1
|
Robinson L, Flynn M, Cooper M. Individual differences in motivation to change in individuals with eating disorders: A systematic review. Int J Eat Disord 2024; 57:1069-1087. [PMID: 38436481 DOI: 10.1002/eat.24178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Motivation to change has been suggested to significantly impact treatment outcomes in eating disorders (EDs). This review will investigate factors associated with motivation to change in EDs with the aim of supporting clinicians to be aware and sensitive to factors that might obstruct recovery and to inform motivation-based interventions. METHOD Using PRISMA guidelines, this article identified 24 studies through database searches meeting eligibility criteria. Only correlates of motivation were identified, limiting the ability of this review to identify causal relationships. Factors that changed alongside changes in motivation were identified from longitudinal studies. RESULTS This review identified factors such as individual characteristics, co-morbid psychopathology, lack of treatment autonomy and relationships with others to be associated with motivation to change in individuals with EDs. In addition, motivation to change significantly increased alongside self-esteem and identity re-negotiation when measured longitudinally. DISCUSSION Motivational interviewing can typically focus on exploring ambivalence to treatment, identifying goals and values, and increasing self-efficacy. However, this review identifies individual and relational factors to be particularly significant and may obstruct recovery from an ED. As such, evidence-based targets have been identified to inform clinicians and motivation-based interventions. PUBLIC SIGNIFICANCE Knowledge of factors associated with motivation to change in EDs is important to understand those who may have poorer treatment outcomes. Motivation may be improved by supporting individuals' relationship with others and tailoring interventions according to temperament and personality traits. Utilizing an individual's social support as they enter ED treatment may be effective in maximizing motivation to recover.
Collapse
Affiliation(s)
- Lauren Robinson
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| |
Collapse
|
2
|
Heider KS, Dempfle A, Altdorf S, Herpertz-Dahlmann B, Dahmen B. Motivation to Change in the Course of a Pilot Study of a Step-Down Treatment Approach of Inpatient and Anorexia Nervosa-Specific Home Treatment and Its Effects on Treatment Outcome. Front Psychiatry 2021; 12:693103. [PMID: 34690825 PMCID: PMC8529001 DOI: 10.3389/fpsyt.2021.693103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/23/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction: Anorexia nervosa (AN) is a serious mental disorder that typically manifests in adolescence. Motivation to change is an important predictor for treatment outcome in adolescent AN, even though its development over the often long therapeutic process, with transitions between treatment settings, has not yet been studied. In this pilot study, the course of motivation to change and its effect on treatment outcome were investigated over the course of a step-down treatment approach during a 12-month observation period. Methods: Twenty-one adolescents admitted to inpatient treatment because of AN received multidisciplinary home treatment (HoT) with several weekly visits after short inpatient stabilization. Eating disorder (ED-)specific cognitive [Eating Disorder Inventory 2 (EDI-2) subscales] and physical [% expected body weight (%EBW)] illness severity and motivation to change [Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ)] were assessed at the time of admission, discharge from hospital, at the end of HoT, and at a 12-month follow-up. Changes in motivation over time and its relationship with treatment outcome were investigated. Results: Mean motivation to change improved significantly over the course of treatment from the contemplation stage [2nd stage, mean ANSOCQ sum score 47.26 (SD 17.60)] at admission to the action stage [4th stage, mean ANSOCQ sum score 77.64 (SD 18.97)] at the end of HoT (p < 0.001) and remained stable during the follow-up period. At each assessment, higher motivation to change was significantly correlated with lower ED-specific cognitive illness severity (Spearman ρs: -0.53 to -0.77, all p < 0.05). Only pretreatment motivation to change significantly predicted ED-specific cognitive illness severity after the first inpatient treatment phase when taking prior illness severity into account. Conclusions: Motivation to change is an important aspect of treatment success in adolescent AN, especially in the early phase of treatment. In addition, home treatment contributed significantly to a higher motivation. Further longitudinal research into how motivation to change in adolescent patients with AN is related to outcome in this often severe and enduring disease and into targeted therapeutic strategies and interventions that reliably enhance the motivation to change in adolescent patients with AN seems promising.
Collapse
Affiliation(s)
- Kathrin Sophie Heider
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sophie Altdorf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Haynos AF, Lavender JM, Nelson J, Crow SJ, Peterson CB. Moving towards specificity: A systematic review of cue features associated with reward and punishment in anorexia nervosa. Clin Psychol Rev 2020; 79:101872. [PMID: 32521390 DOI: 10.1016/j.cpr.2020.101872] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/16/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.
Collapse
Affiliation(s)
- Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America.
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; The Metis Foundation, San Antonio, TX, United States of America
| | - Jillian Nelson
- Department of Psychology, George Mason University, Fairfax, VA, United States of America
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Riesco N, Agüera Z, Granero R, Jiménez-Murcia S, Menchón JM, Fernández-Aranda F. Other Specified Feeding or Eating Disorders (OSFED): Clinical heterogeneity and cognitive-behavioral therapy outcome. Eur Psychiatry 2018; 54:109-116. [PMID: 30193141 DOI: 10.1016/j.eurpsy.2018.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND with the DSM-5 new eating disorders (EDs) diagnostic subtypes were identified within the Other Specified Feeding or Eating Disorders (OSFED) category, which have so far been under-researched. Objectives of this study were to examine differential features among OSFED subtypes, exploring short-term cognitive-behavioral therapy (CBT) response and identifying clinical predictors of therapy outcome. METHODS the sample included 176 female patients diagnosed with OSFED [82 atypical anorexia nervosa (atypical-AN), 57 purging disorder (PD), and 37 subthreshold bulimia nervosa (sub-BN)]. Assessment included eating-related, psychopathological and personality measures. RESULTS results showed similar clinical and personality profiles between the diagnostic subtypes, with hardly any differences, only observable in the core symptoms of each diagnosis. The sub-BN group was the one which showed more social impairment. Regarding treatment outcome, the three groups did not reveal significant differences in remission rates, therapeutic adherence or dropout rates, reaching rates of dropout from 36.8% to 50% (p = .391). However, different ED subtype predictors appear related with full remission or dropout risk, specifically personality traits. CONCLUSIONS our results suggest that OSFED patients may benefit similarly from the same CBT outpatient group approach. However, high dropout rates and low motivation seems to be an important limitation and challenge for future approaches.
Collapse
Affiliation(s)
- Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.
| | - Roser Granero
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Reas DL, Rø Ø. Less symptomatic, but equally impaired: Clinical impairment in restricting versus binge-eating/purging subtype of anorexia nervosa. Eat Behav 2018; 28:32-37. [PMID: 29310054 DOI: 10.1016/j.eatbeh.2017.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/18/2017] [Accepted: 12/28/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study investigated subtype differences in eating disorder-specific impairment in a treatment-seeking sample of individuals with anorexia nervosa (AN). METHOD The Clinical Impairment Assessment (CIA) and the Eating Disorder Examination-Questionnaire (EDE-Q) were administered to 142 patients. Of these, 54.9% were classified as restricting type (AN-R) and 45.1% were classified as binge-eating/purging type (AN-B/P) based on an average weekly occurrence of binge eating and/or purging episodes (≥4 episodes/28days). RESULTS Individuals with AN-B/P exhibited higher levels of core ED psychopathology (dietary restraint, eating concern, shape/weight concerns) in addition to the expected higher frequency of binge/purge episodes. No significant differences existed between AN subtypes in the severity of ED-related impairment. Weight/shape concerns and binge eating frequency significantly predicted level of impairment. Differential associations were observed between the type of ED pathology that significantly contributed to impairment according to AN subtype. DISCUSSION Although those with AN-B/P displayed higher levels of core attitudinal and behavioral ED pathology than AN-R, no significant differences in ED-specific impairment were found between AN subtypes. Eating disorder-related impairment in AN was not related to the severity of underweight or purging behaviors, but was uniquely and positively associated with weight/shape concerns and binge eating frequency.
Collapse
Affiliation(s)
- Deborah Lynn Reas
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway.
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| |
Collapse
|
9
|
Haynos AF, Berg KC, Cao L, Crosby RD, Lavender JM, Utzinger LM, Wonderlich SA, Engel SG, Mitchell JE, Le Grange D, Peterson CB, Crow SJ. Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 126:495-505. [PMID: 27893231 DOI: 10.1037/abn0000202] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite robust support for the role of affect in the maintenance of binge eating and purging, the relationship between affect and restrictive eating remains poorly understood. To investigate the relationship between restrictive eating and affect, ecological momentary assessment data from 118 women with anorexia nervosa (AN) were used to examine trajectories of higher-order dimensions of negative affect (NA) and positive affect (PA), as well as lower-order dimensions of NA (Fear, Guilt) and PA (Joviality, Self-Assurance) relative to restrictive eating. Affect trajectories were modeled before and after restrictive eating episodes and AN subtype was examined as a moderator of these trajectories. Across the sample, Guilt significantly increased before and decreased after restrictive eating episodes. Global NA, Global PA, Fear, Joviality, and Self-Assurance did not vary relative to restrictive eating episodes across the sample. However, significant subtype by trajectory interactions were detected for PA indices. Among individuals with AN restricting subtype, Global PA, Joviality, and Self-Assurance decreased prior to and Self-Assurance increased following restrictive eating episodes. In contrast, Global PA and Self-Assurance increased prior to, but did not change following, restrictive eating episodes among individuals with AN binge eating/purging subtype. Results suggest that dietary restriction may function to mitigate guilt across AN subtypes and to enhance self-assurance among individuals with AN restricting subtype. (PsycINFO Database Record
Collapse
Affiliation(s)
- Ann F Haynos
- Department of Psychiatry, University of Minnesota Medical Center
| | - Kelly C Berg
- Department of Psychiatry, University of Minnesota Medical Center
| | - Li Cao
- Neuropsychiatric Research Institute
| | | | | | - Linsey M Utzinger
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | | | | | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical Center
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota Medical Center
| |
Collapse
|
10
|
Shingleton RM, Pratt EM, Gorman B, Barlow DH, Palfai TP, Thompson-Brenner H. Motivational Text Message Intervention for Eating Disorders: A Single-Case Alternating Treatment Design Using Ecological Momentary Assessment. Behav Ther 2016; 47:325-38. [PMID: 27157027 DOI: 10.1016/j.beth.2016.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/08/2016] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study tested a motivational text message treatment adjunct for individuals with eating disorders (EDs) who exhibited high dietary restraint/restriction. METHOD A replicated single-case alternating treatment design was used to examine (a) the feasibility of combining a brief motivational interview with subsequent text messages and (b) the influence of the text messages on eating behaviors and motivation to change in individuals with EDs (N=12). The protocol was 8weeks and the text messages were adjunctive to cognitive-behavioral therapy. RESULTS The intervention was well accepted (mean rating=7/10) and feasible within the context of monetary compensation (mean daily monitoring compliance =91%). Text messages did not impact behavioral outcomes: dietary restraint and kilocalorie intake. They had mixed effects on motivation to change dietary restraint, measured by the Readiness and Motivation Questionnaire (RMQ). When receiving text messages, RMQ precontemplation scores (desire to restrict) significantly increased, indicating decreased motivation; however, action scores (effort toward reducing dietary restraint) significantly increased, indicating increased motivation. These effects were moderated by weight status. Underweight individuals (n=4; body mass index [BMI]<19.0) reported increased ambivalence-that is, an increased desire to restrict and increased action toward reducing restriction-in response to the text messages. Normal weight participants (n=8; BMI>19.0) reported only increased action toward reducing restriction in response to the text messages. DISCUSSION These data demonstrate text messages are a potentially feasible and acceptable treatment adjunct and may be effective at increasing motivation to change for normal weight individuals, while their influence on underweight patients is more complex. These findings provide a foundation for future research in technology-based motivational interventions for EDs and offer preliminary evidence for using these methods among normal weight individuals.
Collapse
Affiliation(s)
| | | | - Bernard Gorman
- Derner Institute of Advanced Psychological Studies, Adelphi University
| | | | | | | |
Collapse
|
11
|
Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry 2015; 2:1099-111. [PMID: 26514083 DOI: 10.1016/s2215-0366(15)00356-9] [Citation(s) in RCA: 422] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 02/07/2023]
Abstract
Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that contributes to illness onset and maintenance. Genetic factors influence risk, psychosocial and interpersonal factors can trigger onset, and changes in neural networks can sustain the illness. Substantial advances in treatment, particularly for adolescent patients with anorexia nervosa, point to the benefits of specialised family-based interventions. Adults with anorexia nervosa too have a realistic chance of achieving recovery or at least substantial improvement, but no specific approach has shown clear superiority, suggesting a combination of re-nourishment and anorexia nervosa-specific psychotherapy is most effective. To successfully fight this enigmatic illness, we have to enhance understanding of the underlying biological and psychosocial mechanisms, improve strategies for prevention and early intervention, and better target our treatments through improved understanding of specific disease mechanisms.
Collapse
Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany.
| | - Katrin E Giel
- Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany; Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Cynthia M Bulik
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Phillipa Hay
- School of Medicine and Centre for Health Research Western Sydney University, Penrith, NSW, Australia
| | | |
Collapse
|