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Sutherland KA, Coe JB, O'Sullivan TL. Assessing owners' readiness to change their behaviour to address their companion animal's obesity. Vet Rec 2023; 192:e1979. [PMID: 36073659 DOI: 10.1002/vetr.1979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Owner behaviour change in relation to management is critical for successful pet weight loss. The stages of change (SOC) can be used to conceptualise the process of intentional behaviour change. Clients may be more likely to make successful changes when practitioners use communication techniques appropriate for a client's current stage. The objective of this cross-sectional study was to assess pet owners' SOC in relation to managing the weight of their overweight or obese pet. METHODS An online questionnaire targeting dog and cat owners was distributed via snowball sampling. A total of 532 questionnaires were included in the analysis. Of these, 153 participants (28.8%) self-identified their pet's body condition score (BCS) as greater than 5 (on a nine-point scale). An adapted University of Rhode Island Change Assessment scale was completed by 119 of these participants (77.8%) to assess their readiness to change related to managing their overweight or obese pet. RESULTS Most participants were scored in the precontemplation (52.1%) and contemplation (42%) stages, where readiness to change is low. Owner assessments likely resulted in underestimation of pets' BCS. CONCLUSION The results offer preliminary insight into the SOC of owners who identify their pets as overweight or obese. Developing tools to assess and understand owners' readiness to change may be useful in informing veterinary professionals' communication approaches when engaging in weight management conversations.
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Affiliation(s)
- Katja A Sutherland
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Jason B Coe
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Terri L O'Sullivan
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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2
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Kambanis PE, Bottera AR, Mancuso CJ, De Young KP. Motivation to change predicts naturalistic changes in binge eating and purging, but not fasting or driven exercise among individuals with eating disorders. Eat Disord 2022; 30:279-301. [PMID: 33135984 DOI: 10.1080/10640266.2020.1823174] [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: 10/23/2022]
Abstract
We examined the naturalistic relations between motivation to change and change in four specific eating disorder (ED) behaviors-binge eating (BE), purging, fasting, and driven exercise-in a community-based sample of individuals with EDs over two consecutive 6-week periods. We conducted cross-lagged generalized estimating equations using the transtheoretical model's four stages of change to predict changes in the ED behaviors 6 weeks later. Individuals reported lower pre-contemplation for behaviors typically associated with more distress (e.g., BE, purging) than they did for behaviors associated with less distress (e.g., fasting and driven exercise). Action predicted decreases in BE and purging frequencies but not fasting or driven exercise frequencies. Naturalistic relations between ED behavior severity/frequency and motivation to change these features can be detected over 6-week intervals; that is, attempts at change in individuals' natural environments can be successful over relatively brief periods of time, especially when individuals experience the motivation to change these features. The process of motivation to change ED behaviors is not linear, and our study highlights the movement between stages of change among individuals with EDs. Future research is needed to examine how much of the observed changes are sustained.
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Affiliation(s)
| | | | | | - Kyle P De Young
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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3
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Spriggs MJ, Douglass HM, Park RJ, Read T, Danby JL, de Magalhães FJC, Alderton KL, Williams TM, Blemings A, Lafrance A, Nicholls DE, Erritzoe D, Nutt DJ, Carhart-Harris RL. Study Protocol for "Psilocybin as a Treatment for Anorexia Nervosa: A Pilot Study". Front Psychiatry 2021; 12:735523. [PMID: 34744825 PMCID: PMC8563607 DOI: 10.3389/fpsyt.2021.735523] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Anorexia nervosa (AN) is a serious and life-threatening psychiatric condition. With a paucity of approved treatments, there is a desperate need for novel treatment avenues to be explored. Here, we present (1) an overview of the ways through which Public Patient Involvement (PPI) has informed a trial of psilocybin-assisted therapy for AN and (2) a protocol for a pilot study of psilocybin-assisted therapy in AN currently underway at Imperial College London. The study aims to assess the feasibility, brain mechanisms and preliminary outcomes of treating anorexia nervosa with psilocybin. Methods: (1) PPI: Across two online focus groups, eleven individuals with lived experience of AN were presented with an overview of the protocol. Their feedback not only identified solutions to possible barriers for future participants, but also helped the research team to better understand the concept of "recovery" from the perspective of those with lived experience. (2) Protocol: Twenty female participants [21-65 years old, body mass index (BMI) 15 kg/m2 or above] will receive three oral doses of psilocybin (up to 25 mg) over a 6-week period delivered in a therapeutic environment and enveloped by psychological preparation and integration. We will work with participant support networks (care teams and an identified support person) throughout and there will be an extended remote follow-up period of 12 months. Our two-fold primary outcomes are (1) psychopathology (Eating Disorder Examination) across the 6-month follow-up and (2) readiness and motivation to engage in recovery (Readiness and Motivation Questionnaire) across the 6-week trial period. Neurophysiological outcome measures will be: (1) functional magnetic resonance imaging (fMRI) brain changes from baseline to 6-week endpoint and (2) post-acute changes in electroencephalography (EEG) activity, including an electrophysiological marker of neuronal plasticity. Discussion: The results of this pilot study will not only shed light on the acceptability, brain mechanisms, and impression of the potential efficacy of psilocybin as an adjunct treatment for AN but will be essential in shaping a subsequent Randomised Control Trial (RCT) that would test this treatment against a suitable control condition. Clinical Trial Registration: identifier: NCT04505189.
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Affiliation(s)
- Meg J. Spriggs
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Hannah M. Douglass
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Rebecca J. Park
- OxBREaD Research Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Tim Read
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Jennifer L. Danby
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Kirsty L. Alderton
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Tim M. Williams
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Allan Blemings
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Adele Lafrance
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | - Dasha E. Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - David J. Nutt
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Robin L. Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
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4
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Yim SH, Spencer L, Gordon G, Allen KL, Musiat P, Schmidt U. Views on online self-help programmes from people with eating disorders and their carers in UK. Eur J Public Health 2021; 31:i88-i93. [PMID: 34240155 PMCID: PMC8495677 DOI: 10.1093/eurpub/ckab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Digitalizing the healthcare system has been declared a priority by the UK
government. People with eating disorders (EDs), especially those with
bulimia nervosa (BN) or binge eating disorder (BED), and ED carers may
benefit from online self-help programmes, due to the shame and stigma
associated with EDs and barriers in accessing treatment, skills-training or
support. Qualitative studies are needed to explore stakeholders’
needs, attitudes to and views about online self-help, to optimize
intervention design and delivery. Methods Focus groups and telephone interviews were conducted with people with BN or
BED, and carers of people with anorexia nervosa, between March and September
2018 in the UK. Results People with EDs and carers perceived online self-help positively in the
context of barriers to seeking and accessing treatment and support, despite
some seeing it as inferior to face-to-face support. Most reported little
experience with online interventions. Participants thought the disadvantages
of online interventions could be overcome by reminders, progress summaries,
regular engagement and engaging with peers. Receiving guidance was seen as
an important functionality in the intervention by people with EDs. Conclusions People with EDs and their carers are aware of the potential benefits of
online self-help despite having little experience with this form of
intervention. A stepped-care approach that utilizes technology-based
interventions as a first step and makes such interventions available
directly to the consumer may fit the attitudes and needs of stakeholders.
The study provides a foundation for future research on design and delivery
of ED online self-help.
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Affiliation(s)
- See Heng Yim
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy Spencer
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gemma Gordon
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karina L Allen
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Musiat
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
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5
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Kasson E, Vázquez MM, Doroshenko C, Fitzsimmons-Craft EE, Wilfley DE, Taylor CB, Cavazos-Rehg PA. Exploring Social Media Recruitment Strategies and Preliminary Acceptability of an mHealth Tool for Teens with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7979. [PMID: 34360270 PMCID: PMC8345665 DOI: 10.3390/ijerph18157979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
(1) Background: The current study leveraged social media to connect with teens with EDs to identify population specific characteristics and to gather feedback on an mHealth intervention. (2) Methods: We recruited teens with EDs from social media in two phases: (1) Discovery Group, (2) Testing Group. The Discovery Group (n = 14) participants were recruited from Facebook/Instagram and were asked to review the app for up to one week and provide qualitative feedback. After incorporating feedback from the Discovery Group, we refined our social media outreach methods to connect with 30 teens with EDs to pilot this mobile app. Recruitment from a variety of platforms on social media was successful, with the majority of enrolled participants in the Testing Group coming from Snapchat (60%) and a large percentage of participants belonging to gender and sexual minority groups (63%). (3) Results: Participants from both groups experienced extremely high rates of depression (100% Discovery, 90% Testing) and/or anxiety symptoms (100% Discovery, 93% Testing) in addition to ED symptoms, and noted this as a possible barrier to app engagement. (4) Conclusion: Use of social media for recruitment of teens with EDs is feasible and may connect with groups who may be more difficult to reach using traditional recruitment methods. Among the Discovery Group there was high acceptability of and interest in an app to support ED recovery, and characteristics of both groups demonstrated need for support in other mental health domains. Future studies should evaluate the preliminary efficacy of such tools among teens to determine the effects of such interventions on ED symptoms and other mental health outcomes.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Melissa M. Vázquez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Christine Doroshenko
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Center for m2Health, Palo Alto University, Palo Alto, CA 94304, USA
| | - Patricia A. Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
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6
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Schmidt-Hantke J, Vollert B, Hagner F, Beintner I, Hütter K, Nitsch M, Jacobi C, Waldherr K. Stakeholders' perspectives on online interventions to improve mental health in eating disorder patients and carers in Germany. Eur J Public Health 2021; 31:i80-i87. [PMID: 34240153 PMCID: PMC8266537 DOI: 10.1093/eurpub/ckab057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Eating disorders are causing severe consequences for those affected as well as a high burden for their carers. Although there is a substantial need for psychological assistance, different factors are hindering access to support. Internet-based interventions can help to overcome these barriers. To date, there is only little knowledge on attitudes of potential users, facilitators (e.g. psychologists) and decision makers (e.g. health insurances) regarding these interventions. METHODS We conducted focus groups with potential users (N = 30) and semi-structured interviews with potential decision makers (N = 4). Potential facilitators (N = 41) participated in an online survey. Stakeholders' experiences, attitudes, and their needs regarding Internet-based interventions for eating disorder patients and carers were assessed. Furthermore, hindering and fostering factors related to reach, adoption, implementation and maintenance were analyzed. RESULTS About two-thirds of the participating facilitators have heard or read about Internet-based interventions in general. In contrast, the other stakeholders mentioned to have no or little experience with such interventions. Factors like anonymity, availability and cost-effectiveness were seen as major advantages. Also disadvantages, e.g. lack of personal contact, limitations by disease severity and concerns on data safety, were mentioned. Stakeholders stated the need for interventions which are usable, evidence-based, tailored and provide personal support. CONCLUSION Stakeholders considered Internet-based programmes to have more advantages than disadvantages. Effort should be put in providing systematic education to address prejudices. When offering an online intervention, stakeholders' needs, as well as a continuous evaluation and adaptation, have to be taken into account.
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Affiliation(s)
- Juliane Schmidt-Hantke
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Bianka Vollert
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Franziska Hagner
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Ina Beintner
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Kristian Hütter
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Martina Nitsch
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Corinna Jacobi
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
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7
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Litmanovich-Cohen L, Yaroslavsky A, Halevy-Yosef LR, Shilton T, Enoch-Levy A, Stein D. Post-hospitalization Daycare Treatment for Adolescents With Eating Disorders. Front Psychiatry 2021; 12:648842. [PMID: 34135782 PMCID: PMC8200532 DOI: 10.3389/fpsyt.2021.648842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background: There are several possible facilities for the treatment of eating disorders (EDs). Specifically, there is the issue of the use of specialized daycare and ambulatory services over inpatient settings and the place of daycare programs following inpatient treatment. Aim: We sought to examine the contribution of post-hospitalization daycare program to the treatment of adolescents hospitalized with an ED. Methods: We assessed 61 female adolescents hospitalized with an ED. All but three were diagnosed with clinical or subthreshold anorexia nervosa (AN). Three were diagnosed with bulimia nervosa. Thirty-seven patients continued with a post-hospitalization daycare program for at least 5 months, whereas 24 did not enter or were enrolled in the program for <5 months. Patients completed on admission to, and discharge from, inpatient treatment self-rating questionnaires assessing ED-related symptoms, body-related attitudes and behaviors, and depression and anxiety. Social functioning was assessed 1 year from discharge using open-ended questions. One-year ED outcome was evaluated according to the patients' body mass index (BMI) and according to composite remission criteria, assessed with a standardized semistructured interview. To be remitted from an ED, patients were required to maintain a stable weight, to have regular menstrual cycles, and not to engage in binging, purging, and restricting behaviors for at least eight consecutive weeks before their assessment. Results: BMI was within normal range at follow-up, whether completing or not completing daycare treatment, and around 75% of the patients had menstrual cycles. By contrast, when using comprehensive composite remission criteria, less than a quarter of former inpatients not entering/not completing daycare program achieved remission vs. almost a half of the completers. In addition, a greater percentage of completers continued with psychotherapy following discharge. Fifty percent of both groups showed good post-discharge social functioning. No between-group differences were found in the BMI and the scores of the self-rating questionnaires at admission to, and discharge from, inpatient treatment. Conclusion: Adolescent females with EDs can maintain a normal-range BMI from discharge to 1-year follow-up, even if not completing daycare treatment. By contrast, completion of a post-hospitalization daycare program may improve the 1-year follow-up ED-related outcome of former ED inpatients.
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Affiliation(s)
- Liron Litmanovich-Cohen
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Hadarim Eating Disorders Outpatient Service, Shalvata Mental Health Center, Hod Hsaharon, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Liron Roni Halevy-Yosef
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Tal Shilton
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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To contemplate or not to contemplate evaluating a preliminary intervention proposal in an outpatient setting: the contemplation therapy group. Eat Weight Disord 2020; 25:389-398. [PMID: 30414075 DOI: 10.1007/s40519-018-0610-2] [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: 08/24/2017] [Accepted: 10/26/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The concept for the contemplation group intervention was derived from motivational interviewing (MI) to support people suffering from an eating disorder who are reluctant to engage with treatment. This evaluation focuses on the contemplation group run by the eating disorder services in the Cardiff and Vale area between 2012 and 2016 to investigate the outcomes for participants and implications for working with people suffering from an eating disorder who are ambivalent about change. METHOD Quantitative measures were used to assess eating disorder symptomatology, motivation to change and location within the stages of change model. A brief qualitative evaluation of client experiences was also included. RESULTS While dropout was high, a number of patients displayed increased readiness for treatment at the end of the group or even started to engage in change-focussed therapy. Participants who completed the group described it as challenging but helpful. CONCLUSIONS This evaluation shows that explorative contemplation of their ambivalence towards their eating disorder and treatment was helpful for the participants of the group and supported them in achieving more clarity and decisiveness regarding whether to engage in treatment or not. Further research is needed to evaluate long-term outcomes for patients who feel ambivalent towards treatment, and to explore what interventions can be used to help them. EVIDENCE LEVEL Level IV: Evidence obtained from multiple time series with or without the intervention.
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9
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Kristmannsdottir G, Keski-Rahkonen A, Kuusinen KL. Changes in the sense of agency: Implications for the psychotherapy of bulimia nervosa- A case study. J Clin Psychol 2019; 75:1415-1428. [PMID: 30980392 DOI: 10.1002/jclp.22787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A sense of agency is a transtheoretical concept that increases our understanding of important processes in psychotherapy. Agency can be described in terms of how strongly the person believes that she can have an impact on her problematic experiences and behaviors. In this case study, a patient's sense of agency in relation to symptoms of bulimia nervosa was assessed during 3 years of psychotherapy. Five distinct phases of agency in relation to eating disorder symptoms were identified: A false sense of agency or no agency at all, a weak sense of agency, a nascent sense of agency, a wavering sense of agency, and a strong sense of agency. A better understanding of patient agency can facilitate adapting approaches and methods best suited for the patient's capacity for change throughout treatment.
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10
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Spencer L, Schmidt-Hantke J, Allen K, Gordon G, Potterton R, Musiat P, Hagner F, Beintner I, Vollert B, Nacke B, Görlich D, Beecham J, Bonin EM, Jacobi C, Schmidt U. A web-based intervention for carers of individuals with anorexia nervosa (We Can): Trial protocol of a randomised controlled trial investigating the effectiveness of different levels of support. Internet Interv 2019; 16:76-85. [PMID: 30775267 PMCID: PMC6364327 DOI: 10.1016/j.invent.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/17/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a life-threatening mental disorder that is associated with substantial caregiver burden. Carers of individuals with AN report high levels of distress and self-blame, and insufficient knowledge to help their loved ones. However, carers can have a very important role to play in aiding recovery from AN, and are often highly motivated to assist in the treatment process. This manuscript presents the protocol for a randomised controlled trial (RCT) of We Can, a web-based intervention for carers for people with AN. The study aims to investigate the effectiveness of We Can delivered with different intensities of support. METHODS The study takes the form of a multi-site, two-country, three group RCT, comparing We Can (a) with clinician messaging support (We Can-Ind), (b) with moderated carer chatroom support (We Can-Chat) and (c) with online forum only (We Can-Forum). Participants will be 303 carers of individuals with AN as well as, where possible, the individuals with AN themselves. Recruitment will be via specialist eating disorder services and carer support services in the UK and Germany. Randomisation of carers to one of the three intervention conditions in a 1:1:1 ratio will be stratified by whether or not the individual with AN has (a) agreed to participate in the study and (b) is a current inpatient. The We Can intervention will be provided to carers online over a period of 12 weeks. Participants will complete self-report questionnaires at pre-intervention (T1), mid-intervention (mediators only; 4-weeks post-randomisation), post-intervention (T2; 3-months post randomisation), and 6 months (T3) and 12 months (T4) after randomisation. The primary outcome variables are carer symptoms of depression and anxiety. Secondary outcome variables will be measured in both carers and individuals with AN. Secondary carer outcome variables will include alcohol and drug use and quality of life, caregiving behaviour, and the acceptability and use of We Can and associated supports. Secondary outcomes measured in individuals with AN will include eating disorder symptoms, and symptoms of depression and anxiety. The study will also evaluate the cost-effectiveness of the three We Can conditions, and test for mediators and moderators of the effects of We Can. The trial is registered at the International Standard Randomisation Controlled Trial Number (ISRCTN) database, registration number: ISRCTN11399850. DISCUSSION The study will provide insight into the effectiveness of We Can and its optimal method/s of delivery.
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Key Words
- AESED, accommodation and enabling scale for eating disorders
- AN, anorexia nervosa
- AQoL-8D, assessment of quality of Life-8D
- AUDIT, alcohol use disorders identification test
- Anorexia nervosa
- BDSEE, brief dyadic scale of expressed emotion
- BFI-10, Big Five – 10 item version
- BMI, body mass index
- CASK, caregiver skills scale
- CD-RISC-10, Connor–Davidson resilience scale-10
- CEQ, adapted credibility/expectancy questionnaire
- CSRI, client service receipt inventory
- Carer support
- DUDIT, drug use disorders identification test
- E-treatment
- ECI, experience of caregiving inventory
- EDE-Q, eating disorder examination-questionnaire
- EDSIS, eating disorders symptom impact scale
- GAD-7, generalized anxiety disorder (GAD)-7 scale
- ICare
- Mental health
- OAO, overcoming anorexia online
- Online interventions
- PHQ-9, patient health questionnaire 9-item depression scale
- RCT, randomised controlled trial
- RSE, rosenberg self-esteem scale
- WAI-SR, adapted working alliance inventory – short revised
- WHOQOL, World Health Organisation quality of life scale
- We Can-Chat, We Can with moderated carer chatroom support
- We Can-Forum, We Can with online forum support only
- We Can-Ind, We Can with clinician email support
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Affiliation(s)
- Lucy Spencer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Juliane Schmidt-Hantke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Karina Allen
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
- The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, UK
| | - Gemma Gordon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Rachel Potterton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Peter Musiat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Franziska Hagner
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Ina Beintner
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Bianka Vollert
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Barbara Nacke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmedingstraße 56, Münster, Germany
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Corinna Jacobi
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
- The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, UK
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11
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Iyar MM, Cox DW, Kealy D, Srikameswaran S, Geller J. Is stage of change enough? Confidence as a predictor of outcome in inpatient treatment for eating disorders. Int J Eat Disord 2019; 52:283-291. [PMID: 30701590 DOI: 10.1002/eat.23026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 12/27/2018] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE While stage of change has been shown to be a robust predictor of eating disorder treatment outcome, little attention has been paid to the role of confidence. This study sought to better understand the role of confidence and the possible interaction it may have with stage of change in promoting eating disorder symptom change. METHOD Participants were adult women in inpatient treatment for eating disorders. They completed measures of motivation for change, which assessed precontemplation, action, confidence and internality (changing for oneself vs. others) and eating disorder symptom severity at pretreatment (N = 159) and posttreatment (n = 59). Only treatment completer analyses were used. RESULTS Precontemplation and confidence had significant effects on pretreatment and posttreatment symptom severity, while action only had a significant effect on pretreatment symptoms. Confidence was shown to moderate relations between both measures of stage of change (i.e., precontemplation and action) and symptoms posttreatment. Follow-up analyses indicated that high precontemplation was associated with poor outcome, irrespective of confidence, however, low precontemplation was associated with better outcome at high levels of confidence. The interaction between confidence and action was also significant at very high levels of confidence. That is, among individuals who had high action at baseline, those with low confidence had significantly poorer outcomes relative to those with high confidence. DISCUSSION Findings indicate that stage of change and confidence are both important prognostic factors and suggest that early behavior change in the absence of confidence may not guarantee best outcomes in inpatient eating disorder treatment.
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Affiliation(s)
- Megumi M Iyar
- St. Paul's Hospital Eating Disorders Program, Vancouver, British Columbia, Canada.,Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - Daniel W Cox
- Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Suja Srikameswaran
- St. Paul's Hospital Eating Disorders Program, Vancouver, British Columbia, Canada
| | - Josie Geller
- St. Paul's Hospital Eating Disorders Program, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Denison-Day J, Appleton KM, Newell C, Muir S. Improving motivation to change amongst individuals with eating disorders: A systematic review. Int J Eat Disord 2018; 51:1033-1050. [PMID: 30189116 DOI: 10.1002/eat.22945] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE People with eating disorders can have low motivation to change their eating disorder behaviors. Interventions aiming to enhance motivation to change have been increasingly advocated in their treatment. Questions remain regarding the strength of the evidence supporting the effectiveness of interventions that specifically focus on improving motivation. This review explored the evidence for improving motivation to change in eating disorders via clinical interventions. METHOD Searches of the published and unpublished literature were conducted by searching databases (PubMed, PsychInfo, Web of Science) and trial registries (WHO ICTRP), and by contacting authors. Studies were included if they investigated an intervention for eating disorder patients, included a pre-post outcome measure of motivation to change and were published in English. Risk of bias was also assessed. RESULTS Forty-two studies were included in the final review. Evidence was found to support the use of interventions to improve motivation to change, though it was unclear whether motivational interventions present a more effective option than approaches that do not exclusively or specifically focus on motivation. However, motivational interventions were identified as being more effective than low intensity treatments. Risk of bias in included studies was generally high. DISCUSSION Motivation was found to increase across treatments in general, whether or not the focus of the intervention was on enhancing motivation. It is unclear if interventions specifically targeting motivation to change provide additional benefit over and above established treatment approaches.
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Affiliation(s)
- James Denison-Day
- Bournemouth University, Department of Psychology, Research Center for Behavior Change, Bournemouth, United Kingdom
| | - Katherine M Appleton
- Bournemouth University, Department of Psychology, Research Center for Behavior Change, Bournemouth, United Kingdom
| | - Ciarán Newell
- Dorset Healthcare University NHS Foundation Trust, Poole, United Kingdom
| | - Sarah Muir
- Bournemouth University, Department of Psychology, Research Center for Behavior Change, Bournemouth, United Kingdom
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13
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Ziser K, Resmark G, Giel KE, Becker S, Stuber F, Zipfel S, Junne F. The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2018; 26:379-393. [PMID: 29577487 DOI: 10.1002/erv.2590] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 11/08/2022]
Abstract
Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa.
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Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Becker
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
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14
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Prior AL, Woodward D, Hoefkens T, Clayton D, Thirlaway K, Limbert C. Telephone helplines as a source of support for eating disorders: Service user, carer, and health professional perspectives. Eat Disord 2018; 26:164-184. [PMID: 29192839 DOI: 10.1080/10640266.2017.1364934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Access to care for eating disorders can be problematic for numerous reasons including lack of understanding and delays with treatment referrals. Previous research has highlighted the benefits of telephone helplines as an accessible source of support for those who may not wish to access face-to-face support or to fill a gap for those waiting for treatment. This study aimed to gain an insight into the perspectives of those who may use or refer others to a telephone helpline in order to identify the requirements of such a service. Triangulation of service user, carer and health professionals' perspectives resulted in identification of themes relating to the type of support, delivery and practicalities of a helpline. The findings indicated that telephone helplines may offer numerous benefits for individuals with an eating disorder, whether accessed as a first step, alongside treatment or as an extension of this support when in recovery. Additionally helplines may provide an opportunity for carers to access information and discuss their own experiences, while supporting their loved one. Raising awareness of these services is important to encourage those affected by an eating disorder to access and make the most of this type of support. These findings offer an insight into the key requirements for new and existing service development with regard to both the type of support and the method of communication required by individuals with eating disorders.
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Affiliation(s)
- Amie-Louise Prior
- a Department of Applied Psychology , Cardiff Metropolitan University, Cardiff , UK
| | - Debbie Woodward
- a Department of Applied Psychology , Cardiff Metropolitan University, Cardiff , UK
| | - Toni Hoefkens
- a Department of Applied Psychology , Cardiff Metropolitan University, Cardiff , UK
| | - Debbie Clayton
- a Department of Applied Psychology , Cardiff Metropolitan University, Cardiff , UK
| | - Katie Thirlaway
- a Department of Applied Psychology , Cardiff Metropolitan University, Cardiff , UK
| | - Caroline Limbert
- a Department of Applied Psychology , Cardiff Metropolitan University, Cardiff , UK
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15
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King G, Chiarello LA, Thompson L, McLarnon MJW, Smart E, Ziviani J, Pinto M. Development of an observational measure of therapy engagement for pediatric rehabilitation. Disabil Rehabil 2017; 41:86-97. [DOI: 10.1080/09638288.2017.1375031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Lisa A. Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, U.S.A
| | - Laura Thompson
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | | | - Eric Smart
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Madhu Pinto
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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16
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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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17
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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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18
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Mikschl S, Schlegl S, Külz AK, Rief W, Voderholzer U. Funktionalitäten von Essstörungen - Ergebnisse einer Analyse im stationären Setting. VERHALTENSTHERAPIE 2016. [DOI: 10.1159/000448496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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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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20
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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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21
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King G, Currie M, Petersen P. Child and parent engagement in the mental health intervention process: a motivational framework. Child Adolesc Ment Health 2014; 19:2-8. [PMID: 32878365 DOI: 10.1111/camh.12015] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND This article proposes a conceptual model of child and parent engagement in the mental health intervention process. METHOD A scoping review was performed of articles on predictors of engagement in mental health interventions, the effectiveness of engagement interventions, and interpersonal aspects of care. A comprehensive search of PsycINFO and PsycARTICLES was performed for literature published in English from 2000 to 2012. RESULTS Based on the review, a motivational framework is proposed in which engagement is defined as a state comprised of a hopeful stance, conviction, and confidence, brought about when therapists optimize engagement processes of receptiveness, willingness, and self-efficacy. CONCLUSIONS Implications concern the need to help clients understand what to expect from the therapy process, and to educate therapists about engagement strategies.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
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22
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Ego-syntonicity and ego-dystonicity of eating-related intrusive thoughts in patients with eating disorders. Psychiatry Res 2013; 208:67-73. [PMID: 23541243 DOI: 10.1016/j.psychres.2013.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 12/02/2012] [Accepted: 01/09/2013] [Indexed: 11/22/2022]
Abstract
The main objective of the present study was to analyse the role of the ego-dystonicity and ego-syntonicity of eating disorder intrusive thoughts (EDITs) in the genesis and maintenance of eating disorders (EDs). Participants were 98 female patients with EDs, 56 Spanish and 42 English (27.19±9.59 years; body mass index (BMI): 18.72±2.87). All of them completed the eating attitudes test, the Eating Attitudes Test, the Eating Intrusive Thoughts Inventory, the Ego-Dystonicity Questionnaire-Reduced version, and the Ego-Syntonicity Questionnaire. Patients indicated that their EDITs were rational and also undesirable and immoral, suggesting that EDITs are not fully ego-syntonic or ego-dystonic. Multivariate analysis of variance (MANOVA) indicated no differences in ego-syntonicity and ego-dystonicity across ED subtypes. Path analyses were performed to investigate the mediating role of the EDITs' ego-syntonicity and ego-dystonicity in their interference, dysfunctional appraisals and control strategies. They showed, first, that the more interference an EDIT caused, the more ego-syntonic and the less ego-dystonic it was and, second, that when the EDITs were assessed as ego-syntonic, patients tried to do what they indicated, whereas when they were assessed as ego-dystonic, patients made efforts to neutralise them. Clinical implications for the conceptualisation and treatment of ED are discussed.
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23
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Knowles L, Anokhina A, Serpell L. Motivational interventions in the eating disorders: what is the evidence? Int J Eat Disord 2013; 46:97-107. [PMID: 23001832 DOI: 10.1002/eat.22053] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Eating disorder treatments are plagued by poor engagement and high drop-out. People who disengage from eating disorder treatment appear poorly motivated to change, and may benefit from adaptations of Motivational Interviewing (AMIs). OBJECTIVE To investigate whether the use of interventions specifically designed to enhance motivation in the eating disorders is supported empirically. METHOD Literature was reviewed for relevant studies. RESULTS Eight studies have investigated the efficacy of AMIs. AMIs improve motivation to change bingeing and reduce actual bingeing behavior. There was little support for AMIs for compensatory or restrictive behaviors. There was mixed evidence that AMIs may improve motivation, but little to suggest they are more effective than other approaches. DISCUSSION The widespread interest in using motivational approaches in the eating disorders is not strongly supported by the literature. The current evidence base does not support the widespread dissemination of motivation-enhancing interventions in the eating disorders.
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Affiliation(s)
- Lucy Knowles
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom.
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24
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The use of motivational interviewing in eating disorders: a systematic review. Psychiatry Res 2012; 200:1-11. [PMID: 22717144 DOI: 10.1016/j.psychres.2012.05.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 05/08/2012] [Accepted: 05/10/2012] [Indexed: 11/22/2022]
Abstract
This review examines the effectiveness of interventions that include the principles and techniques of motivational interviewing (MI) and its adaptations in the treatment of eating disorders. The aims are (1) to examine both the context and effectiveness of MI and Motivational Enhancement Therapy (MET) when used with either patients or carers of people with eating disorders, (2) to identify limitations and/or difficulties in this process and (3) to identify further research needs in this area. Electronic databases were searched up until April 2012. Articles were screened according to predetermined inclusion and exclusion criteria. Thirteen studies were finally selected for inclusion. A wide range of participants, interventions and outcomes were measured which made comparative analysis difficult. Promising results were found for interventions that included MI, particularly with regards to its use in increasing a readiness and motivation to change. Consequently, there is potential for using MI in the field of eating disorders, particularly with respect to 'readiness for change'. More homogeneity in study design and delivery of MI is needed along with some markers of treatment fidelity, including information as to how adherence to the intervention is assured.
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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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26
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Waller G. The myths of motivation: time for a fresh look at some received wisdom in the eating disorders? Int J Eat Disord 2012; 45:1-16. [PMID: 22170018 DOI: 10.1002/eat.20900] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2010] [Indexed: 11/12/2022]
Abstract
The eating disorders typically involve poor motivation to change. This article reviews the evidence behind many of our beliefs about motivation and whether we need a different conceptual framework for understanding why patients commonly get "stuck." The outcome literature is reviewed, and demonstrates that there is little evidence that we are effective in enhancing motivation to induce changes in symptoms. Indeed, there are suggestions that commonly used models are unhelpful. Verbal expressions of motivation are not the best indicator of likely treatment response, and can best be understood as providing a "manifesto," which has functions that can obstruct recovery from the eating disorder. A behavioral analysis of motivation is likely to be more effective. Cognitive, emotional, and behavioral methods for enhancing motivation are outlined, with the aim of bypassing the motivational manifesto and encouraging positive therapeutic change.
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Affiliation(s)
- Glenn Waller
- Vincent Square Eating Disorders Clinic, Central and North West London NHS Foundation Trust, London, United Kingdom.
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27
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Muscat AC. Ready, Set, Go: The Transtheoretical Model of Change and Motivational Interviewing for “Fringe” Clients. JOURNAL OF EMPLOYMENT COUNSELING 2011. [DOI: 10.1002/j.2161-1920.2005.tb01089.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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28
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Grover M, Naumann U, Mohammad-Dar L, Glennon D, Ringwood S, Eisler I, Williams C, Treasure J, Schmidt U. A randomized controlled trial of an Internet-based cognitive-behavioural skills package for carers of people with anorexia nervosa. Psychol Med 2011; 41:2581-2591. [PMID: 21733215 DOI: 10.1017/s0033291711000766] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) poses a major burden on families. Carers (e.g. parents or partners) of people with AN are often highly distressed and may inadvertently respond in ways that can contribute to the maintenance of the disorder, e.g. through high levels of over-involvement and criticism [also known as expressed emotion (EE)]. This study aimed to evaluate the efficacy of a novel web-based systemic cognitive-behavioural (CBT) intervention for carers of people with AN, designed to reduce carer distress and teach skills in how to offer effective support. METHOD Carers of people with AN (n=64) were randomly allocated to either the web-intervention, overcoming anorexia online, with limited clinician supportive guidance (by email or phone), or to ad-hoc usual support from the UK patient and carer organization Beat. Carer outcomes were assessed at post-treatment (4 months) and follow-up (6 months). RESULTS Compared with the control intervention, web-based treatment significantly reduced carers' anxiety and depression (primary outcome) at post-treatment, with a similar trend in carers' EE. Other secondary outcomes did not favour the online intervention. Gains were maintained at follow-up. CONCLUSIONS This is the first ever study to use an online CBT program to successfully reduce carer distress and improve carers' ability to support the person with AN.
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Affiliation(s)
- M Grover
- King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
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29
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Geller J, Brown KE, Srikameswaran S. The efficacy of a brief motivational intervention for individuals with eating disorders: a randomized control trial. Int J Eat Disord 2011; 44:497-505. [PMID: 20872758 DOI: 10.1002/eat.20847] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Individuals with eating disorders are often ambivalent about recovery, and previous research has shown that readiness for change predicts enrollment in intensive treatment, symptom change, dropout, and relapse. Given the demonstrated importance of readiness for change, researchers and clinicians have turned to investigating interventions designed to enhance motivation. The purpose of this research was to determine the efficacy of Readiness and Motivation Therapy (RMT), a five-session individual preparatory intervention for individuals with eating disorders. METHOD Participants completed the Readiness and Motivation Interview and measures of eating disorder symptomatology, self-esteem, and psychiatric symptoms at intake. One hundred eighty-one participants were randomly assigned to the treatment (RMT) or wait-list control condition and were reassessed at 6-week and 3-month follow-up; 113 completed assessments at all three time points and primary analyses were based on these individuals. RESULTS Surprisingly, improvements in readiness for change, depression, drive for thinness, and bulimia symptoms occurred over time in both RMT and control conditions. However, at post and at follow-up, individuals who received RMT were less likely to have high ambivalence than were those from the control condition. DISCUSSION RMT may be of benefit to highly reluctant, clinically challenging patients and help them make better use of future, action-oriented treatment.
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Affiliation(s)
- Josie Geller
- Eating Disorders Program, St. Paul's Hospital, Vancouver, Canada.
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30
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Allen KL, Fursland A, Raykos B, Steele A, Watson H, Byrne SM. Motivation-focused treatment for eating disorders: a sequential trial of enhanced cognitive behaviour therapy with and without preceding motivation-focused therapy. EUROPEAN EATING DISORDERS REVIEW 2011; 20:232-9. [PMID: 21793108 DOI: 10.1002/erv.1131] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 02/25/2011] [Accepted: 04/21/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a motivation-focused intervention prior to individual cognitive behavioural eating disorder treatment. METHOD Enhanced cognitive-behavioural therapy (CBT-E) in its usual form was compared with CBT-E preceded by four sessions of motivation-focused therapy (MFT) (MFT + CBT-E). Participants were adult outpatients seen at a specialist eating disorder clinic in Western Australia, who met criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition eating disorder. A sequential trial of CBT-E as usual (n = 43) and MFT + CBT-E (n = 52) was conducted over a 40-month period. RESULTS The MFT phase was associated with significant increases in readiness to change. There were no significant between-group differences in treatment completion rates, and treatment completers in both conditions reported comparable reductions in eating disorder symptoms over time. CONCLUSION In this sample, MFT + CBT-E was not associated with superior treatment outcome when compared with CBT-E as usual.
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Affiliation(s)
- Karina L Allen
- Centre for Clinical Interventions, Northbridge, Western Australia, Australia.
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31
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Pettersen G, Rosenvinge JH, Wynn R. Eating disorders and psychoeducation--patients' experiences of healing processes. Scand J Caring Sci 2011; 25:12-8. [PMID: 20409067 DOI: 10.1111/j.1471-6712.2010.00783.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the treatment of eating disorders, little is known about the role and impact of psychoeducative programmes and whether patients experience such programmes as helpful in their healing processes. Examining these questions is the purpose of this study, using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis of healing processes experienced during the programme participation resulted in six main categories, i.e. 'Self-awareness', 'Setting boundaries', 'Feelings and self-mobilization', 'Self-regulation', 'Self-reflexivity' and 'Motivation and Self-improvement'. Our study clearly indicates that according to the patients' experiences, a psychoeducative programme may facilitate healing processes. The study also supports a possible indirect impact on healing processes in terms of more readiness to seek treatment. There is a need for more knowledge about how to bring about an effective interplay between treatment and psychoeducative programmes.
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Affiliation(s)
- Gunn Pettersen
- Department of Research and Development, University Hospital of Northern Norway, Tromsø, Norway.
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32
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Long CG, Fitzgerald KA, Hollin CR. Treatment of chronic anorexia nervosa: a 4-year follow-up of adult patients treated in an acute inpatient setting. Clin Psychol Psychother 2011; 19:1-13. [DOI: 10.1002/cpp.738] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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33
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Williams S, Reid M. Understanding the experience of ambivalence in anorexia nervosa: the maintainer's perspective. Psychol Health 2010; 25:551-67. [PMID: 20204933 DOI: 10.1080/08870440802617629] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
People with anorexia often feel ambivalent about whether they wish to maintain it or recover from it. One place where individuals can communicate their experiences of wanting to maintain their anorexia is through pro-anorexia websites. This study investigated the experiences and understandings of those who wish to maintain their anorexia and looked at how these understandings may affect their treatment experiences. Data were collected online and analysed using interpretative phenomenological analysis (IPA). Anorexia denoted meanings of a 'tool', an 'entity' and a 'disease'. Participants felt ambivalent about whether their anorexia gave them control or controlled them, whether it played a positive or negative role and whether they wished to maintain their behaviours or recover. Participants also discussed barriers to recovery. Theoretical and treatment implications are discussed.
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Affiliation(s)
- Sarah Williams
- Department of Psychology, Queen Margaret University, Edinburgh, UK.
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34
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Geller J, Cassin SE, Brown KE, Srikameswaran S. Factors associated with improvements in readiness for change: low vs. normal BMI eating disorders. Int J Eat Disord 2009; 42:40-6. [PMID: 18636540 DOI: 10.1002/eat.20574] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine factors associated with improvements in readiness for change as a function of body mass index (BMI) in individuals assessed for eating disorders treatment. METHOD Participants (n = 128) completed the Readiness and Motivation Interview (RMI) and measures of psychiatric and eating disorder symptoms, quality of life, and self-esteem at baseline and at 5-month follow-up. RESULTS Participants whose readiness for change showed improvements in psychiatric symptom severity, global self-esteem, and in the importance of friendships as a determinant of self-esteem. Only those with a normal baseline BMI (20 kg/m(2) or greater) improved in eating disorder symptoms and quality of life, and reported increased importance of personal development and decreased importance of shape and weight as determinants of self-esteem. CONCLUSION Correlates of readiness differed between low and normal BMI participants, suggesting that weight status may be an important variable to consider in preparing highly ambivalent individuals for treatment.
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Affiliation(s)
- Josie Geller
- Eating Disorders Program, St. Paul's Hospital, Vancouver, Canada.
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35
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Malson H, Clarke S, Finn M. I. `I Don't Think That's Normal': A Reflection on Accounts of Experiences of Treatment for Eating Disorders. FEMINISM & PSYCHOLOGY 2008. [DOI: 10.1177/0959353507083097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Helen Malson
- Centre for Appearance Research, School of Psychology,
Faculty of Applied Sciences, University of the West of England, Frenchay Campus,
Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Simon Clarke
- Department of Adolescent Medicine, Westmead Hospital,
Sydney, Australia,
| | - Mark Finn
- English Studies Communication & Philosophy, University of Cardiff, Cardiff, Wales, UK,
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36
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Dean HY, Touyz SW, Rieger E, Thornton CE. Group motivational enhancement therapy as an adjunct to inpatient treatment for eating disorders: a preliminary study. EUROPEAN EATING DISORDERS REVIEW 2008; 16:256-67. [DOI: 10.1002/erv.851] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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37
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McHugh MD. Readiness for change and short-term outcomes of female adolescents in residential treatment for anorexia nervosa. Int J Eat Disord 2007; 40:602-12. [PMID: 17610253 DOI: 10.1002/eat.20425] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine if readiness for change (RFC) at admission predicted length of stay (LOS) and short-term outcomes among female adolescents in residential treatment for anorexia nervosa (AN). METHOD Using a prospective cohort design to collect data from participants (N = 65) at admission and discharge, Kaplan-Meier survival analysis and Cox regression tested whether RFC on admission predicted time in LOS to a favorable short-term outcome--a composite endpoint based on minimum criteria for weight gain, drive for thinness, depression, anxiety, and health-related quality of life (HRQOL). RESULTS Participants with low RFC had a mean survival time to a favorable short-term outcome of 59.4 days compared to 34.1 days for those with high RFC (log rank = 8.44, df = 1, p = .003). The probability of a favorable short-term outcome was 5.30 times greater for participants with high RFC. CONCLUSION Readiness for change is a useful predictor of a favorable short-term outcome and should be considered in the assessment profile of patients with AN.
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Affiliation(s)
- Matthew D McHugh
- The Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
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38
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Lammers MW, Exterkate CC, De Jong CAJ. A Dutch day treatment program for anorexia and bulimia nervosa in comparison with internationally described programs. EUROPEAN EATING DISORDERS REVIEW 2007; 15:98-111. [PMID: 17676678 DOI: 10.1002/erv.767] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A Dutch day treatment program for patients with anorexia and bulimia nervosa is described and compared to intensive day treatment programs for patients with eating disorders outlined in international literature. The 5-day program is described in terms of its general characteristics, intended outcome and specific treatment interventions. Along these parameters it is compared to the programs found in a systematic literature search of day hospitalization programs for eating disorders. Global inspection shows a lot of similarities between all the programs. Looking more closely, also many important differences exist (concerning, e.g. treatment duration, intensity of treatment, theoretical orientation, goals of treatment and weight gain regime). Because of the differences, it is hard to compare outcome data between centres. Besides, on many of these dimensions, the literature does not yet tell us unambiguously what is best for our patients. Therefore, it is necessary to keep the dialogue between treatment centres going.
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Affiliation(s)
- M W Lammers
- Amarum, Specialist Centre for Eating Disorders, Zutphen, The Netherlands.
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39
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Martinez E, Castro J, Bigorra A, Morer A, Calvo R, Vila M, Toro J, Rieger E. Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire. EUROPEAN EATING DISORDERS REVIEW 2007; 15:13-23. [PMID: 17676668 DOI: 10.1002/erv.725] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess motivation to change in adolescent patients with bulimia nervosa through the Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), an instrument adapted from the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) already validated in anorexic patients. METHOD Subjects were 30 bulimia nervosa patients (mean age = 16.3 years) who were receiving treatment at an eating disorders unit. The evaluation instruments were: the BNSOCQ, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI). The BNSOCQ was re-administered 1 week later to evaluate test-retest reliability. RESULTS The BNSOCQ demonstrated good internal consistency (Cronbach's alpha = 0.94) and one week test-retest reliability (Pearson's r = 0.93). Negative significant correlations were found between the BNSOCQ and several EDI-2 scales (Pearson's r between -0.51 and -0.84) and the BDI (r = -0.74). CONCLUSION The study provides initial support for the reliability and validity of the BNSOCQ as a self-report instrument for assessing motivation to change in adolescents with bulimia nervosa.
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Affiliation(s)
- Esteve Martinez
- Department of Child and Adolescent Psychiatry and Psychology Hospital Clínic Universitari of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Spain
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40
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Castro-Fornieles J, Casulà V, Saura B, Martínez E, Lazaro L, Vila M, Plana MT, Toro J. Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa. Int J Eat Disord 2007; 40:129-35. [PMID: 17080450 DOI: 10.1002/eat.20340] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyze variables that predict weight maintenance in adolescent anorexia nervosa. METHOD The Eating Attitudes Test, the Beck Depression Inventory, the Leyton Obsessional Inventory, the State and Trait Anxiety Inventory, and the Anorexia Nervosa Stages of Change Questionnaire were administered to 49 anorexia nervosa patients (mean age 14.3 years, SD 1.7) consecutively admitted to an eating disorder unit. They were evaluated at admission, at discharge, and after nine months follow-up. RESULTS At discharge, patients had improved in body mass index (p < .001), eating attitudes (p = .002), depressive symptomatology (p = .001), and motivation to change (p < .001). Patients with good weight maintenance at follow-up had higher body mass index (p = .017) at admission, lower abnormal eating attitudes (p = .035), depressive symptomatology (p = .026), and higher motivation to change (p = .004) at discharge. Logistic regression analysis showed a high motivation to change at discharge and a high body mass index at admission to be predictors of weight maintenance. CONCLUSION High motivation to change, low abnormal eating attitudes, depressive symptomatology at discharge, and high body mass index at admission are associated with weight maintenance in adolescent anorexia nervosa.
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Affiliation(s)
- Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Institute Clinic of Neurosciences, Hospital Clínic Universitari of Barcelona, Barcelona, Spain.
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41
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Jones A, Bamford B, Ford H, Schreiber-Kounine C. How important are motivation and initial Body Mass Index for outcome in day therapy services for eating disorders? EUROPEAN EATING DISORDERS REVIEW 2007; 15:283-9. [PMID: 17676698 DOI: 10.1002/erv.736] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study was designed to investigate the impact of initial Body Mass Index (BMI) and motivation for recovery on a 12-week day therapy programme for Eating Disorders. Outcome was assessed by changes in eating disorder symptomology, mood and self-esteem. A battery of assessment questionnaires was given to 34 eating disorder clients on admission to and completion of the programme. This study found that BMI at admission did not affect treatment outcome directly. Only patient self-rated motivation directly affected treatment outcome with more highly motivated clients making more significant changes to their eating disorder symptomology across the programme. However, motivation, BMI and duration of illness influenced how likely a patient was to complete the 12 weeks and completion of the programme had a direct effect on eating disorder symptomology, mood and self-esteem. BMI and motivation can therefore be seen to indirectly effect the outcome of treatment via the ability to complete the programme.
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Affiliation(s)
- Alysun Jones
- STEPS Eating Disorders Unit, Avon & Wiltshire Mental Health Partnership NHS Trust Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.
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42
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Gale C, Holliday J, Troop NA, Serpell L, Treasure J. The pros and cons of change in individuals with eating disorders: a broader perspective. Int J Eat Disord 2006; 39:394-403. [PMID: 16528730 DOI: 10.1002/eat.20250] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The goals of the current study were to develop a questionnaire measuring the pros and cons of eating disorder symptoms and to explore the themes endorsed by different eating disorder groups. METHOD Participants recruited from an eating disorder volunteer register and an outpatient clinic completed the Pros and Cons of Eating Disorders scale (P-CED). Principal components analyses (PCA) were performed to validate the factorial structure of the original items and to explore the factorial structure of the new items. Planned comparisons were used to compare P-CED scores between diagnostic groups. RESULTS PCA indicated a 10-factor solution for the original Pros and Cons of Anorexia Nervosa scale (P-CAN) items and a 4-factor solution for the new items. Participants with anorexia nervosa (AN) scored significantly higher than participants with bulimia nervosa (BN) on five of the P-CED subscales but there were no significant differences between the two AN subtypes. CONCLUSION The P-CED is a useful tool for identifying the positive and negative aspects of eating disorders that can be targeted in treatment or used as an outcome measure in research.
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Affiliation(s)
- Corinne Gale
- Eating Disorders Unit, Department of Psychological Medicine, Institute of Psychiatry, London, United Kingdom
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43
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Brown KE, Geller J. Supporting friends and family members with eating disorders: discrepancies between intentions and reality. Eat Disord 2006; 14:215-28. [PMID: 16807215 DOI: 10.1080/10640260600638915] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined how female undergraduate students anticipated they would approach a friend or family member with disordered eating and what kinds of support they believed to be helpful. The relationship between eating disorder symptomatology and anticipated approaches also was examined. Participants read vignettes depicting scenarios involving a friend or family member with disordered eating and described their anticipated approach. They also rated the helpfulness of various support attempts, and completed the EDI-2. Although collaborative approaches were rated more favorably than controlling approaches, 76% of responses generated by participants fell into the latter category. Reasons for the discrepancy between support attempts offered and those that are believed to be most helpful and the implications of these findings to the treatment and prevention of eating disorders are addressed.
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Affiliation(s)
- Krista E Brown
- Eating Disorders Program, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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44
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Ryan V, Malson H, Clarke S, Anderson G, Kohn M. Discursive constructions of ‘eating disorders nursing’: an analysis of nurses' accounts of nursing eating disorder patients. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.666] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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45
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Rushford N. Fear of gaining weight: its validity as a visual analogue scale in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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46
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Dunn EC, Neighbors C, Larimer ME. Motivational enhancement therapy and self-help treatment for binge eaters. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2006; 20:44-52. [PMID: 16536664 DOI: 10.1037/0893-164x.20.1.44] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate whether a single session of motivational enhancement therapy (MET) would increase participant readiness to change, improve the efficacy of self-help treatment for binge eaters, and improve participant compliance with the self-help manual. METHOD Participants with bulimia nervosa or binge eating disorder were randomly assigned either to attend a 1-hr MET session prior to receiving the self-help manual (n = 45) or to receive the self-help manual only (n = 45). Participants were followed for 4 months for assessment of self-reported eating disorder outcome and compliance. RESULTS The MET intervention resulted in increased readiness to change for binge eating compared with the self-help-only (SH) condition. Few differences were found between the MET condition and the SH condition for changes in eating attitudes and frequency of binge eating and compensatory behaviors. No significant effects were found for compliance. DISCUSSION This research adds to the literature regarding the use of brief motivational interventions to enhance readiness for change in populations with eating disorders.
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Affiliation(s)
- Eric C Dunn
- Department of Psychology, University of Washington, WA, USA.
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47
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Ametller L, Castro J, Serrano E, Martínez E, Toro J. Readiness to recover in adolescent anorexia nervosa: prediction of hospital admission. J Child Psychol Psychiatry 2005; 46:394-400. [PMID: 15819648 DOI: 10.1111/j.1469-7610.2004.00360.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine if motivation to change in anorexia nervosa during treatment is a predictor of hospitalisation in adolescent patients. METHOD The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) were administered to a group of 70 anorexia nervosa patients (mean age 15.6 years). They were all receiving treatment at a specialised Eating Disorder Unit and were at different points in the treatment programme. Admission during 6-9 month follow-up was recorded in 63 of these patients who had been admitted to the Unit. The other 7 patients were contacted by phone to determine if they had been hospitalised in another unit during the follow-up period. RESULTS Patients who needed hospital admission during follow-up had higher mean scores at first evaluation on some of the EDI-2 scales and on the BDI, lower ANSOCQ scores and were more likely to have been outpatients at first evaluation. In the logistic regression analysis a low ANSOCQ score and being an outpatient at first evaluation were shown to be independent predictors of hospitalisation during follow-up. CONCLUSIONS Low motivation to change, depressive symptomatology and some EDI-2 scales are related to the necessity of hospital admission in adolescent patients with anorexia nervosa.
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Affiliation(s)
- L Ametller
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, IDIBAPS, Spain
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48
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Vansteenkiste M, Soenens B, Vandereycken W. Motivation to change in eating disorder patients: a conceptual clarification on the basis of self-determination theory. Int J Eat Disord 2005; 37:207-19. [PMID: 15822077 DOI: 10.1002/eat.20099] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study critically reviews the different motivational frameworks that are applied in the study of eating disorders and provides a more comprehensive conceptualization of motivation to change on the basis of self-determination theory. METHOD The most important conceptualizations of motivation to change among eating disorder patients are identified. RESULTS Eating disorder patients' motivation to change has been defined very differently, adding confusion to the field and preventing research from being cumulative. On the basis of self-determination theory we argue (a) that the quality of motivation to change is primarily reflected in the degree of internalization of change rather than by the intrinsic motivation to change; (b) that the internalization of change suggests more than only the change being initiated from within the person (internal motivation) for it requires an acceptance of the personal importance of change; and (c) that, in addition to its quality, the quantity of motivation to change should be considered too. DISCUSSION These three conceptual issues are applied to the study of motivational dynamics in eating-disordered patients.
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Holliday J, Wall E, Treasure J, Weinman J. Perceptions of illness in individuals with anorexia nervosa: a comparison with lay men and women. Int J Eat Disord 2005; 37:50-6. [PMID: 15690466 DOI: 10.1002/eat.20056] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The current study examined and compared perceptions of illness in individuals with anorexia nervosa (AN) and lay men and women. METHOD Participants with AN (n = 95) completed the Revised Illness Perception Questionnaire (IPQ-R). Lay participants (n = 80) completed a modified IPQ-R to elicit perceptions of AN. RESULTS Participants with AN viewed their illness as chronic and highly distressing, with strong negative consequences. They had fairly negative perceptions of illness controllability and curability, which contrasted with the more optimistic beliefs held by lay participants. Both groups implicated emotional and psychological causes. DISCUSSION The profile of illness perceptions expressed by the AN sample is associated with poor mental health and functioning and may inform the treatment approach. Lay perceptions of AN differed in the conceptualization of AN as a "slimming disease" amenable to change. This discrepancy may contribute to the stigmatization of AN.
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Affiliation(s)
- Joanna Holliday
- Eating Disorders Unit, Institute of Psychiatry, London, United Kingdom.
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Cockell SJ, Zaitsoff SL, Geller J. Maintaining change following eating disorder treatment. ACTA ACUST UNITED AC 2004. [DOI: 10.1037/0735-7028.35.5.527] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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