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Panea-Pizarro I, Moran JM, Lavado-García J, Beato-Fernández L, Domínguez-Martin AT, Huerta-González S, Novo A, Pedrera-Zamorano JD, López-Espuela F. Health-Related Quality of Life in Spanish Women with Eating Disorders. Nutrients 2021; 13:nu13020403. [PMID: 33513985 PMCID: PMC7912180 DOI: 10.3390/nu13020403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/12/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
People with eating disorders show impaired health-related quality of life (HRQoL). We aimed to investigate the relative role of physical and mental factors and stage of change as possible predictors of HRQoL in a group of Spanish women (n = 124) with eating disorders. For this purpose, initial and follow-up data were obtained after 6 months from patients attending an outpatient treatment unit for eating disorders. The determinants of the physical and mental domains of the Medical Outcomes Survey Short-form Health Survey (SF-36) questionnaire were investigated in the total sample and separately based on the eating disorder diagnosis by multiple linear regression. Lower scores in the physical component of the SF-36 questionnaire were associated with the presence of a higher body mass index (BMI) at follow-up as well as a higher score in the "action" component of the Attitudes towards Change in Eating Disorders Questionnaire (ACTA). Conversely, a higher index in the EuroQoL-5D overall quality of life questionnaire (EQ-5D) and the presence of obsessive compulsive disorder were associated with a higher score in the physical dimension. The instrument used demonstrated the ability to assess changes associated with the physical component of these patients over the period studied, and the analysis provided more information and specific data on different aspects of HRQoL, thus allowing a more detailed analysis of the information.
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Affiliation(s)
- Isabel Panea-Pizarro
- Mental Health Department, Hospital General Universitario, 13001 Ciudad Real, Spain; (I.P.-P.); (L.B.-F.)
| | - José M. Moran
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avd. Universidad s/n, 10003 Cáceres, Spain; (J.M.M.); (J.D.P.-Z.); (F.L.-E.)
| | - Jesús Lavado-García
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avd. Universidad s/n, 10003 Cáceres, Spain; (J.M.M.); (J.D.P.-Z.); (F.L.-E.)
- Correspondence: ; Tel.: +34-927257450
| | - Luis Beato-Fernández
- Mental Health Department, Hospital General Universitario, 13001 Ciudad Real, Spain; (I.P.-P.); (L.B.-F.)
| | | | - Sara Huerta-González
- Nursing College, Universidad Veracruzana, Región Poza Rica, Tuxpan 92870, Mexico;
| | - Andre Novo
- Nursing Department, Instituto Politecnico de Bragança, 5300-252 Bragança, Portugal;
| | - Juan D. Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avd. Universidad s/n, 10003 Cáceres, Spain; (J.M.M.); (J.D.P.-Z.); (F.L.-E.)
| | - Fidel López-Espuela
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avd. Universidad s/n, 10003 Cáceres, Spain; (J.M.M.); (J.D.P.-Z.); (F.L.-E.)
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Sansfaçon J, Booij L, Gauvin L, Fletcher É, Islam F, Israël M, Steiger H. Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2020; 53:1879-1900. [PMID: 32954512 DOI: 10.1002/eat.23376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Identifying modifiable predictors of outcomes following treatment for eating disorders may help to tailor interventions to patients' individual needs, improve treatment efficacy, and develop new interventions. The goal of this meta-analysis was to quantify the association between pretreatment motivation and posttreatment changes in eating disorder symptomology. METHOD We reviewed 196 longitudinal studies reporting on change on indices of overall eating-disorder symptomatology, weight gain, binge-eating, vomiting, anxiety/depression, and treatment adherence. Meta-analyses were performed using two complementary approaches: (a) combined probability analysis using the added Z's method; (b) effect size analyses. Using random-effect models, effect sizes were pooled when there were at least three studies with the same type of statistical design and reporting statistics on the same outcome. Heterogeneity in study outcome was evaluated using Q and I2 statistics. Studies were reviewed qualitatively when the number of studies or reported data were insufficient to perform a meta-analysis. RESULTS Forty-two articles were included. Although samples and treatments differed substantially across studies, results across studies were remarkably consistent. Both combined-probability and effect-size analyses indicated positive effects of pretreatment motivation on improvement in general eating-disorder symptoms (Cohen's r = .17), and an absence of effects on anxiety/depression symptoms. Remaining outcome indices were subject to selective reporting and/or small sample size bias. DISCUSSION Our findings underscore the importance of incorporating treatment engagement approaches in the treatment of eating disorders. Optimal reporting of study findings and improving study quality would improve future efforts to obtain an in-depth understanding of the relationship between motivation and eating disorder symptoms.
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Affiliation(s)
- Jeanne Sansfaçon
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Linda Booij
- Department of Psychology, Concordia University, Montreal, Quebec, Canada.,Centre de Recherche de l'Hôpital Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Lise Gauvin
- Centre de Recherche du Centre Hospitalier, Université de Montréal, Montreal, Quebec, Canada.,Department of Social & Preventive Medicine, École de santé publique, Université de Montréal, Montreal, Quebec, Canada
| | - Émilie Fletcher
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Farah Islam
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mimi Israël
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Woodruff K, Clark L, Joy E, Summers SA, Metos JM, Clark N, Jordan KC. An Interpretive Description of Women's Experience in Coordinated, Multidisciplinary Treatment for an Eating Disorder. Glob Qual Nurs Res 2020; 7:2333393620913271. [PMID: 32426422 PMCID: PMC7218325 DOI: 10.1177/2333393620913271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
Coordinated, multidisciplinary treatment for women with eating disorders is consistently recommended as maximally effective, but few studies have considered the patient experience. This qualitative study examined the experiences of women receiving such care in an outpatient setting. Using an interpretive description methodology, we conducted 12 in-depth interviews with participants who were diagnosed with an eating disorder and were receiving team-based treatment. Patients uniformly advocated for the coordinated, multidisciplinary treatment approach. Analysis of participants’ experiences yielded four categories: relying on the lifeline of communication, supporting autonomy, drawing on individual strengths, and valuing synergy. These findings build on previous research emphasizing the importance of autonomy support and connectedness in the recovery process from an eating disorder. Findings highlight the importance of nurses to support a multidisciplinary care approach to working with this patient population; these women’s voices also support a treatment approach that, despite being widely recommended, is vastly understudied and underutilized.
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Affiliation(s)
| | - Lauren Clark
- University of California, Los Angeles, Los Angeles, California, USA
| | | | | | | | - Nica Clark
- Southern Utah University, Cedar City, Utah, USA
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4
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Characteristics of patients in an eating disorder sample who dropped out: 2-year follow-up. Eat Weight Disord 2019; 24:767-775. [PMID: 28717972 DOI: 10.1007/s40519-017-0416-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/04/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This manuscript explores the characteristics of individuals diagnosed with an eating disorder who dropped out of treatment, compared with those who completed it. METHOD The participants were 196 patients diagnosed with eating disorders (according to DSM-IV-TR criteria) who consecutively began treatment for the first time in an eating disorders unit. They were assessed at baseline with a set of questionnaires evaluating eating habits, temperament, and general psychopathology. During the follow-up period, patients who dropped out were re-assessed via a telephone interview. RESULTS In the course of a 2-year follow-up, a total of 80 (40.8%) patients were labeled as dropouts, and 116 (59.2%) remaining subjects were considered completers. High TCI scores in the character dimensions of Disorderliness (NS4) (p < .01) and total Novelty Seeking (NST), along with low scores in Dependency (RD4), were significantly associated with dropout in the course of 2 years. Once the results were submitted to logistic regression analysis, dropout only remained associated with high scores in Disorderliness (NS4) and, inversely, with an initial Anorexia Nervosa (AN) diagnosis (p < .05). Reasons for dropout stated by the patients included logistic difficulties, subjective improvement of their condition, and lack of motivation. DISCUSSION Clinicians should handle the first therapeutic intervention with particular care in order to enhance their understanding of clients and their ability to rapidly identify those who are at risk of dropping out of treatment. LEVEL OF EVIDENCE Level III: Cohort Study.
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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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Steiger H, Sansfaçon J, Thaler L, Leonard N, Cottier D, Kahan E, Fletcher E, Rossi E, Israel M, Gauvin L. Autonomy support and autonomous motivation in the outpatient treatment of adults with an eating disorder. Int J Eat Disord 2017; 50:1058-1066. [PMID: 28842966 DOI: 10.1002/eat.22734] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/18/2017] [Accepted: 05/08/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Across diverse clinical problems, therapists' autonomy support has been found to increase patients' autonomous motivation for change. Being self-motivated has, in turn, been linked to superior treatment response. In people undergoing outpatient eating disorder (ED) treatment, we examined associations among ratings of autonomy support received from therapists and other carers, self-reported engagement in therapy, and clinical outcomes. METHOD Ninety-seven women with anorexia nervosa, bulimia nervosa, or a related ED provided measures of motivational status and clinical symptoms at the beginning and end of time-limited (12-16 weeks) segments of specialized treatment. At mid-treatment, patients also rated the extent to which they perceived their individual therapists, group therapists, group-therapy peers, family members, friends, and romantic partners as being autonomy supportive. RESULTS Overall, multiple regression analyses indicated autonomy support to moderate (rather than mediate) the link between initial autonomous motivation and later change in autonomous motivation-with results indicating that, independently of ED diagnosis or treatment intensity, greater perceived autonomy support (from therapists and nontherapists alike) coincided with larger increases in autonomous motivation over the course of therapy. In turn, higher autonomous motivation at end-of-therapy coincided with larger reductions in eating symptoms. DISCUSSION Findings suggest that the experience of autonomy support (from therapists and nontherapists) is associated with increasing motivation in people undergoing ED treatment, and that becoming self-motivated is linked to better outcomes. Such results indicate that support from therapists, relatives, and peers can favorably influence personal engagement in individuals undergoing ED treatment.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Jeanne Sansfaçon
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Niamh Leonard
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Danaëlle Cottier
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Emilie Fletcher
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Erika Rossi
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Lise Gauvin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Verdun, Quebec, Canada
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Pauli D, Aebi M, Winkler Metzke C, Steinhausen HC. Motivation to change, coping, and self-esteem in adolescent anorexia nervosa: a validation study of the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). J Eat Disord 2017; 5:11. [PMID: 28417002 PMCID: PMC5392907 DOI: 10.1186/s40337-016-0125-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding motivation to change is a key issue in both the assessment and the treatment of eating disorders. Therefore, sound instruments assessing this construct are of great help to clinicians. Accordingly, the present study analysed the psychometric properties of the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), including its relation to coping style and self-esteem. METHODS N = 92 adolescents referred to an eating disorders outpatient clinic meeting criteria for anorexia nervosa gave written informed consent to participate in this study and completed the ANSOCQ, the Eating Disorder Inventory, the Eating Attitudes Test, the Body Image Questionnaire, two questionnaires measuring Self-Related Cognitions and the Coping Across Situations Questionnaire. After a treatment period of nine months, clinical anorexia nervosa diagnosis and the body mass index were re-assessed. In addition to exploratory factor analysis, correlational analysis was used to test for the convergent validity of the ANSOCQ and logistic regression analysis was used to test its predictive validity. RESULTS The ANSOCQ had good psychometric properties. Factor analysis yielded two meaningful factors labelled as 'weight gain and control' and 'attitudes and feelings'. Internal consistencies of the two factors amounted to Cronbach's alpha = .87 and .76, respectively. Significant correlations with other scales measuring eating disorder psychopathology were indicative of meaningful construct validity. Higher motivation to change was related to higher self-esteem and a more active coping style. Higher (positive) ANSOCQ total scores predicted remission of anorexia nervosa after nine months of treatment. A higher score on 'attitudes and feelings' was a protective factor against drop-out from intervention. CONCLUSIONS The ANSOCQ is a clinically useful instrument for measuring motivation to change in adolescents with AN. Two factorial dimensions explain most of the variation. Self-esteem and coping style are relevant additional constructs for the understanding of the motivation to change in anorexia nervosa. TRIAL REGISTRATION NCT02828956. Retrospectively registered July 2016.
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Affiliation(s)
- Dagmar Pauli
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, Neumünsterallee 3, 8032 Zurich, Switzerland
| | - Marcel Aebi
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, Neumünsterallee 3, 8032 Zurich, Switzerland.,Child and Youth Forensic Psychiatry, Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Clinical Psychology for Children/Adolescents and Couples/Families, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Christa Winkler Metzke
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, Neumünsterallee 3, 8032 Zurich, Switzerland
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, Neumünsterallee 3, 8032 Zurich, Switzerland.,Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland.,Centre for Child and Adolescent Mental Health, Capital Region Psychiatry, Copenhagen, Denmark
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Merrill BM, Warren JS, Garcia DJ, Hardy SA. Youth motivation as a predictor of treatment outcomes in a community mental health system. Psychother Res 2015; 27:215-226. [PMID: 26429772 DOI: 10.1080/10503307.2015.1090037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between youth motivation and psychotherapy outcomes in routine community mental health settings. METHOD One hundred fifty youth, ages 12-17, from three community mental health clinics completed the Youth Outcome Questionnaire and Treatment Support Measure at frequent intervals over the course of treatment. RESULTS Increases in motivation followed a curvilinear trajectory. On average, youth motivation significantly increased over the course of therapy according to both self- and parent reports (p < .001). The slope for youth motivation over the course of therapy was negatively associated with the slope for mental health symptoms (p < .001). Initial youth motivation did not predict overall change or the rate of change in symptoms. However, there was significant individual variability in patterns of youth motivation. CONCLUSIONS Our findings demonstrate that youth show increases in motivation over the course of therapy with most gains occurring in the first few sessions. Because increases in motivation over the course of therapy were related to decreases in mental health symptoms, further research is needed to examine how treatment interventions or other factors such as parent motivation may moderate this relationship. Additional research examining the likely complex relationship between initial youth motivation and treatment outcomes in community mental health settings is needed.
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Affiliation(s)
- Brett M Merrill
- a Department of Psychology, Brigham Young University , Provo , UT , USA
| | - Jared S Warren
- a Department of Psychology, Brigham Young University , Provo , UT , USA
| | - Darren J Garcia
- b Department of Psychology , University of Tennessee , Knoxville , TN , USA
| | - Sam A Hardy
- a Department of Psychology, Brigham Young University , Provo , UT , USA
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Clausen L, Lübeck M, Jones A. Motivation to change in the eating disorders: a systematic review. Int J Eat Disord 2013; 46:755-63. [PMID: 23847134 DOI: 10.1002/eat.22156] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 05/24/2013] [Accepted: 05/28/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the study was to review the eating disorder literature in order to examine the effect of pretreatment autonomous/level of motivation to change on treatment outcome as measured by change in eating disorder pathology. METHOD Relevant databases were systematically searched for studies in which motivation to change prior to treatment was examined in relation to treatment outcome. RESULTS Pretreatment autonomous/level of motivation were associated with change in restrictive eating behaviors, bingeing behaviors, and cognitive/affective measures of eating disorder pathology. There was mixed support for the effect of motivation to change on global measures of eating disorder symptoms and virtually no support for the effect of motivation to change on purging behavior. DISCUSSION The level of pretreatment motivation the person exhibits prior to commencement of treatment appears to be helpful in predicting treatment outcome.
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Affiliation(s)
- Loa Clausen
- Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
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10
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Dray J, Wade TD. Is the transtheoretical model and motivational interviewing approach applicable to the treatment of eating disorders? A review. Clin Psychol Rev 2012; 32:558-65. [DOI: 10.1016/j.cpr.2012.06.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 06/12/2012] [Accepted: 06/25/2012] [Indexed: 11/24/2022]
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Rodríguez-Cano T, Beato-Fernandez L, Moreno LR, Vaz Leal FJ. Influence of attitudes towards change and self-directness on dropout in eating disorders: a 2-year follow-up study. EUROPEAN EATING DISORDERS REVIEW 2012; 20:e123-8. [PMID: 22302485 DOI: 10.1002/erv.2157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 12/08/2011] [Accepted: 12/21/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examined dropout-related factors at the Outpatient Eating Disorders Treatment Programme. METHOD One hundred ninety-six eating disorders patients following DSM-IV diagnostic criteria that consecutively commenced treatment were recruited and followed up for a 2-year period. A total of 151 patients completed the whole assessment with a set of questionnaires evaluating eating and general psychopathology. The Attitudes towards Change in Eating Disorders questionnaire was used, and personality was evaluated using the Temperament and Character Inventory. During the follow-up period, patients were re-assessed. Two years later, 102 patients continued on treatment. RESULTS Scores on Precontemplation at the beginning were predictors for dropout at 2-year follow-up. Character variables, as Responsibility, Integrity and Self-acceptance were protective factors to be at Precontemplation stage. DISCUSSION The clinician's challenge is to help eating disorders patients to develop an unyielding sense of responsibility and self-acceptance, aimed to integrate the therapeutic choice into their own intrapersonal frame of goals.
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Abstract
Eating disorders are serious psychiatric illnesses that often present during adolescence and young adulthood. They are associated with medical as well as psychological disturbances, and pediatricians play an important role in their identification, diagnosis, and management. There has been a paucity of treatment research that specifically focuses on children and adolescents with eating disorders. This article reviews the scientific evidence for the use of psychotropic medication in the treatment of children and adolescents with eating disorders.
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Affiliation(s)
- Neville H Golden
- Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
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13
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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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14
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Zaitsoff SL, Taylor A. Factors related to motivation for change in adolescents with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2009; 17:227-33. [PMID: 19308946 DOI: 10.1002/erv.915] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the association between motivation for change and eating disorder symptom severity, the quality of the parent-adolescent relationship and depressive symptom severity in adolescents with eating disorders. METHOD Fifty-four female adolescents with eating disorders (mean age = 15.8 years, SD = 1.6) participated in this research prior to beginning outpatient treatment. Participants completed the Motivational Stages of Change for Adolescents Recovering from an Eating Disorder, the Eating Disorders Inventory-2, the Relations with Parents scale from the Behavioral Assessment System for Children and Adolescents Self-report and the Child Depression Inventory. RESULTS Greater motivation for change was associated with less body dissatisfaction, more adaptive parent-adolescent relationships and fewer depressive symptoms. The association between motivation for change and adolescents' perception of their relationship with their parents remained significant even after controlling for age, body dissatisfaction and depressive symptoms. CONCLUSION Involvement of families in treatment for adolescents with eating disorders may serve to enhance their motivation to recover.
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15
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Casasnovas C, Fernández-Aranda F, Granero R, Krug I, Jiménez-Murcia S, Bulik CM, Vallejo-Ruiloba J. Motivation to change in eating disorders: clinical and therapeutic implications. EUROPEAN EATING DISORDERS REVIEW 2007; 15:449-56. [PMID: 17960774 DOI: 10.1002/erv.780] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study was to understand the clinical impact of the motivational stage of change on the psychopathology and symptomatology of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). METHOD The participants were 218 eating disorder (ED) patients (58 AN, 95 BN and 65 EDNOS), consecutively admitted to our hospital. All patients fulfilled DSM-IV criteria for these disorders. ASSESSMENT Assessment measures included the Eating Disorders Inventory (EDI), Bulimic Investigation Test Edinburgh (BITE), Beck Depression Inventory (BDI), four analogue scales of motivational stage, as well as a number of other clinical and psychopathological indices. RESULTS Our results indicated higher motivation for change in BN than in AN and EDNOS patients (p < 0.05). For all groups, motivation to change was predicted by chronological age (p < 0.05). However, a longer duration of illness was only predictive of the motivational levels in EDNOS (p < 0.05) patients. CONCLUSIONS Compared to BN, AN and EDNOS patients are most resistant to change and the younger these patients are, the less likely they are to be motivated to change their disturbed eating behaviour.
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Affiliation(s)
- C Casasnovas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
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