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Thai H, Audet ÉC, Koestner R, Lepage M, O'Driscoll GA. The role of motivation in clinical presentation, treatment engagement and response in schizophrenia-spectrum disorders: A systematic review. Clin Psychol Rev 2024; 113:102471. [PMID: 39111125 DOI: 10.1016/j.cpr.2024.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/28/2024] [Accepted: 07/27/2024] [Indexed: 09/09/2024]
Abstract
Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies (N = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy.
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Affiliation(s)
- Helen Thai
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Élodie C Audet
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Richard Koestner
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Martin Lepage
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
| | - Gillian A O'Driscoll
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Flaudias V, Pires S, Martinot D, Boudoukha AH, Damase E, Mondillon L, Llorca PM, Silvert L. Anorexia nervosa: Enhancing motivation to change with self-determination theory. L'ENCEPHALE 2024; 50:573-577. [PMID: 38311480 DOI: 10.1016/j.encep.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 02/06/2024]
Abstract
Motivational deficits (little or no motivation to change) are often reported in patients with eating disorders, particularly anorexia nervosa. The motivational approaches frequently used by French clinicians rely solely on a dichotomous view of motivation (intrinsic vs. extrinsic). In self-determination theory, certain forms of extrinsic motivation can strengthen an individual's commitment to an activity, providing they are self-determined. This theory therefore extends and enriches the dual motivational approach by highlighting potentially useful forms of extrinsic motivation and by emphasizing the importance of behavioral regulation. Empirical work is now needed to assess how clinicians can use self-determination theory to enhance motivation to change among patients with anorexia nervosa and encourage their adherence to care management plans.
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Affiliation(s)
- Valentin Flaudias
- Laboratoire de psychologie des Pays de la Loire (LPPL), UR 4638, université d'Angers, Nantes université, chemin de la Censive-du-Tertre, 44300 Nantes, France; Department of Psychiatry, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Sylvie Pires
- CRIAVS AURA, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Delphine Martinot
- Université Clermont Auvergne, CNRS, LAPSCO, 63000 Clermont-Ferrand, France
| | - Abdel-Halim Boudoukha
- Laboratoire de psychologie des Pays de la Loire (LPPL), UR 4638, université d'Angers, Nantes université, chemin de la Censive-du-Tertre, 44300 Nantes, France
| | | | - Laurie Mondillon
- Université Clermont Auvergne, CNRS, LAPSCO, 63000 Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU de Clermont-Ferrand, Clermont-Ferrand, France; CNRS, Clermont-Auvergne INP, Institut Pascal, University of Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Laetitia Silvert
- Université Clermont Auvergne, CNRS, LAPSCO, 63000 Clermont-Ferrand, France
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Tempia Valenta S, Rapezzi M, Marcolini F, Speciani M, Giordani G, De Panfilis C, De Ronchi D, Atti AR. Assessing motivation for treatment in eating disorders: psychometric validation of the Italian version of the Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ-ITA). Eat Weight Disord 2024; 29:23. [PMID: 38573529 PMCID: PMC10995063 DOI: 10.1007/s40519-024-01653-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Treatment resistance is a significant challenge in addressing eating disorders (EDs). The Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ) has been previously validated in ED populations to assess patients' motivation for treatment. This study aimed to validate the ACMTQ in the Italian language (ACMTQ-ITA) and evaluate its psychometric properties. METHODS We recruited a clinical sample of adults aged 18 or older, diagnosed with EDs, proficient in the Italian language, and providing written informed consent. Participants with psychiatric comorbidities such as schizophrenia, bipolar disorder, and substance use disorder were excluded from the study. Validity of the ACMTQ-ITA was assessed using reliability analysis with Cronbach's α and McDonald's ω estimates, and Confirmatory Factor Analysis (CFA). RESULTS Results from the reliability analysis confirmed the internal consistency of the Autonomous Motivation (AM) factor (α = 0.82, ω = 0.82), the Controlled Motivation (CM) factor (α = 0.76, ω = 0.77), and the ACMTQ-ITA overall score (α = 0.79). The CFA confirmed the two-factor solution (i.e., AM and CM) identified in the original validation of the ACMTQ (Comparative Fit Index = 0.92, Akaike Information Criterion = 3427.26, Bayesian Information Criterion = 3486.82; Root Mean Square Error of Approximation = 0.08, Standardized Root Mean Square Residual = 0.09). CONCLUSION The ACMTQ-ITA emerged as a valid and reliable tool for measuring motivation for treatment in individuals with EDs. Its implementation may facilitate the comprehension of treatment motivation, offering valuable clinical insights and implications for health management practices. LEVEL OF EVIDENCE Level V, descriptive studies.
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Affiliation(s)
- Silvia Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy.
| | - Matilde Rapezzi
- Department of Management, University of Bologna, Bologna, Italy
| | - Federica Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Maurizio Speciani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Gabriele Giordani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Chiara De Panfilis
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
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Sarol H. Empowering motivation: the journey of wheelchair basketball athletes to overcome constraints. Front Psychol 2024; 15:1330971. [PMID: 38348247 PMCID: PMC10859490 DOI: 10.3389/fpsyg.2024.1330971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction The aim of this phenomenological study is to determine the motivational factors in the participation of wheelchair basketball players in sports according to Self-Determination Theory. Methods The study group of the research was determined by the criterion sampling method, which is one of the purposeful sampling methods. Accordingly, thirteen (13) wheelchair athletes constituted the study group. In the research, a personal information form and a semi-structured interview form were prepared as data collection tools within the framework of the self-determination theory. Interviews were conducted face-to-face with the prepared interview forms. The data were analyzed by reflexive thematic analysis method. Results Six (6) themes emerged: constraints, coping strategies, appreciation, positive feedback, need for existence, and development. Sixteen sub-themes related to these themes were identified. Conclusion The most significant factors causing a lack of motivation in wheelchair basketball athletes were observed to be structural constraints such as access to materials and facilities. Extrinsic sources of motivation were identified as the positive attitudes and behaviors of individuals in their environment, often related to admiration, appreciation, and being set as an example, and this situation has a positive impact on wheelchair basketball athletes. On the other hand, it can be stated that intrinsic motivations such as identity change, gaining self-confidence, and the feeling of success are crucial in overcoming constraints through sports participation.
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Tang H, Zhang W, Liu W, Xiao H, Jing H, Song F, Guo S, Li T, Yi L, Zhang Y, Shang L. The nutritional literacy of breast cancer patients receiving chemotherapy and its association with treatment self-regulation and perceived social support. Support Care Cancer 2023; 31:472. [PMID: 37458828 DOI: 10.1007/s00520-023-07941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Chemotherapy can lead to malnutrition and post-menopausal recurrence among breast cancer (BC) patients, who need to achieve nutritional literacy (NL) to cope. The objective of this study was to explore the NL level in Chinese BC patients receiving chemotherapy and its predictors including both internal motivation and the external environment. METHODS A total of 326 BC female patients from three hospitals were enrolled. Participants completed the Nutrition Literacy Measurement Scale for Chinese Adult (NLMS-CA), Chinese version from the Treatment Self-Regulation Questionnaire (TSRQ-C), and the Perceived Social Support Scale (PSSS) to assess NL, treatment self-regulation, and social support. Stepwise multivariate linear regression was used to identify the main factors of NL. RESULTS The total NL score was 151.31 ± 16.85, the "knowledge understanding" dimension had the lowest score. In the final regression model, patients with higher scores for "autonomous motivation" and "introjected regulation" on the TSRQ-C and "family support" and "other support" on the PSSS, higher educational levels and average monthly household incomes and endocrine therapy had higher NL levels (adjusted R2 = 66.7%, p < 0.05). CONCLUSIONS The overall NL score among Chinese BC patients receiving chemotherapy was satisfactory, but the knowledge understanding score was low. Higher autonomous motivation, introjected regulation, family support and other support scores, higher educational and household income levels, and endocrine therapy were predictors of NL in female patients. Interventions should be designed according to the specific performances and predictors of NL in female patients.
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Affiliation(s)
- Han Tang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, Changle West Road 169#, Xi'an, Shaanxi Province, China
- Department of Clinical Nursing, School of Nursing, The Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wei Zhang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, Changle West Road 169#, Xi'an, Shaanxi Province, China
| | - Wei Liu
- Department of Breast Surgery 2 (Area 1), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Han Xiao
- Department of Breast Surgery 2 (Area 1), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Haihong Jing
- Department of Breast Surgery 2 (Area 1), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Fangxia Song
- Department of Breast Surgery 2 (Area 1), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Shengjie Guo
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ting Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Luanxing Yi
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
| | - Yuhai Zhang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, Changle West Road 169#, Xi'an, Shaanxi Province, China
| | - Lei Shang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, Changle West Road 169#, Xi'an, Shaanxi Province, China.
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de Vos JA, Radstaak M, Bohlmeijer ET, Westerhof GJ. Modelling trajectories of change in psychopathology and well-being during eating disorder outpatient treatment. Psychother Res 2022; 33:415-427. [PMID: 36330764 DOI: 10.1080/10503307.2022.2139647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: There are considerable differences in how eating disorder (ED) patients respond to treatment. This study aimed to identify change trajectories of mental health during treatment. Method: Longitudinal data of 442 patients was used with five time points during a year of outpatient treatment. ED psychopathology and well-being were used as primary measures. A series of latent growth mixture models were applied to model trajectories of change. Results: Three latent classes were found for ED psychopathology and well-being. For ED psychopathology, a high baseline severity and slow recovery class (55.9% of the patients), a high baseline severity followed by a substantial recovery class (19.9%) and a moderate baseline severity and no significant recovery class (24.2%) were found. For well-being, a low baseline followed by a slow growth class (44.6%), a low baseline and substantial growth class (9.5%) and a moderate and stable well-being class (45.9%) was found. General psychopathology, early symptom change, hope for recovery, intrinsic motivation and the ED type were predictive of class membership in either ED psychopathology or well-being. Conclusions: This study shows variability in ED psychopathology and well-being change trajectories, modelled in meaningful latent recovery classes. These results may have clinical implications, such as adjusting patients' treatment based on change trajectories.
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Affiliation(s)
- Jan Alexander de Vos
- Centre for eHealth and well-being research, University of Twente, Psychology, Health, & Technology, Enschede, The Netherlands
- Human Concern, Centrum voor eetstoornissen, Amsterdam, The Netherlands
| | - Mirjam Radstaak
- Centre for eHealth and well-being research, University of Twente, Psychology, Health, & Technology, Enschede, The Netherlands
| | - Ernst T. Bohlmeijer
- Centre for eHealth and well-being research, University of Twente, Psychology, Health, & Technology, Enschede, The Netherlands
| | - Gerben J. Westerhof
- Centre for eHealth and well-being research, University of Twente, Psychology, Health, & Technology, Enschede, The Netherlands
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Oliverio S, Steiger H, St-Hilaire A, Paquin-Hodge C, Leloup AG, Israel M, Thaler L. Barriers and facilitators to providing autonomy supportive counselling to individuals seeking treatment for an eating disorder. Eat Weight Disord 2022; 27:2919-2929. [PMID: 35366169 DOI: 10.1007/s40519-022-01395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Self-determination theory suggests that autonomous motivation for change (i.e., motivation that is internal and self-endorsed) can be enhanced in therapeutic contexts by clinicians acting in an autonomy supportive manner. While previous research has established a link between autonomy support (AS) and autonomous motivation in enhancing outcomes in eating disorder (ED) treatment, few studies have examined factors that support or hinder therapists' ability to be autonomy supportive in the context of an ED therapeutic encounter. The goal of the present study was to conduct a qualitative analysis of personal and contextual factors that facilitated or hindered therapists' ability to provide autonomy supportive interventions. METHODS Semi-structured interviews were conducted with 10 therapists conducting outpatient psychotherapy at a specialized eating disorders treatment program. Data were analyzed using thematic analysis. RESULTS The most frequently noted facilitators were organizational support of AS interventions and patients' engagement and motivation for treatment. The most frequently noted barriers were patients' personality variables such as patients that exhibit passive and help-rejecting behaviours, as well as therapists feeling overwhelmed due to a high workload. CONCLUSION Our results provide insight into the factors that facilitate and impede the utilization of an autonomy supportive approach in specialized ED treatment and can be used to inform future quantitative research on such factors. LEVEL OF EVIDENCE Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Stephanie Oliverio
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada. .,Research Centre, Douglas University Institute, Montreal, Canada.
| | - Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada
| | - Annie St-Hilaire
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Chloé Paquin-Hodge
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Anne-Gaëlle Leloup
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Clinique Baca, Montreal, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
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Radjack R, Chiron AG, Ibrahim N, Louvel A, Baconnet I, Hellier É, Moro MR. [Contributions of discussion groups in the therapeutic education of bulimic disorders]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:42-45. [PMID: 35148856 DOI: 10.1016/j.soin.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The treatment of patients suffering from bulimic disorders requires a multidisciplinary approach combining a somatic approach and a psychiatric approach. The Maison des adolescents of the Cochin Hospital offers a therapeutic education program focused on the management of compulsive binge eating. Its modalities have been modified over the years in order to better adjust to the needs of these patients. Monthly discussion groups have been added to the individual interviews, and have been key points in structuring the treatment.
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Affiliation(s)
- Rahmeth Radjack
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations, Team DevPsy, 16 avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
| | - Anne-Gaëlle Chiron
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France
| | - Nour Ibrahim
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations, Team DevPsy, 16 avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Aude Louvel
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France
| | - Isabelle Baconnet
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France
| | - Éloïse Hellier
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France
| | - Marie Rose Moro
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations, Team DevPsy, 16 avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
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Eating Behaviors Among Male Bodybuilders and Runners: Application of the Trans-Contextual Model of Motivation. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2021. [DOI: 10.1123/jcsp.2019-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article focuses on two popular sports that can put male athletes at risk of developing an eating disorder: bodybuilding and running. Bodybuilders concentrate on gaining muscle mass and runners on leaning body mass. Based on the trans-contextual model of motivation, this study aimed to better understand the psychological mechanisms underlying eating disorders in these athletes. In all, 272 male bodybuilders and 217 male runners completed measures of sport motivation, theory of planned behavior variables (i.e., attitude, subjective norm, perceived behavioral control, and intention to gain muscle mass/lean body mass), and eating disorders (dieting, control, and bulimia behaviors). The results revealed satisfactory fit indices for both samples. Autonomous and controlled motivations for sport were positively directly and indirectly related to eating disorders in these athletes. This motivational mechanism needs more in-depth investigation, and motivational profiles might help distinguish athletes with and without eating disorders.
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DeBois K, Chatfield SL. Misinformation, thin-ideal internalization, and resistance to treatment: an interpretive phenomenological analysis of the experience of orthorexia nervosa. Eat Weight Disord 2021; 26:1963-1973. [PMID: 33074459 DOI: 10.1007/s40519-020-01049-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Orthorexia nervosa (ON) is an emerging pattern of disordered eating which may be driven by a pathological desire to consume only highly nutritious foods, absent concern over body weight, as is noted in anorexia nervosa (AN). This study seeks to clarify the development and progression of ON and add to researchers' understanding of this potential disorder. METHOD Utilizing Interpretive Phenomenological Analysis to guide data collection and analysis, interviews were conducted with 18 individuals who self-identified as having ON. RESULTS Participants described a clear distinction between orthorexia nervosa and clinically recognized eating disorders, with which they had prior experience. In addition, they demonstrated patterns of inflexible thinking that guided their perceptions of themselves and others. As a result, participants rapidly integrated newly acquired nutritional information, which led to escalations in restriction, social isolation, and physical symptoms of malnutrition. While prior findings on the relationship between ON and weight are conflicting, previously proposed criteria for ON emphasize an absence of weight-related concerns. The results of the present study suggest that weight control is a primary motivating factor in the escalating pattern of restriction. CONCLUSION The nuanced results from this work evidence the value of interpretive qualitative approaches to improve understanding of ON. In particular, participants' described inflexible thinking with respect to eating behaviors may help inform or revise screening instruments and provide important insights for treatment of ON. LEVEL OF EVIDENCE Level V, qualitative descriptive research.
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Affiliation(s)
- Kristen DeBois
- Kent State University College of Public Health, Moulton Hall, 800 Hilltop Drive, Kent, OH, 44242, USA.
| | - Sheryl L Chatfield
- Kent State University College of Public Health, Moulton Hall, 800 Hilltop Drive, Kent, OH, 44242, USA
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11
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Bannatyne A, Stapleton P. Eating Disorder Patient Experiences of Volitional Stigma Within the Healthcare System and Views on Biogenetic Framing: A Qualitative Perspective. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Beato‐Fernandez L, Muñoz‐Martinez V, Mata‐Saenz B, Gimeno‐Clemente N, Rojo‐Moreno L, Vaz‐Leal FJ, Rodriguez‐Cano T. Attitudes towards change mediate the effect of dissociation on psychopathological outcome in the treatment of eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:724-738. [DOI: 10.1002/erv.2774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Luis Beato‐Fernandez
- Eating Disorders Unit General Hospital of Ciudad Real C/ Obispo Rafael Torija s/n Ciudad Real Spain
| | - Victoria Muñoz‐Martinez
- Eating Disorders Unit General Hospital of Ciudad Real C/ Obispo Rafael Torija s/n Ciudad Real Spain
| | - Beatriz Mata‐Saenz
- Eating Disorders Unit General Hospital of Ciudad Real C/ Obispo Rafael Torija s/n Ciudad Real Spain
| | | | - Luis Rojo‐Moreno
- Department of Psychiatry, Faculty of Medicine University of Valencia Valencia Spain
| | - Francisco J. Vaz‐Leal
- Department of Psychiatry, Faculty of Medicine University of Extremadura Badajoz Spain
| | - Teresa Rodriguez‐Cano
- Eating Disorders Unit General Hospital of Ciudad Real C/ Obispo Rafael Torija s/n Ciudad Real Spain
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13
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Paquin Hodge C, Gauvin L, St-Hilaire A, Israel M, Azzi M, Kahan E, Thaler L, Dansereau E, Steiger H. A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome? Int J Eat Disord 2019; 52:1015-1023. [PMID: 31408212 DOI: 10.1002/eat.23150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although hospitalization is sometimes necessary when treating individuals with anorexia nervosa, the available literature provides limited guidance to inform decisions surrounding optimal components or duration of inpatient treatments. We report observational data comparing outcomes of two inpatient treatments. The first was longer and more strictly structured around a Contingency Management Protocol (CMP) emphasizing external incentives for achieving weight-restoration goals; the second was a shorter Autonomy Support Protocol (ASP) that progressively increased patient autonomy around meal management without external incentives. METHOD We compared data from 41 patients who participated in the ASP to a historical sample of 41 patients treated using the CMP. At admission, discharge, and post-treatment follow-up, participants completed the Eating Disorder Examination Questionnaire and the Behavior and Symptom Identification Scale-32, and we measured height and weight to compute body mass index. RESULTS Multilevel modeling analyses that controlled for time in treatment and time in follow-up indicated the two protocols yielded equivalent in-treatment gains and post-treatment loss of gains. DISCUSSION Our results indicate that shorter inpatient stays emphasizing autonomous control over eating behavior may yield outcomes that are equivalent to those of lengthier, more stringent, and more costly approaches implicating external incentives and controls.
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Affiliation(s)
- Chloé Paquin Hodge
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Lise Gauvin
- Centre de Recherche du Centre Hospitalier, de l'Université de Montréal and École de santé publique de l'Université de Montréal, Montreal, Canada
| | - Annie St-Hilaire
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Michelle Azzi
- Psychiatry Department, McGill University, Montreal, Canada.,Psychology Department, McGill University, Montreal, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Eve Dansereau
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
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14
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Ryan RM, Soenens B, Vansteenkiste M. Reflections on self-determination theory as an organizing framework for personality psychology: Interfaces, integrations, issues, and unfinished business. J Pers 2018; 87:115-145. [PMID: 30325499 DOI: 10.1111/jopy.12440] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This special issue focuses on self-determination theory (SDT) as an integrative framework for the wider field of personality research. In this commentary our aims include: reflecting on the utility and strengths of SDT as such a general framework and responding to the various contributions in this issue regarding their use of SDT as a guiding, complementary, or contrasting framework. METHODS AND RESULTS We describe how SDT has developed organically and conservatively from "within" based on the emerging patterns of evidence, as well through the ongoing challenges from other models and frameworks. We then discuss each of the various contributions to this special issue, addressing themes that include SDT's breadth of methods, and its relevance to topics such as narcissism, wisdom, individual differences, Big-Five traits, and the neuropsychology of motivation, among others. Across these discussions, we highlight fruitful avenues for research and cross-fertilization across the fields of personality, development, motivation, and neuroscience. At the same time, we counter some claims made about SDT, and forward certain cautions regarding the integration of SDT and other personality frameworks and models. CONCLUSIONS We conclude by revisiting the value of broad theory, and SDT in particular, for coordinating complex research findings concerning motivation, personality development and wellness across multiple levels of analysis and, perhaps more importantly, for pointing researchers to the right questions within today's prolific empiricism.
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Affiliation(s)
- Richard M Ryan
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia.,Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, New York
| | - Bart Soenens
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Maarten Vansteenkiste
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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15
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Brooks JM, Kaya C, Chan F, Thompson K, Cotton BP, Sánchez J, Fortuna K. Validation of the Behavioural Regulation in Exercise Questionnaire-2 for adults with chronic musculoskeletal pain. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018; 25:395-404. [PMID: 32133037 PMCID: PMC7055823 DOI: 10.12968/ijtr.2018.25.8.395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIMS The Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2) has demonstrated reliability and validity in the general population; yet the psychometric properties have not been tested among rehabilitation populations, such as persons experiencing chronic musculoskeletal pain. The objective of the current study was to examine the factorial structure and psychometric properties of the BREQ-2 in a sample of adults with chronic musculoskeletal pain. METHODS Adults with chronic musculoskeletal pain (n=211) were recruited from clinical and community networks in the United States. Data were collected using a cross-sectional online survey and analysed using confirmatory factor analysis, multiple indicators multiple causes analysis, and correlational techniques. Participants completed the BREQ-2 and other measures relevant to self-determination theory, including outcome expectancies, self-efficacy and family and friend support for physical activity and exercise. FINDINGS Results indicated the intercorrelated model fit the data well. The five factors of amotivation, external regulation, introjected regulation, identified regulation and intrinsic regulation toward physical activity and exercise demonstrated good reliability and construct validity. CONCLUSIONS This study provides evidence of factorial and construct validity for the BREQ-2 among people with chronic musculoskeletal pain. Implications for rehabilitation practitioners and researchers are discussed.
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Affiliation(s)
- Jessica M Brooks
- Department of Rehabilitation & Health Services, University of North Texas, Denton, Texas, USA
| | - Cahit Kaya
- Department of Educational Sciences, Giresun University, Giresun, Turkey
| | - Fong Chan
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | | | - Jennifer Sánchez
- Rehabilitation and Counsellor Education, University of Iowa, Iowa City, Iowa, USA
| | - Karen Fortuna
- Department of Psychiatry, Dartmouth College, Lebanon, New Hampshire, USA
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16
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Abstract
AbstractAnorexia nervosa (AN) is a notoriously costly and challenging psychiatric illness to treat. Despite an accumulating evidence base, psychological treatment fails to achieve symptom abstinence in many patients with eating disorders, a shortcoming that is likely to be further pronounced in AN. The case study reported here describes how a mutually agreed break in a course of psychotherapy following an initial lack of progress might have influenced outcome for a client with a severe eating disorder. The patient received 26 sessions of CBT and results, consistent with those of larger studies, showed significant improvement on primary symptom measures. These results are discussed in the context of relevant psychological theories and an exploration of the client's motivation. Consideration is also given to other factors that may have influenced outcome.
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17
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Muir S, Newell C, Griffiths J, Walker K, Hooper H, Thomas S, Thomas PW, Arcelus J, Day J, Appleton KM. MotivATE: A Pretreatment Web-Based Program to Improve Attendance at UK Outpatient Services Among Adults With Eating Disorders. JMIR Res Protoc 2017; 6:e146. [PMID: 28747295 PMCID: PMC5550733 DOI: 10.2196/resprot.7440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background In the UK, eating disorders affect upward of 725,000 people per year, and early assessment and treatment are important for patient outcomes. Around a third of adult outpatients in the UK who are referred to specialist eating disorder services do not attend, which could be related to patient factors related to ambivalence, fear, and a lack of confidence about change. This lack of engagement has a negative impact on the quality of life of patients and has implications for service costs. Objective To describe the development of a Web-based program (“MotivATE”) designed for delivery at the point of referral to an eating disorder service, with the aim of increasing service attendance. Methods We used intervention mapping and a person-based approach to design the MotivATE program and conducted a needs assessment to determine the current impact of service nonattendance on patients (via a review of the qualitative evidence) and services (through a service provision survey to understand current issues in UK services). Following the needs assessment, we followed the five steps of program development outlined by Bartholomew et al (1998): (1) creating a matrix of proximal program objectives; (2) selecting theory-based intervention methods and strategies; (3) designing and organizing the program; (4) specifying adoption and implementation plans; and (5) generating program evaluation plans. Results The needs assessment identified current nonattendance rates of 10%-32%. We defined the objective of MotivATE as increasing attendance rates at an eating disorder service and considered four key determinants of poor attendance: patient ambivalence about change, low patient self-efficacy, recognition of the need to change, and expectations about assessment. We chose aspects of motivational interviewing, self-determination theory, and the use of patient stories as the most appropriate ways to enable change. Think-aloud piloting with people with lived experience of an eating disorder resulted in positive feedback on the MotivATE program. Participants related well to the stories used. Nonetheless, because of feedback, we further modified the program in line with patients’ stage of change and addressed issues with the language used. A consultation with service staff meant that we could make clear implementation plans. Finally, a randomized controlled trial is currently underway to evaluate the MotivATE program. Conclusions Using intervention mapping, we have developed a novel pretreatment Web-based program that is acceptable to people with eating disorders. To our knowledge, this is the first such program. The model of development described here could be a useful template for designing further programs for other difficult-to-engage populations.
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Affiliation(s)
- Sarah Muir
- Bournemouth University, Psychology Department, Poole, United Kingdom
| | - Ciarán Newell
- Dorset Healthcare University NHS Foundation Trust, Poole, United Kingdom
| | | | - Kathy Walker
- Patient Safety, University Hospital Coventry and Warwickshire, Coventry, United Kingdom
| | - Holly Hooper
- Research Centre for Behaviour Change, Psychology Department, Bournemouth University, Poole, United Kingdom
| | - Sarah Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth, United Kingdom
| | - Peter W Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth, United Kingdom
| | - Jon Arcelus
- Institute of Mental Health, Nottingham University, Nottingham, United Kingdom
| | - James Day
- Research Centre for Behaviour Change, Psychology Department, Bournemouth University, Poole, United Kingdom
| | - Katherine M Appleton
- Research Centre for Behaviour Change, Psychology Department, Bournemouth University, Poole, United Kingdom
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18
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Gueguen J, Piot MA, Orri M, Gutierre A, Le Moan J, Berthoz S, Falissard B, Godart N. Group Qigong for Adolescent Inpatients with Anorexia Nervosa: Incentives and Barriers. PLoS One 2017; 12:e0170885. [PMID: 28152083 PMCID: PMC5289494 DOI: 10.1371/journal.pone.0170885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 01/12/2017] [Indexed: 01/28/2023] Open
Abstract
Background Qigong is a mind-body intervention focusing on interoceptive awareness that appears to be a promising approach in anorexia nervosa (AN). In 2008, as part of our multidimensional treatment program for adolescent inpatients with AN, we began a weekly qigong workshop that turned out to be popular among our adolescent patients. Moreover psychiatrists perceived clinical benefits that deserved further exploration. Methods and findings A qualitative study therefore sought to obtain a deeper understanding of how young patients with severe AN experience qigong and to determine the incentives and barriers to adherence to qigong, to understanding its meaning, and to applying it in other contexts. Data were collected through 16 individual semi-structured face-to-face interviews and analyzed with the interpretative phenomenological analysis method. Eleven themes emerged from the analysis, categorized in 3 superordinate themes describing the incentives and barriers related to the patients themselves (individual dimension), to others (relational dimension), and to the setting (organizational dimension). Individual dimensions associated with AN (such as excessive exercise and mind-body cleavage) may curb adherence, whereas relational and organizational dimensions appear to provide incentives to join the activity in the first place but may also limit its post-discharge continuation. Once barriers are overcome, patients reported positive effects: satisfaction associated with relaxation and with the experience of mind-body integration. Conclusions Qigong appears to be an interesting therapeutic tool that may potentiate psychotherapy and contribute to the recovery process of patients with AN. Further analysis of the best time window for initiating qigong and of its place in overall management might help to overcome some of the barriers, limit the risks, and maximize its benefits.
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Affiliation(s)
- Juliette Gueguen
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
- * E-mail:
| | - Marie-Aude Piot
- Univ. Paris-Descartes, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Massimiliano Orri
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
| | - Andrea Gutierre
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | | | - Sylvie Berthoz
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Bruno Falissard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
| | - Nathalie Godart
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
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19
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Sansfaçon J, Steiger H, Gauvin L, Fletcher É, Israël M. Does level of motivation for change impact post-treatment outcomes in the eating disorders? Protocol for a systematic review with quantitative analysis. J Eat Disord 2017; 5:17. [PMID: 28465827 PMCID: PMC5408493 DOI: 10.1186/s40337-017-0147-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating Disorders are highly prevalent and widespread mental health problems, with marked risk of chronicity and refractoriness to treatment. Affected individuals are hesitant to change their behaviours and therefore struggle to maintain motivation for therapy. This review aims to produce the first high-quality meta-analysis of the literature on the impact of level of motivation for change on post-treatment outcomes in anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorder (OSFED). METHODS A systematic review will be conducted using Cochrane library, Embase, MEDLINE, and PsychINFO. Research registrars and bibliographies of included articles will be screened, and experts will be contacted. The search strategy consists of terms related to eating disorders, motivation, and outcome. Randomized controlled trials, clinical controlled trials, time series, and before-after studies will be included. Participants will be adolescents and adults who are diagnosed with anorexia nervosa, bulimia nervosa, binge-eating disorder or OSFED and who are entering psychotherapy treatment. The predictor studied is defined as motivation for change at the beginning of treatment. The primary outcome will be an overall change in eating-disorder symptomatology at the end of treatment and at less than, and over 6-month follow-up. Other outcomes of interest include change in restricting, binging, and compensatory behaviours, change in shape, weight and eating concerns, change in psychiatric comorbidities, weight restoration, and dropout rates. Articles will be selected, data will be extracted, and the risk of bias will be assessed by independent reviewers using forms pre-created on Eppi-Reviewer 4 software. Results will be combined using a random-effects model. Studies of all sizes and qualities will be included in the analyses. Heterogeneity will be examined by funnel plot, Cochran's Q, and I2 statistic. Sensitivity analyses will be performed to account for clinical and methodological differences across studies. DISCUSSION This systematic review will help determine the predictive value of motivation for change on treatment outcomes in eating disorders. TRIAL REGISTRATION Our systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016035285). All modifications will be available on the PROSPERO website, along with the dates, a description, and a justification.
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Affiliation(s)
- Jeanne Sansfaçon
- Douglas Mental Health University Institute, Montréal, Québec Canada.,Psychiatry Department, McGill University, Montréal, Québec Canada
| | - Howard Steiger
- Douglas Mental Health University Institute, Montréal, Québec Canada.,Psychiatry Department, McGill University, Montréal, Québec Canada.,Psychology Department, McGill University, Montréal, Québec Canada
| | - Lise Gauvin
- CHUM Research Centre, Montréal, Québec Canada.,Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec Canada
| | - Émilie Fletcher
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Mimi Israël
- Douglas Mental Health University Institute, Montréal, Québec Canada.,Psychiatry Department, McGill University, Montréal, Québec Canada
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20
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Vellisca González MY, Latorre JI, Orejudo S, Gómez del Barrio A, Moreno L, Checa Esquiva I. Motivo de abandono del tratamiento desde la perspectiva del paciente con un trastorno de la conducta alimentaria. UNIVERSITAS PSYCHOLOGICA 2016. [DOI: 10.11144/javeriana.upsy-15-4.matp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Los tratamientos psicológicos y farmacológicos para los trastornos de la conducta alimentaria comportan costes personales y sanitarios. El propósito de nuestro estudio ha sido identificar los diferentes motivos que pueden estar asociados al abandono en ambos tipos de tratamientos en pacientes diagnosticados de un trastorno de la conducta alimentaria. Método: Se examinaron diversas características (edad, sexo, diagnóstico, motivos y tipos de abandono, y satisfacción respecto a la unidad de trastornos de la conducta alimentaria) en 212 pacientes atendidos en un servicio especializado en el tratamiento de trastornos de la conducta alimentaria durante un periodo de dos años. Resultados: Nuestros datos apoyan la hipótesis de que la causa de abandono de los tratamientos más frecuente ha sido la mejoría del trastorno de la conducta alimentaria. Conclusiones: Nuestros resultados indican que los motivos de abandono son heterogéneos. Se pueden establecer dos perfiles diferenciados de abandonos, uno ligado a la mejoría y a los impedimentos físicos temporales, y otro relacionado con motivos diversos.
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21
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Sheridan G, McArdle S. Exploring Patients' Experiences of Eating Disorder Treatment Services From a Motivational Perspective. QUALITATIVE HEALTH RESEARCH 2016; 26:1988-1997. [PMID: 26138701 DOI: 10.1177/1049732315591982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study employed qualitative methods to explore eating disorder (ED) patients' perspectives on their treatment experiences to gain insight into those factors that influenced their motivational trajectory. Semistructured interviews were conducted with a purposive female sample of current (N = 11) and discharged (N = 3) ED service users, aged 18 to 31 years (M = 23.21, SD = 4.19). An interpretive thematic analytic approach, comprising both inductive and deductive methods of analysis, was employed to identify key themes in the data. Self-determination theory (SDT) provided a conceptual lens for analyzing data. Participants highlighted that factors such as physical design and nature of the treatment environment, relational aspects of care, and therapeutic methods all played a role in treatment engagement. The findings highlight ways in which current ED services might more effectively meet the needs of service users and support the utility of applying SDT to the study of motivational dynamics in the treatment of EDs.
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22
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Gulliksen KS, Nordbø RHS, Espeset EMS, Skårderud F, Holte A. Four Pathways to Anorexia Nervosa: Patients' Perspective on the Emergence of AN. Clin Psychol Psychother 2016; 24:846-858. [PMID: 27726246 DOI: 10.1002/cpp.2050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Studies show that patients' perception of their illness has a direct influence both on their utilization of health services and their adherence to treatment plans. This may be particularly relevant to the treatment of Anorexia Nervosa (AN). Previous studies on AN have typically explored single psycho-social factors that patients with AN relate to the emergence of their illness. There is a need for more coherent systematic descriptions of the complexity of the patients' narratives about how their illness emerged. In this study, we sought to identify common components in the participants' narratives. By identifying different combinations of these components in the narratives, we sought to describe differences in patients' perceived pathways to AN. METHODS Participants were 36 women aged 18-51 years who had been treated for AN within the past 2 years at five clinical institutions in Norway. Semi-open qualitative interviews were conducted, tape-recorded, transcribed and analysed using grounded theory techniques. RESULTS We identified the following four distinct perceived pathways into AN: 'The Avoidant', 'The Achiever', 'The Transformer' and 'The Punisher'. The pathways could be regarded as four different projects for mastering life's challenges. DISCUSSION Our results suggest that there seem to be at least four pathways into AN. This indicates that a common array of symptoms might cover very different psychological dynamics. These might need to be treated therapeutically in different ways and should probably be taken into account during the refinement of diagnostic tools. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Although patients with AN might present similar symptoms, patients' perspectives on the emergence of their problems indicate that a common array of symptoms cover a variety of subjective psychological dynamics. From the experienced patient's stance, there are at least four distinct pathways to the emergence of AN. Attempts to master the challenges of life were found to be a common denominator in the emergence of AN. Recognition and integration of the patient's understanding of her or his problems should be given high priority in treatment of AN.
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Affiliation(s)
- Kjersti S Gulliksen
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Eating Disorders Gaustad, Oslo University Hospital, Oslo, Norway
| | - Ragnfrid H S Nordbø
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ester M S Espeset
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Finn Skårderud
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,Institute for Eating Disorders, Oslo, Norway
| | - Arne Holte
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.,Modum Bad Research Institute, Vikersund, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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Salzmann-Erikson M, Dahlén J. Nurses' Establishment of Health Promoting Relationships: A Descriptive Synthesis of Anorexia Nervosa Research. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 26:1-13. [PMID: 28111516 PMCID: PMC5219017 DOI: 10.1007/s10826-016-0534-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Qualitative values that address personal and interpersonal dimensions are often overlooked in research that examines mental well-being among young patients with anorexia nervosa. The aim of this review was to identify and describe factors that promote and impede the relationships between nurses and the children, adolescents and young adults who are diagnosed with anorexia nervosa and also to explore and describe how those relationships benefit the patients' processes toward increased health and well-being. A descriptive literature synthesis was conducted following the four steps as described by Evans. The three databases CINAHL, PsycINFO and PubMed were used to search for qualitative articles. Fourteen articles met the criteria for inclusion and were analysed. Key findings were identified, and categories and themes were formulated and compared across the studies. Four themes are presented in the results: (1) The essentials in a relationship; (2) The person at the centre; (3) The nurses' attitudes; and (4) Knowledge. In addition to the contribution to the knowledge of how anorexia is manifested, our findings demonstrate the necessity for nurses to be person-centred in their relationships with patients and to have attitudes characterised by presence, genuine commitment and motivation. Nurses are more likely to convey a sense of trust and safety when they communicate with openness and honesty. Our review suggests that the motivation for patients to adhere to treatment is likely to increase when nurses approach patients with these characteristics and attitudes. We argue that the findings are relevant for nurses in their everyday practices.
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Affiliation(s)
- Martin Salzmann-Erikson
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, SE-80176 Sverige Sweden
| | - Jeanette Dahlén
- Child and Adolescent Psychiatry Outpatient Clinic, Stockholm County Council, Stockholm, Sweden, Ersta Sköndal University College, Institution for Caring Science, Stockholm, Sweden
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24
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Larsson E, Lloyd S, Westwood H, Tchanturia K. Patients’ perspective of a group intervention for perfectionism in anorexia nervosa: A qualitative study. J Health Psychol 2016; 23:1521-1532. [DOI: 10.1177/1359105316660183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study aimed to explore the experiences of adults with anorexia nervosa who took part in a perfectionism group intervention in an inpatient setting. Thematic analysis was used to explore patient feedback collected in focus groups. Patient feedback was generally positive and centred around three main themes: perceived benefits of the group, the content of the group and suggested improvements. The findings suggest that a brief perfectionism group intervention is an acceptable treatment with a range of perceived benefits for patients with severe anorexia nervosa. Understanding patients’ experiences of the intervention can provide further important information to maximise therapeutic impact of the group in inpatient settings.
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Affiliation(s)
| | | | | | - Kate Tchanturia
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
- Ilia State University, Georgia
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25
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Thaler L, Israel M, Antunes JM, Sarin S, Zuroff DC, Steiger H. An examination of the role of autonomous versus controlled motivation in predicting inpatient treatment outcome for anorexia nervosa. Int J Eat Disord 2016; 49:626-9. [PMID: 26841197 DOI: 10.1002/eat.22510] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/28/2015] [Accepted: 12/29/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We explored the effect of autonomous and controlled motivation on outcomes for patients undergoing inpatient treatment for Anorexia Nervosa (AN). METHOD Data on 80 patients with AN were available for the start of treatment, and for 49 at end of treatment. Patients completed measures of autonomous and controlled motivation, eating disorder symptoms and attitudes, and comorbid psychopathology at the start and end of treatment. RESULTS Patients showed significant improvements on eating symptoms and comorbid psychopathology over the course of treatment. Autonomous motivation was a significant predictor of change in severity of eating symptoms and attitudes such that patients with higher pre-treatment levels of autonomous motivation showed larger post-treatment reductions on these indices. No such effects were associated with controlled motivation. DISCUSSION This study highlights a relationship between autonomous motivation and outcome in an inpatient setting. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:626-629).
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Affiliation(s)
- Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | | | | | - David C Zuroff
- Psychology Department, McGill University, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Psychology Department, McGill University, Montreal, Quebec, Canada
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26
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Benefits of group cognitive remediation therapy in anorexia nervosa: case series. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2016; 30:42-9. [PMID: 26943839 PMCID: PMC4799273 DOI: 10.1007/s40211-016-0177-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/19/2016] [Indexed: 12/30/2022]
Abstract
Background Cognitive remediation therapy (CRT) is a treatment targeting cognitive difficulties in psychiatric disorders. CRT has been used with patients with severe anorexia nervosa (AN) in individual and group formats. Research of group CRT in AN is limited. Methods Evaluation of a series of CRT groups delivered in inpatient and intensive daycare services was performed. Participants’ self-reported cognitive flexibility and central coherence, as well as motivation to change were assessed pre- and post-group. Additionally, patients’ evaluative feedback was collected after completion of the group. Results There was a significant improvement in the patients’ self-reported cognitive flexibility and bigger picture thinking, as well as in their self-efficacy to change. The feedback questionnaires highlighted that patients found the sessions useful and reported confidence in using some of the skills and strategies they learnt in the group. Conclusion In line with evidence from small-scale reports, this larger scale case series study indicates that group CRT leads to increased flexibility and bigger picture thinking, as well as improved confidence in the ability to change for participants. CRT in a group format seems to be a practical and helpful intervention for patients with AN in intensive treatment programmes.
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Brachel RV, Windgassen A, Hötzel K, Hirschfeld G, Vocks S. Was passiert nach dem letzten Klick? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2016. [DOI: 10.1026/1616-3443/a000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Bisherige Studien zeigen, dass internetbasierte Interventionen kurzfristig die Veränderungsmotivation bei Essstörungen verbessern können. Zur Stabilität dieser Effekte ist jedoch wenig bekannt. Fragestellung: Wie entwickeln sich die Veränderungsmotivation, die Essstörungspsychopathologie und das Selbstwertgefühl 8 Wochen nach Abschluss eines internetbasierten Motivationsprogramms? Methode: Neunzig Frauen bearbeiteten den Stages of Change Questionnaire for Eating Disorders, den Eating Disorder Examination-Questionnaire und die Rosenberg Self-Esteem-Scale unmittelbar (Post) sowie 8 Wochen nach Abschluss der Intervention (Katamnese). Ergebnisse: Es zeigten sich stabile Effekte in der Veränderungsmotivation sowie im Selbstwertgefühl. Zusätzlich zeigten sich in der Essstörungspsychopathologie signifikante Verbesserungen. Schlussfolgerungen: Die Studie belegt die längerfristige Wirksamkeit eines internetbasierten Motivationsprogramms für Frauen mit Essstörungen.
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Affiliation(s)
- Ruth von Brachel
- Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | - Anja Windgassen
- Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Katrin Hötzel
- Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | | | - Silja Vocks
- Klinische Psychologie und Psychotherapie, Universität Osnabrück
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Duncan TK, Sebar B, Lee J. Reclamation of power and self: a meta-synthesis exploring the process of recovery from anorexia nervosa. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21662630.2014.978804] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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van der Kaap-Deeder J, Vansteenkiste M, Soenens B, Verstuyf J, Boone L, Smets J. Fostering self-endorsed motivation to change in patients with an eating disorder: the role of perceived autonomy support and psychological need satisfaction. Int J Eat Disord 2014; 47:585-600. [PMID: 24590551 DOI: 10.1002/eat.22266] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 01/27/2014] [Accepted: 02/13/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although several studies have established the beneficial effects of self-endorsed forms of motivation for lasting therapeutic change, the way patients with an eating disorder can be encouraged to volitionally pursue change has received less attention. On the basis of Self-Determination Theory, this longitudinal study addressed the role of an autonomy-supportive environment and psychological need satisfaction in fostering self-endorsed motivation for change and subsequent weight gain. METHOD Female inpatients (n = 84) with mainly anorexia nervosa and bulimia nervosa filled out questionnaires at the onset of, during, and at the end of treatment regarding their perceived autonomy support from parents, staff members, and fellow patients, their psychological need satisfaction, and their reasons for undertaking change. Furthermore, the body mass index (BMI) of the patients at the onset and end of treatment was assessed by the staff. Path analyses were used to investigate the relations between these constructs. RESULTS At the start of treatment, perceived parental autonomy support related positively to self-endorsed motivation through psychological need satisfaction. Perceived staff and fellow patients autonomy support related to changes in self-endorsed motivation over the course of treatment through fostering change in psychological need satisfaction. Finally, relative increases in self-endorsed motivation related to relative increases in BMI throughout treatment in a subgroup of patients with anorexia nervosa. DISCUSSION These results point to the importance of an autonomy-supportive context for facilitating self-endorsed motivation.
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Lloyd S, Fleming C, Schmidt U, Tchanturia K. Targeting Perfectionism in Anorexia Nervosa Using a Group-Based Cognitive Behavioural Approach: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2014; 22:366-72. [DOI: 10.1002/erv.2313] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Samantha Lloyd
- King's College London; Department of Psychological Medicine, Institute of Psychiatry; London UK
| | - Caroline Fleming
- South London and Maudsley NHS Foundation Trust; Eating Disorders National service; London UK
| | - Ulrike Schmidt
- King's College London; Department of Psychological Medicine, Institute of Psychiatry; London UK
- South London and Maudsley NHS Foundation Trust; Eating Disorders National service; London UK
| | - Kate Tchanturia
- King's College London; Department of Psychological Medicine, Institute of Psychiatry; London UK
- South London and Maudsley NHS Foundation Trust; Eating Disorders National service; London UK
- Illia State University; Tbilisi Georgia
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Carter JC, Kelly AC. Autonomous and controlled motivation for eating disorders treatment: baseline predictors and relationship to treatment outcome. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 54:76-90. [PMID: 25045794 DOI: 10.1111/bjc.12062] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 05/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to identify baseline predictors of autonomous and controlled motivation for treatment (ACMT) in a transdiagnostic eating disorder sample, and to examine whether ACMT at baseline predicted change in eating disorder psychopathology during treatment. METHOD Participants were 97 individuals who met DSM-IV-TR criteria for an eating disorder and were admitted to a specialized intensive treatment programme. Self-report measures of eating disorder psychopathology, ACMT, and various psychosocial variables were completed at the start of treatment. A subset of these measures was completed again after 3, 6, 9, and 12 weeks of treatment. RESULTS Multiple regression analyses showed that baseline autonomous motivation was higher among patients who reported more self-compassion and more received social support, whereas the only baseline predictor of controlled motivation was shame. Multilevel modelling revealed that higher baseline autonomous motivation predicted faster decreases in global eating disorder psychopathology, whereas the level of controlled motivation at baseline did not. CONCLUSION The current findings suggest that developing interventions designed to foster autonomous motivation specifically and employing autonomy supportive strategies may be important to improving eating disorders treatment outcome. PRACTITIONER POINTS The findings of this study suggest that developing motivational interventions that focus specifically on enhancing autonomous motivation for change may be important for promoting eating disorder recovery. Our results lend support for the use of autonomy supportive strategies to strengthen personally meaningful reasons to achieve freely chosen change goals in order to enhance treatment for eating disorders. One study limitation is that there were no follow-up assessments beyond the 12-week study and we therefore do not know whether the relationships that we observed persisted after treatment. Another limitation is that this was a correlational study and it is therefore important to be cautious about making causal conclusions when interpreting the results.
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Affiliation(s)
- Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Abstract
BACKGROUND Anorexia nervosa (AN) is a serious psychiatric disorder with high mortality rates a poor outcome and no empirically supported treatment of choice for adults. Weight increase is essential for recovery from AN why research exploring important contributors is crucial. AIMS The current study examined the importance of motivation to change eating behaviour, treatment expectations and experiences, eating disorder symptomatology, self-image and treatment alliance for predicting weight increase. METHODS Female patients (n = 89) between 18 and 46 years of age with AN were assessed pre-treatment and at 6- and 36-month follow-ups with interviews and self-report questionnaires. At the 6-month follow-up the response rates differed from n = 58 (65%) to 66 (74%), and at the 36-month follow-up the response rates differed from n = 71 (80%) to 82 (92%). RESULTS At treatment start, expressed motivation to change eating habits, social insecurity and self-neglect were predictors of weight increase from 0 to 6 months, while duration, the time from onset to entering treatment, body dissatisfaction and interoceptive awareness were predictors of weight increase from 0 to 36 months. CONCLUSIONS In designing treatment for adult patients with AN, it is essential to include multifaceted interventions addressed to patients' motivation to change, social relations, negative self-image and body dissatisfaction in order to achieve weight increase. Early detection and thereby short duration is an additional important factor that contributes to weight increase.
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Espíndola CR, Blay SL. Long term remission of anorexia nervosa: factors involved in the outcome of female patients. PLoS One 2013; 8:e56275. [PMID: 23460796 PMCID: PMC3584089 DOI: 10.1371/journal.pone.0056275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 01/08/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is usually marked by difficult recovery. OBJECTIVE To elicit, describe and characterize factors involved in successful AN remission for at least five years and post-recovery life. METHODS A qualitative study design using semi-structured interviews according to grounded theory methodology was used. An intentional sample of 15 information rich AN patients was selected using two sampling procedures: the criterion and "snowball" techniques. Qualitative interviews were audiotaped, transcribed, and entered into a content analysis. Researchers coded transcripts and developed themes. RESULTS Four core parameters were found to be associated with remission: (i) 'motivation to change/stimuli'; (ii) 'empowerment/autonomy'; (iii) 'media related factors'; (iv) 'treatment factors'. Clinical remission can be associated with residual symptoms. CONCLUSIONS The recovery model involves not only one, but rather a set of inter-active variables, each one can partially explain remission. Media factors can take a new role on recovery. Remission, however, can be followed by remnants of the disease and functional limitations.
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Affiliation(s)
- Cybele R. Espíndola
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, Brazil
| | - Sergio L. Blay
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, Brazil
- * E-mail:
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Wollburg E, Meyer B, Osen B, Löwe B. Psychological Change Mechanisms in Anorexia Nervosa Treatments: How Much Do We Know? J Clin Psychol 2013; 69:762-73. [DOI: 10.1002/jclp.21945] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Jakubowska A, Woolgar MJ, Haselton PA, Jones A. Review of staff and client experiences of a motivational group intervention: meeting the needs of contemplators. Eat Disord 2013; 21:16-25. [PMID: 23241087 DOI: 10.1080/10640266.2013.741965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This descriptive article outlines the processes undertaken by the STEPS Unit when designing a new group for people with anorexia nervosa, bulimia nervosa, and EDNOS. The group was designed to help clients explore their eating disorders in an environment where change was not required. A retrospective follow-up of the clients' treatment pathway, and the experiences of the facilitators and clients, is presented. Each group ran for 12 weeks, with 16 different groups of people. A total of 101 clients completed the 12 week program. A follow-up of the clients showed that 41% of those who completed the group moved from a contemplative stage into therapy involving behavioural change. The results are promising and of clinical relevance. This work adds to the existing literature in this field in that it includes a paradoxical emphasis on the positives of the eating disorder unlike traditional motivational interviewing techniques, resulting in a deeper commitment to change.
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Affiliation(s)
- Angie Jakubowska
- The STEPS Unit Eating Disorder Service, Southmead Hospital, Bristol, UK.
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Motivational Dynamics Among Eating-disordered Patients With and Without Nonsuicidal Self-injury: A Self-Determination Theory Approach. EUROPEAN EATING DISORDERS REVIEW 2012. [DOI: 10.1002/erv.2215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Paulson-Karlsson G, Nevonen L. Anorexia nervosa: treatment expectations - a qualitative study. J Multidiscip Healthc 2012; 5:169-77. [PMID: 22888259 PMCID: PMC3413044 DOI: 10.2147/jmdh.s33658] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a serious illness with a high mortality rate, a poor outcome, and no empirically supported treatment of choice for adults. Patients with anorexia nervosa strive for thinness in order to obtain self-control and are ambivalent toward change and toward treatment. In order to achieve a greater understanding of patients' own understanding of their situation, the aim of this study was to examine the expectations of potential anorexic patients seeking treatment at a specialized eating-disorder unit. METHODS A qualitative study design was used. It comprised 15 women between 18 and 25 years of age waiting to be assessed before treatment. The initial question was, "What do you expect, now that you are on the waiting list for a specialized eating-disorder unit?" A content analysis was used, and the text was coded, categorized according to its content, and further interpreted into a theme. RESULTS FROM THE RESULTS EMERGED THREE MAIN CATEGORIES OF WHAT PARTICIPANTS EXPECTED: "treatment content," "treatment professionals," and "treatment focus." The overall theme, "receiving adequate therapy in a collaborative therapeutic relationship and recovering," described how the participants perceived that their expectations could be fulfilled. DISCUSSION Patients' expectations concerning distorted thoughts, eating behaviors, a normal, healthy life, and meeting with a professional with knowledge and experience of eating disorders should be discussed before treatment starts. In the process of the therapeutic relationship, it is essential to continually address patients' motivations, in order to understand their personal motives behind what drives their expectations and their desire to recover.
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Affiliation(s)
- Gunilla Paulson-Karlsson
- Academy of Health and Medical Sciences, Örebro University, Örebro and Anorexia-Bulimia Unit, Child and Adolescent Psychiatry Centre, Queen Silvia Children’s Hospital, Göteborg, Sweden
| | - Lauri Nevonen
- Academy of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Pettersen G, Thune-Larsen KB, Wynn R, Rosenvinge JH. Eating disorders: challenges in the later phases of the recovery process. Scand J Caring Sci 2012; 27:92-8. [DOI: 10.1111/j.1471-6712.2012.01006.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Muñoz P, Quintana JM, Las Hayas C, Padierna A, Aguirre U, González-Torres MA. Quality of life and motivation to change in eating disorders. Perception patient-psychiatrist. Eat Behav 2012; 13:131-4. [PMID: 22365796 DOI: 10.1016/j.eatbeh.2011.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/15/2011] [Accepted: 11/15/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess motivation to change (Mch) of patients with an eating disorder (ED) and its relationship with quality-of-life (QoL) by comparing patient and psychiatrist perceptions. METHOD Patients (n=358) with an ED completed the disease-specific Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire, the Eating Attitudes Test (EAT-26) and the Short-Form Health Survey (SF-12) at baseline; 273 completed them after 1 year of treatment. The relationship between health-related quality of life (HRQoL) and the Mch stage was assessed using analysis of variance. Chi-square and Kappa statistical analysis assessed congruence in motivational change perception of the patients and psychiatrists. RESULTS Higher patient-reported Mch was associated with higher HRQoL at the study beginning and end but not using the patient Mch as perceived by the psychiatrist. Initially, the patient and psychiatrist perceptions of Mch differed (kappa coefficient, -0.01); after 1 year they tended to converge (k=0.34). CONCLUSIONS Higher Mch and higher QoL are positively associated. However, patient and psychiatrist perceptions of Mch and the relationship with QoL differ. After 1 year of treatment, these differences decreased.
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Affiliation(s)
- Pedro Muñoz
- Department of Psychiatry, Ortuella Mental Health Center, Ortuella, Bizkaia, Spain.
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Verstuyf J, Patrick H, Vansteenkiste M, Teixeira PJ. Motivational dynamics of eating regulation: a self-determination theory perspective. Int J Behav Nutr Phys Act 2012; 9:21. [PMID: 22385782 PMCID: PMC3309946 DOI: 10.1186/1479-5868-9-21] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 03/02/2012] [Indexed: 11/10/2022] Open
Abstract
Within Western society, many people have difficulties adequately regulating their eating behaviors and weight. Although the literature on eating regulation is vast, little attention has been given to motivational dynamics involved in eating regulation. Grounded in Self-Determination Theory (SDT), the present contribution aims to provide a motivational perspective on eating regulation. The role of satisfaction and thwarting of the basic psychological needs for autonomy, competence, and relatedness is introduced as a mechanism to (a) explain the etiology of body image concerns and disordered eating and (b) understand the optimal regulation of ongoing eating behavior for healthy weight maintenance. An overview of empirical studies on these two research lines is provided. In a final section, the potential relevance and value of SDT in relation to prevailing theoretical models in the domain of eating regulation is discussed. Although research on SDT in the domain of eating regulation is still in its early stages and more research is clearly needed, this review suggests that the SDT represents a promising framework to more thoroughly study and understand the motivational processes involved in eating regulation and associated problems.
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Affiliation(s)
- Joke Verstuyf
- Department of Developmental, Personality and Social Psychology, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Heather Patrick
- National Cancer Institute, 6130 Executive Boulevard, Rockville, MD 20852-7335 USA
| | - Maarten Vansteenkiste
- Department of Developmental, Personality and Social Psychology, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Pedro J Teixeira
- Faculty of Human Kinetics, Technical University of Lisbon, Estrada da Costa, 1495-688 Cruz Quebrada, Portugal
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Mansour S, Bruce KR, Steiger H, Zuroff DC, Horowitz S, Anestin AS, Sycz L. Autonomous Motivation: A Predictor of Treatment Outcome in Bulimia-Spectrum Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2012; 20:e116-22. [DOI: 10.1002/erv.2154] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 09/05/2011] [Accepted: 11/06/2011] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | | | - Sarah Horowitz
- Department of Psychology; McGill University; Quebec; Canada
| | - Annelie S. Anestin
- Eating Disorders Program; Douglas Mental Health University Institute; Quebec; Canada
| | - Lindsay Sycz
- Eating Disorders Program; Douglas Mental Health University Institute; Quebec; Canada
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Bardone-Cone AM. Examining the match between assessed eating disorder recovery and subjective sense of recovery: preliminary findings. EUROPEAN EATING DISORDERS REVIEW 2011; 20:246-9. [PMID: 21710559 DOI: 10.1002/erv.1123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined how individuals, clinically assessed as fully or partially recovered from an eating disorder (ED), subjectively perceived themselves in terms of stage of change in the recovery process. Individuals formerly seen for an ED at a Midwestern clinic were recruited. Using validated definitions of recovery, 18 were fully recovered (physical, behavioural and psychological recovery), and 15 were partially recovered (only physical and behavioural recovery); these groups were compared on overall stage of change and confidence related to this stage, dieting stage of change and internality of motivation. The fully and partially recovered groups endorsed being fully recovered (overall and for dieting) at similar rates. There were trends for the fully recovered group seeking change primarily for themselves and being more confident in their stage of change choice. Results have implications for approaches when a client's assessed recovery stage does not match her subjective sense of recovery and for better understanding recovery from an ED.
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Affiliation(s)
- Anna M Bardone-Cone
- Department of Psychology, University of North Carolina at Chapel Hill, NC 27599, USA.
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Huas C, Godart N, Foulon C, Pham-Scottez A, Divac S, Fedorowicz V, Peyracque E, Dardennes R, Falissard B, Rouillon F. Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample. Psychiatry Res 2011; 185:421-6. [PMID: 20546922 DOI: 10.1016/j.psychres.2009.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 11/27/2009] [Accepted: 12/12/2009] [Indexed: 11/29/2022]
Abstract
Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).
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Nordbø RHS, Espeset EMS, Gulliksen KS, Skårderud F, Geller J, Holte A. Reluctance to recover in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2011; 20:60-7. [PMID: 21305676 DOI: 10.1002/erv.1097] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reluctance to recover may explain poor treatment outcome and high dropout and relapse rates in the treatment of anorexia nervosa (AN). This study systematically explored what AN patients describe as interfering with their wish to recover. METHOD Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological study design. Interviews were tape recorded, transcribed and analysed using QSR-NVivo7 (QSR International, Melbourne, Australia) software. RESULTS Seven core obstacles were found to interfere with informants' wish to recover as follows: (i) 'perceiving judgements'; (ii) 'feeling stuck'; (iii) 'feeling distressed'; (iv) 'denying AN'; (v) 'eating'; (vi) 'gaining weight'; and (vii) 'appreciating the benefits'. CONCLUSION The wish to recover is an autonomously based, fundamental motivational requirement for becoming ready to change. Understanding factors that contribute to this wish adds to the clinician's toolbox in motivational work with AN patients.
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Affiliation(s)
- Ragnfrid H S Nordbø
- Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway.
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Dwyer LA, Hornsey MJ, Smith LGE, Oei TPS, Dingle GA. Participant Autonomy in Cognitive Behavioral Group Therapy: An Integration of Self-Determination and Cognitive Behavioral Theories. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2011. [DOI: 10.1521/jscp.2011.30.1.24] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vansteenkiste M, Sheldon KM. There's nothing more practical than a good theory: Integrating motivational interviewing and self-determination theory. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 45:63-82. [PMID: 16480567 DOI: 10.1348/014466505x34192] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this article we compare and integrate two well-established approaches to motivating therapeutic change, namely self-determination theory (SDT; Deci & Ryan, 1985, ) and motivational interviewing (MI; Miller & Rollnick, 1991, ). We show that SDT's theoretical focus on the internalization of therapeutic change and on the issue of need-satisfaction is fully compatible with key principles and clinical strategies within MI. We further suggest that basic need-satisfaction might be an important mechanism accounting for the positive effects of MI. Conversely, MI principles may provide SDT researchers with new insight into the application of SDT's theoretical concept of autonomy-support, and suggest new ways of testing and developing SDT. In short, the applied approach of MI and the theoretical approach of SDT might be fruitfully married, to the benefit of both.
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Abstract
Cognitive Remediation Therapy (CRT) was designed to address the inflexible and detail focused thinking styles frequently reported in individuals with Anorexia Nervosa (AN). This paper reports the development and acceptability of a pilot of CRT for AN in group format. Four group sessions were designed and piloted with 30 patients in an eating disorder service. The voluntary drop out rate was 20%. Outcome measures targeting patients' self-reported cognitive flexibility, self esteem and motivation to change were completed in the first and last sessions. Statistically significant gains were found in self reported ability to change (p=0.03). Both patients and group facilitators found the group acceptable, useful and a positive experience.
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Matusek JA, Wright MO. Ethical dilemmas in treating clients with eating disorders: A review and application of an integrative ethical decision-making model. EUROPEAN EATING DISORDERS REVIEW 2010; 18:434-52. [DOI: 10.1002/erv.1036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Darcy AM, Katz S, Fitzpatrick KK, Forsberg S, Utzinger L, Lock J. All better? How former anorexia nervosa patients define recovery and engaged in treatment. EUROPEAN EATING DISORDERS REVIEW 2010; 18:260-70. [PMID: 20589765 DOI: 10.1002/erv.1020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to explore how individuals with anorexia nervosa (AN) engage in treatment and define recovery. A mixed methods design was used to triangulate the experience of 20 women with a history of AN. Interview data were analysed thematically to explore frequency of emergent themes and current eating disorder psychopathology was assessed using standardized self-report measures. Participants' mean age was 29.35 (SD = 12.11). Participants' scores were indicative of persistent psychopathology. Those with more involvement in treatment choice had better motivation to change and normalized eating. Participants' definition of recovery mapped on well to current research conceptualizations, though a substantial proportion of the group expressed some ambivalence around the concept. Results are interpreted in the context of self-determination theory of motivation and suggest that patients should be involved collaboratively in the formulation of shared goals and concepts of recovery in treatment settings.
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Affiliation(s)
- Alison M Darcy
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305, USA.
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