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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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Whelan J, Love P, Millar L, Allender S, Morley C, Bell C. A rural community moves closer to sustainable obesity prevention - an exploration of community readiness pre and post a community-based participatory intervention. BMC Public Health 2019; 19:1420. [PMID: 31666042 PMCID: PMC6820900 DOI: 10.1186/s12889-019-7644-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background Understanding levels of community readiness can result in prevention efforts that align with communities’ ability and capacity for change and, therefore, be more effective and sustainable. Our study aimed to use baseline (pre-intervention) community readiness scores to assist with the development of obesity prevention strategies, and to assess changes in community readiness over time (pre/post- intervention), to provide evidence of intervention impact. Method Our study was located in a rural and remote area of Victoria, Australia. Community readiness was part of a broader obesity prevention intervention designed to create healthier food and physical activity environments through the combination of systems thinking and collaborative community-led solutions. Interviews were conducted using the community readiness to change tool in 2016 (pre) and 2018 (post) with a community representative sample. Baseline data informed the development of community relevant strategies and the pre/post results formed part of the overall evaluation. Results The tool generated both quantitative and qualitative (quotes) data. A final readiness score was calculated that corresponded to one of the nine stages of readiness. Four of the five domains of the community readiness to change tool showed statistically significant improvements over time (p < 0.05): knowledge of effort, knowledge of issue, community climate, and leadership. The resources domain that did not improve pre/post intervention. Conclusion Community readiness to change interviews, pre- and post- intervention, provided essential information related to the appropriate targeting and pitch of the prevention strategies, as well as providing an overall evaluation of the positive movement in the community’s readiness to implement change.
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Affiliation(s)
- Jillian Whelan
- Institute for Health Transformation, Global Obesity Centre, School of Health and Social Development, Deakin University, Geelong, Australia.
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lynne Millar
- Adjunct Fellow, Victoria University, Melbourne, Australia
| | - Steven Allender
- Institute for Health Transformation, Global Obesity Centre, School of Health and Social Development, Deakin University, Geelong, Australia
| | | | - Colin Bell
- Institute for Health Transformation, Global Obesity Centre, School of Health and Social Development, Deakin University, Geelong, Australia
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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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Sansfaçon J, Steiger H, Gauvin L, Fletcher É, Israël M. Does level of motivation for change impact post-treatment outcomes in the eating disorders? Protocol for a systematic review with quantitative analysis. J Eat Disord 2017; 5:17. [PMID: 28465827 PMCID: PMC5408493 DOI: 10.1186/s40337-017-0147-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating Disorders are highly prevalent and widespread mental health problems, with marked risk of chronicity and refractoriness to treatment. Affected individuals are hesitant to change their behaviours and therefore struggle to maintain motivation for therapy. This review aims to produce the first high-quality meta-analysis of the literature on the impact of level of motivation for change on post-treatment outcomes in anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorder (OSFED). METHODS A systematic review will be conducted using Cochrane library, Embase, MEDLINE, and PsychINFO. Research registrars and bibliographies of included articles will be screened, and experts will be contacted. The search strategy consists of terms related to eating disorders, motivation, and outcome. Randomized controlled trials, clinical controlled trials, time series, and before-after studies will be included. Participants will be adolescents and adults who are diagnosed with anorexia nervosa, bulimia nervosa, binge-eating disorder or OSFED and who are entering psychotherapy treatment. The predictor studied is defined as motivation for change at the beginning of treatment. The primary outcome will be an overall change in eating-disorder symptomatology at the end of treatment and at less than, and over 6-month follow-up. Other outcomes of interest include change in restricting, binging, and compensatory behaviours, change in shape, weight and eating concerns, change in psychiatric comorbidities, weight restoration, and dropout rates. Articles will be selected, data will be extracted, and the risk of bias will be assessed by independent reviewers using forms pre-created on Eppi-Reviewer 4 software. Results will be combined using a random-effects model. Studies of all sizes and qualities will be included in the analyses. Heterogeneity will be examined by funnel plot, Cochran's Q, and I2 statistic. Sensitivity analyses will be performed to account for clinical and methodological differences across studies. DISCUSSION This systematic review will help determine the predictive value of motivation for change on treatment outcomes in eating disorders. TRIAL REGISTRATION Our systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016035285). All modifications will be available on the PROSPERO website, along with the dates, a description, and a justification.
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Affiliation(s)
- Jeanne Sansfaçon
- Douglas Mental Health University Institute, Montréal, Québec Canada.,Psychiatry Department, McGill University, Montréal, Québec Canada
| | - Howard Steiger
- Douglas Mental Health University Institute, Montréal, Québec Canada.,Psychiatry Department, McGill University, Montréal, Québec Canada.,Psychology Department, McGill University, Montréal, Québec Canada
| | - Lise Gauvin
- CHUM Research Centre, Montréal, Québec Canada.,Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec Canada
| | - Émilie Fletcher
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Mimi Israël
- Douglas Mental Health University Institute, Montréal, Québec Canada.,Psychiatry Department, McGill University, Montréal, Québec Canada
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Ackard DM, Cronemeyer CL, Richter S, Egan A. Do symptom-specific stages of change predict eating disorder treatment outcome? Eat Weight Disord 2015; 20:49-62. [PMID: 25249403 DOI: 10.1007/s40519-014-0153-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Interview methods to assess stages of change (SOC) in eating disorders (ED) indicate that SOC are positively correlated with symptom improvement over time. However, interviews require significant time and staff training and global measures of SOC do not capture varying levels of motivation across ED symptoms. This study used a self-report, ED symptom-specific SOC measure to determine prevalence of stages across symptoms and identify if SOC predict treatment outcome. METHODS Participants [N = 182; age 13-58 years; 92% Caucasian; 96% female; average BMI 21.7 (SD = 5.9); 50% ED not otherwise specified (EDNOS), 30.8% bulimia nervosa (BN), 19.2% anorexia nervosa (AN)] seeking ED treatment at a diverse-milieu multi-disciplinary facility in the United States completed stages of change, behavioral (ED symptom use and frequency) and psychological (ED concerns, anxiety, depression) measures at intake assessment and at 3, 6 and 12 months thereafter. Descriptive summaries were generated using ANOVA or Kruskal-Wallis (continuous) and χ (2) (categorical) tests. Repeated measures linear regression models with autoregressive correlation structure predicted treatment outcome. RESULTS At intake assessment, 53.3% of AN, 34.0% of BN and 18.1% of EDNOS patients were in Preparation/Action. Readiness to change specific symptoms was highest for binge-eating (57.8%) and vomiting (56.5%). Frequency of fasting and restricting behaviors, and scores on all eating disorder and psychological measures improved over time regardless of SOC at intake assessment. Symptom-specific SOC did not predict reductions in ED symptom frequency. Overall SOC predicted neither improvement in Eating Disorder Examination Questionnaire (EDE-Q) scores nor reduction in depression or trait anxiety; however, higher overall SOC predicted lower state anxiety across follow-up. CONCLUSIONS Readiness to change ED behaviors varies considerably. Most patients reduced eating disorder behaviors and increased psychological functioning regardless of stages of change, indicating the benefits of treatment and effectiveness of treatment-as-usual for overall psychiatric improvement.
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Affiliation(s)
- Diann M Ackard
- , 5101 Olson Memorial Highway, Suite 4001, Golden Valley, MN, 55422, USA,
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Hötzel K, von Brachel R, Schmidt U, Rieger E, Kosfelder J, Hechler T, Schulte D, Vocks S. An Internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial. Psychol Med 2014; 44:1947-1963. [PMID: 24128818 DOI: 10.1017/s0033291713002481] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Previous research has demonstrated an association between low motivation to change and an unfavorable treatment outcome in patients with an eating disorder. Consequently, various studies have examined the effects of motivational enhancement therapy (MET) on motivation to change and treatment outcome in eating disorders. In each of these studies, MET was administered in a face-to-face setting. However, because of its anonymity and ease of access, the internet provides several advantages as the format for such an intervention. Therefore, the current study investigated the effects of an internet-based program ('ESS-KIMO') to enhance motivation to change in eating disorders. METHOD In total, 212 females were accepted for participation and assigned randomly to the intervention condition (n = 103) or waiting-list control condition (n = 109). The intervention consisted of six online MET sessions. Before and after the intervention or waiting period respectively, participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED), the Pros and Cons of Eating Disorders Scale (P-CED), the Self-Efficacy Scale (SES), and the Rosenberg Self-Esteem Scale (RSES). A total of 125 participants completed the assessment post-treatment. Completer analyses and intent-to-treat analyses were performed. RESULTS Significant time × group interactions were found, indicating a stronger increase in motivational aspects and self-esteem, in addition to a stronger symptom reduction on some measures from pre- to post-treatment in the intervention group compared to the control group. CONCLUSIONS Internet-based approaches can be considered as useful for enhancing motivation to change in eating disorders and for yielding initial symptomatic improvement.
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Affiliation(s)
- K Hötzel
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
| | - R von Brachel
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
| | - U Schmidt
- Section of Eating Disorders, Institute of Psychiatry,King's College London,UK
| | - E Rieger
- Research School of Psychology,Australian National University,Australia
| | - J Kosfelder
- Department of Social Sciences and Cultural Studies,University of Applied Sciences Düsseldorf,Germany
| | - T Hechler
- German Pediatric Pain Center, Children's and Adolescents' Hospital,Witten/Herdecke University,Datteln,Germany
| | - D Schulte
- Department of Psychology, Clinical Psychology and Psychotherapy,Ruhr-University Bochum,Germany
| | - S Vocks
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
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Hoetzel K, von Brachel R, Schlossmacher L, Vocks S. Assessing motivation to change in eating disorders: a systematic review. J Eat Disord 2013; 1:38. [PMID: 24999416 PMCID: PMC4081820 DOI: 10.1186/2050-2974-1-38] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with anorexia and bulimia nervosa are often ambivalent about their eating disorder symptoms. Therefore, a lack of motivation to change is a frequent problem in the treatment of eating disorders. This is of high relevance, as a low motivation to change is a predictor of an unfavourable treatment outcome and high treatment dropout rates. In order to quantify the degree of motivation to change, valid and reliable instruments are required in research and practice. The transtheoretical model of behaviour change (TTM) offers a framework for these measurements. OBJECTIVE This paper reviews existing instruments assessing motivation to change in eating disorders. METHOD We screened N = 119 studies from the databases Medline and Psycinfo found by combinations of the search keywords 'eating disorder', 'anorexia nervosa', 'bulimia nervosa', 'motivation', 'readiness to change', 'assessment', 'measurement', and 'questionnaire'. RESULTS Ultimately, n = 15 studies investigating psychometric properties of different assessment tools of motivation to change in eating disorders were identified. Reviewed instruments can be divided into those assessing the stages of change according to the TTM (6 instruments) and those capturing decisional balance (3 instruments). Overall, the psychometric properties of these instruments are satisfactory to good. DISCUSSION Advantages, disadvantages, and limitations of the reviewed assessment tools are discussed. So far, the TTM provides the only framework to assess motivation to change in eating disorders.
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Affiliation(s)
- Katrin Hoetzel
- Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany
- Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Ruth von Brachel
- Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany
- Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Lena Schlossmacher
- Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Silja Vocks
- Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany
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Castro-Fornieles J, Bigorra A, Martinez-Mallen E, Gonzalez L, Moreno E, Font E, Toro J. Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment. EUROPEAN EATING DISORDERS REVIEW 2010; 19:46-54. [DOI: 10.1002/erv.1045] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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