday J, Troop NA, Serpell L, Treasure J. The pros and cons of change in individuals with eating disorders: a broader perspective. Int J Eat Disord 2006; 39:394-403. [PMID: 16528730 DOI: 10.1002/eat.20250] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The goals of the current study were to develop a questionnaire measuring the pros and cons of eating disorder symptoms and to explore the themes endorsed by different eating disorder groups. METHOD Participants recruited from an eating disorder volunteer register and an outpatient clinic completed the Pros and Cons of Eating Disorders scale (P-CED). Principal components analyses (PCA) were performed to validate the factorial structure of the original items and to explore the factorial structure of the new items. Planned comparisons were used to compare P-CED scores between diagnostic groups. RESULTS PCA indicated a 10-factor solution for the original Pros and Cons of Anorexia Nervosa scale (P-CAN) items and a 4-factor solution for the new items. Participants with anorexia nervosa (AN) scored significantly higher than participants with bulimia nervosa (BN) on five of the P-CED subscales but there were no significant differences between the two AN subtypes. CONCLUSION The P-CED is a useful tool for identifying the positive and negative aspects of eating disorders that can be targeted in treatment or used as an outcome measure in research.
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Affiliation(s)
- Corinne Gale
- Eating Disorders Unit, Department of Psychological Medicine, Institute of Psychiatry, London, United Kingdom
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66
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Rushford N. Readiness to recover in anorexia nervosa: what does it depend on in female inpatients? EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.732] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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67
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Rieger E, Touyz S. An investigation of the factorial structure of motivation to recover in anorexia nervosa using the Anorexia Nervosa Stages of Change Questionnaire. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.684] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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68
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Tracking Readiness and Motivation for Change in Individuals with Eating Disorders Over the Course of Treatment. COGNITIVE THERAPY AND RESEARCH 2005. [DOI: 10.1007/s10608-005-5774-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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69
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Ametller L, Castro J, Serrano E, Martínez E, Toro J. Readiness to recover in adolescent anorexia nervosa: prediction of hospital admission. J Child Psychol Psychiatry 2005; 46:394-400. [PMID: 15819648 DOI: 10.1111/j.1469-7610.2004.00360.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine if motivation to change in anorexia nervosa during treatment is a predictor of hospitalisation in adolescent patients. METHOD The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) were administered to a group of 70 anorexia nervosa patients (mean age 15.6 years). They were all receiving treatment at a specialised Eating Disorder Unit and were at different points in the treatment programme. Admission during 6-9 month follow-up was recorded in 63 of these patients who had been admitted to the Unit. The other 7 patients were contacted by phone to determine if they had been hospitalised in another unit during the follow-up period. RESULTS Patients who needed hospital admission during follow-up had higher mean scores at first evaluation on some of the EDI-2 scales and on the BDI, lower ANSOCQ scores and were more likely to have been outpatients at first evaluation. In the logistic regression analysis a low ANSOCQ score and being an outpatient at first evaluation were shown to be independent predictors of hospitalisation during follow-up. CONCLUSIONS Low motivation to change, depressive symptomatology and some EDI-2 scales are related to the necessity of hospital admission in adolescent patients with anorexia nervosa.
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Affiliation(s)
- L Ametller
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, IDIBAPS, Spain
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70
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Vansteenkiste M, Soenens B, Vandereycken W. Motivation to change in eating disorder patients: a conceptual clarification on the basis of self-determination theory. Int J Eat Disord 2005; 37:207-19. [PMID: 15822077 DOI: 10.1002/eat.20099] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study critically reviews the different motivational frameworks that are applied in the study of eating disorders and provides a more comprehensive conceptualization of motivation to change on the basis of self-determination theory. METHOD The most important conceptualizations of motivation to change among eating disorder patients are identified. RESULTS Eating disorder patients' motivation to change has been defined very differently, adding confusion to the field and preventing research from being cumulative. On the basis of self-determination theory we argue (a) that the quality of motivation to change is primarily reflected in the degree of internalization of change rather than by the intrinsic motivation to change; (b) that the internalization of change suggests more than only the change being initiated from within the person (internal motivation) for it requires an acceptance of the personal importance of change; and (c) that, in addition to its quality, the quantity of motivation to change should be considered too. DISCUSSION These three conceptual issues are applied to the study of motivational dynamics in eating-disordered patients.
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71
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Rodríguez-Cano T, Beato-Fernández L. Attitudes towards change and treatment outcome in eating disorders. Eat Weight Disord 2005; 10:59-65. [PMID: 15943173 DOI: 10.1007/bf03353420] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To investigate the influence of the stage of change on treatment outcome among patients suffering from eating disorders. METHOD Sixty-seven women receiving free outpatient treatment for eating disorders initially participated in this study. Their demographic, lifetime and clinical characteristics, eating disorder symptoms and general distress were assesssed at baseline and after one year, together with the results of self-report questionnaire on Attitudes towards Change in Eating Disorders (ACTA). RESULTS High scores on the Maintenance subscale were protective for eating psychopathology as measured by the Eating Attitudes Test (EAT-40), Eating Disorders Inventory (EDI-2) and the frequency of purging. Action was predictive of weight changes. Precontemplation and Relapse respectively predicted little change in EAT and the Bulimic Inventory Test Edinburgh (BITE). High Preparation scores were predictive of the level of EDI-2 Interoceptive Awareness, Maturity Fears, and Ascetism. DISCUSSION Our results suggest considering the stage of change as a useful outcome predictor.
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Affiliation(s)
- T Rodríguez-Cano
- Eating Disorders Unit, Department of Psychiatry, Ciudad Real Hospital, Spain
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72
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Peake KJ, Limbert C, Whitehead L. Gone, but not forgotten: an examination of the factors associated with dropping out from treatment of eating disorders. EUROPEAN EATING DISORDERS REVIEW 2005. [DOI: 10.1002/erv.645] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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73
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Serpell L, Teasdale JD, Troop NA, Treasure J. The development of the P-CAN, a measure to operationalize the pros and cons of anorexia nervosa. Int J Eat Disord 2004; 36:416-33. [PMID: 15558651 DOI: 10.1002/eat.20040] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Research has suggested that a fundamental aspect of anorexia nervosa (AN) is its egosyntonic nature, the fact that it is often valued by individuals with the disorder. The current study describes the development of the P-CAN, a quantitative measure of both positive (valued) and negative aspects of AN. METHOD Items were derived from a previous qualitative study (Serpell, Treasure, Teasdale, & Sullivan. 1999. International Journal of Eating Disorders, 25, 177-186). Data from 233 women with AN were subjected to a principal components analysis. RESULTS Ten subscales were identified, six describing the pros of AN and four describing the cons of the illness. DISCUSSION The P-CAN shows good psychometric properties and should prove a useful tool for the measurement of attitudes towards AN, as well as offer insights into the maintenance of the disorder.
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Affiliation(s)
- Lucy Serpell
- Department of Mental Health, St. Georges Hospital Medical School, London, UK.
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Wilson GT, Schlam TR. The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clin Psychol Rev 2004; 24:361-78. [PMID: 15245836 DOI: 10.1016/j.cpr.2004.03.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Revised: 03/17/2004] [Accepted: 03/23/2004] [Indexed: 02/03/2023]
Abstract
The transtheoretical stages of change model suffers from conceptual and empirical limitations, including problems of stage definition, measurement, and discreteness. Sequential transition across stages has not been established. The model lacks strong predictive utility, and there is little evidence that therapeutic interventions must be matched to stage to facilitate change. Initial tests applying the model to weight and eating disorders have been negative. Although the model is frequently associated with motivational interviewing (MI), no theory links the two. MI should be evaluated independently as a treatment for weight and eating disorders, to be used either alone or prior to treatments not explicitly addressing motivation. The conceptual compatibility and procedural overlap between cognitive behavioral therapy (CBT) and MI are analyzed.
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Hasler G, Delsignore A, Milos G, Buddeberg C, Schnyder U. Application of Prochaska's transtheoretical model of change to patients with eating disorders. J Psychosom Res 2004; 57:67-72. [PMID: 15256297 DOI: 10.1016/s0022-3999(03)00562-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2003] [Accepted: 09/22/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Although eating disorders cause severe somatic and psychological sequelae, a majority of affected patients are not motivated for treatment. The aim of this study was to assess stages of change in patients with eating disorders and to analyze their correlations with clinical characteristics and treatment processes using Prochaska's transtheoretical model of change. METHODS A consecutive sample (N=88) including outpatients suffering from anorexia (n=29), bulimia (n=32), and eating disorders not otherwise specified (n=27) was recruited from an eating disorders clinic with a low-threshold access. The patients' readiness to change their eating behavior was assessed by a self-rating scale (URICA), and a score for each participant on each subscale (precontemplation, contemplation, action) was derived from the scale. Patients were introduced to a set of eight treatment processes over the course of four treatment sessions. During the four sessions, therapists rated whether or not patients appeared to be using each of the treatment processes. RESULTS While diagnostic subtype, age, illness duration, and previous treatments were not associated with motivational stages, self-referral was positively correlated to treatment motivation. Emotional involvement, specific behavioral change processes, and beginning a continuing treatment were correlated with more advanced stages of change. CONCLUSION This study supports the notion of the stages of change as an independent dimension that is relevant for the treatment of eating disorders. The lack of impact of previous, presumably nonspecific treatments on the stages of change underlines the importance to assess and to improve specifically patients' motivation. Therapeutic work towards the mobilisation of emotions with regard to their eating problem as a means to improve readiness to change should be examined in future studies.
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Affiliation(s)
- Gregor Hasler
- Psychiatric Department, Zürich University Hospital, Zürich, Switzerland.
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76
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Geller J, Drab-Hudson DL, Whisenhunt BL, Srikameswaran S. Readiness to change dietary restriction predicts outcomes in the eating disorders. Eat Disord 2004; 12:209-24. [PMID: 16864319 DOI: 10.1080/10640260490490438] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the relationship between readiness and motivation to change eating disorder symptoms and clinical outcomes during and following intensive residential eating disorder treatment. Sixty-four women completed the Readiness and Motivation Interview (RMI) at baseline, and a subset of participants were reassessed at post-treatment (n=45) and at 6 month follow-up (n=38). The RMI provides readiness scores for each of four symptom domains: restriction, cognitive, bingeing, and compensatory strategies. RMI scores were used to predict decision to enroll in treatment, dropout, symptom change following treatment, and maintenance of symptom change at six-month follow-up. The extent to which participants did not want to make changes to their dietary restriction at baseline (restriction precontemplation) was the most consistent predictor of short-term clinical outcome. The extent to which participants reported changing their restriction for themselves versus others (restriction internality) predicted outcome at 6-month follow-up. These preliminary findings suggest that assessing client readiness and motivation to change dietary restriction is most useful in predicting short and long-term clinical outcomes.
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Affiliation(s)
- Josie Geller
- Department of Psychiatry, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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77
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Abstract
The purpose of this study was to evaluate whether assessing motivation to change binge eating and compensatory behaviors separately would better describe concurrent bulimic symptomatology compared with a general measure of readiness to change eating behaviors. Participants completed the Eating Disorder Diagnostic Scale [EDDS: Stice, Telch, & Rizvi, in Psychol. Assess. 12 (2000) 123] to assess binging and compensatory behaviors, as well as three measures of readiness to change based on the University of Rhode Island Change Assessment Scale (URICA; McConnaughy, DiClemente, Prochaska, & Velicer (1989)): a general measure, which asked about eating behaviors in general, and two behavior specific measures, one asking about binging behavior only and the other asking about compensatory behaviors only. Results revealed that assessing readiness to change binge eating and compensatory behaviors separately accounted for greater variance in bulimic behaviors than a general measure of readiness to change. Results also provided discriminate validity for measuring readiness to change binge eating and compensatory behaviors separately. Results highlight the utility of assessing readiness to change bulimic symptomatology and the importance of measuring motivation to change binging and compensatory behaviors separately.
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Affiliation(s)
- Erin C Dunn
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA.
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78
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Geller J, Brown KE, Zaitsoff SL, Goodrich S, Hastings F. Collaborative versus directive interventions in the treatment of eating disorders: Implications for care providers. ACTA ACUST UNITED AC 2003. [DOI: 10.1037/0735-7028.34.4.406] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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79
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Thornton C, Beumont P, Touyz S. The Australian experience of day programs for patients with eating disorders. Int J Eat Disord 2002; 32:1-10. [PMID: 12183935 DOI: 10.1002/eat.10059] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe the authors' experience in establishing and implementing day programs for the treatment of eating disorders in Australia. METHOD This is a descriptive article based on the author's experience. Five-day programs are described in terms of their structure, theoretical orientation, and intended outcome. RESULTS & DISCUSSION The authors conclude that day programs need to be matched to the heterogeneous needs of the patients according to their stage of change. The further the patient is towards an action stage of change the less supervision of their eating- and skills-based therapy is required. Accordingly, treatment can be more focused on understanding the factors that maintain the eating disorder on a more extensive day program. Patients with longstanding eating disorders that have not responded to traditional treatments may benefit from a readiness and motivational therapy approach in a day program.
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Rieger E, Touyz SW, Beumont PJV. The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ): information regarding its psychometric properties. Int J Eat Disord 2002; 32:24-38. [PMID: 12183943 DOI: 10.1002/eat.10056] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) was developed to assess patients' readiness to recover from anorexia nervosa. In this article we present additional findings supporting the psychometric properties of the ANSOCQ. METHOD Forty-four inpatients with anorexia nervosa participated in the study. At the time of admission, patients were requested to complete the ANSOCQ as well as several other self-report questionnaires assessing constructs related to readiness to change. RESULTS The ANSOCQ demonstrated good construct-related validity in that significant correlations emerged between the ANSOCQ and instruments assessing the theoretically related constructs of decisional balance and self-efficacy. DISCUSSION Having developed a reliable and valid self-report questionnaire for the assessment of readiness to change in anorexia nervosa, the ANSOCQ provides a means of addressing motivational hypotheses which have been advanced in the context of eating disorders.
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Affiliation(s)
- Elizabeth Rieger
- Department of Psychology, University of Sydney, NSW 2006, Australia
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81
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Geller J. Estimating readiness for change in anorexia nervosa: comparing clients, clinicians, and research assessors. Int J Eat Disord 2002; 31:251-60. [PMID: 11920986 DOI: 10.1002/eat.10045] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This research compared the relative ability of clients, clinicians, and research assessors in estimating readiness for change in individuals with anorexia nervosa. METHOD Fifty-six individuals with a current or past diagnosis of anorexia nervosa made ratings of the extent to which they perceived themselves to be ready for treatment and recovery. Clinicians and research assessors made the same ratings based on their impressions following clinical and research assessments, respectively. The outcome variables included questionnaire measures of change activities, assigned behavioral tasks, and clients' decision to accept intensive treatment. RESULTS While research assessor and client ratings predicted questionnaire recovery activities, only research assessor ratings predicted completion of behavioral tasks and clients' decision to accept intensive treatment. Clinician ratings were not related to any of the questionnaire or behavioral recovery activity measures. DISCUSSION Conditions favoring the accurate prediction of readiness for treatment and recovery are discussed, and implications for clinical practice are addressed.
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Affiliation(s)
- Josie Geller
- St. Paul's Hospital Eating Disorders Program, University of British Columbia, Vancouver, British Columbia, Canada.
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Gusella J, Butler G, Nichols L, Bird D. A brief questionnaire to assess readiness to change in adolescents with eating disorders: its applications to group therapy. EUROPEAN EATING DISORDERS REVIEW 2002. [DOI: 10.1002/erv.481] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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83
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Cockell SJ, Geller J, Linden W. The development of a decisional balance scale for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2002. [DOI: 10.1002/erv.463] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Geller J. What a motivational approach is and what a motivational approach isn't: reflections and responses. EUROPEAN EATING DISORDERS REVIEW 2002. [DOI: 10.1002/erv.470] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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