Assessing readiness to change binge eating and compensatory behaviors

Weight-control compensatory behaviors patterns and correlates: a scoping review

Objective

Weight-control compensatory behaviors appear to be a commonly utilized strategy for health management. Individuals engaging in such behaviors believe that the negative consequences from unhealthy behaviors will be neutralized by the positive consequences of healthy behaviors. Existing research has not reached a consensus on whether such behaviors are beneficial to health. This review aims to (1) summarize the patterns of weight-control compensatory health behaviors in different populations, (2) highlight correlates, predictors, and consequences of compensatory health behaviors, and (3) identify gaps for future research.

Method

This review identified existing literature using online databases, CINAHL and PubMed. Primary research articles published after 2000 with non-clinical participants of 12 years or older who engaged in compensatory behaviors for weight control purposes were selected. Descriptive statistics were extracted from 35 studies.

Results

Different patterns for weight-control compensatory behaviors emerged between the female and male sexes. Meanwhile, no clear association of such behaviors was found across weight status. Studies reviewed also highlighted three main areas of compensatory behaviors for weight management, namely dietary behaviors, physical activity, and alcohol consumption. Weight-control compensatory behaviors had significant negative correlations with mental health indicators, such as psychosocial functioning, emotional differentiation ability, and body esteem.

Conclusion

Weight-control compensatory behaviors may be a widely used weight management strategy and can be presented in diverse ways. Although believed to be promoting health, such behaviors appear to be associated with poor psychological well-being. This emerging topic warrants more in-depth investigation to establish the direction of causation. Future research may investigate the relationship between weight-control compensatory behaviors and various aspects of health over longer time periods, examine the engagement of multiple weight-control compensatory behaviors, and focus on high-risk populations.

Urica-VV Scale: A New Research Perspective of The Stage of Readiness for Treatment in Patients with Dysphonia

OBJECTIVE

To obtain evidence of validity for the URICA-V scale and estimate the psychometric properties of its items based on item response theory (IRT).

METHOD

A total of 658 individuals of both sexes over 18 years of age were allocated into two groups: with dysphonia group (WDG) and vocally healthy group (VHG). A digital database was constructed with personal and professional data and item-by-item responses on the URICA-V scale. Subsequently, Cronbach's alpha, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), application of IRT using Samejima's model and ROC curve analysis were used to obtain the cutoff point for the URICA-V scale.

RESULTS

A different version of the original URICA-V scale was obtained. Of the 32 items from the original protocol, 25 better explained the instrument and were regrouped into two domains: contemplation and maintenance. It was possible to identify which items generated higher difficulty (b) and discrimination (a) values and which contributed to the presentation of a calculation based on the theta of each participant. The ROC curve was analyzed, and a cutoff point of -0.236 was established; establishing a cutoff point facilitates the decision of which individuals are in a state of readiness for voice treatment.

CONCLUSION

The present study provided evidence that allows us to propose the URICA-Voice validated (URICA-VV) scale within a more contemporary perspective and with a reduced number of items and domains. In addition, a cutoff point was obtained based on IRT to measure, with greater accuracy, sensitivity and specificity, the stage of readiness and to differentiate individuals who have an indication for speech therapy.

Motivation to change predicts naturalistic changes in binge eating and purging, but not fasting or driven exercise among individuals with eating disorders

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.

Grit, Self-Efficacy, Motivation and the Readiness to Change Index Toward Exercise in the Adult Population

This study examined the relationships between grit personality, self-efficacy, motivation (autonomous, controlled, and amotivation), and the readiness to change index toward exercise. Participants were 391 adults aged between 18 and 64 years old (M = 31.16; SD = 12.45) from Hermosillo, Sonora (Mexico) who completed questionnaires (i.e., the Grit Personality Scale, the Exercise Self-Efficacy Questionnaire, the Treatment Self-Regulation Questionnaire and the Stages of Change Questionnaire for Physical Activity) measuring the variables of interest. The reliability of the instruments was tested using Cronbach's alpha, whereas confirmatory factor analyses were performed for each instrument separately. A measurement model and a structural equation model were assessed as well. The results of the structural equations model showed that grit personality was positively associated with self-efficacy, and in turn, with autonomous motivation and with the readiness to change index. On the other hand, self-efficacy was negatively correlated with controlled motivation, and positively correlated with the readiness to change index. Finally, self-efficacy also showed a negative correlation with amotivation, which, in turn, was negatively correlated with the readiness to change index. These results provide information to develop psychological intervention programs based on grit personality and motivation, with the aim of increasing the number of participants who engage in exercise.

Coping with childhood maltreatment: Avoidance and eating disorder symptoms

Childhood maltreatment is associated with eating disorder symptoms; however, the nature of this association is unclear. We found those who experienced childhood maltreatment had higher avoidant coping and eating disorder symptoms. We also found an additive effect for maltreatment, such that with more types of maltreatment experienced, avoidant coping and eating disorder symptoms were greater. We also found evidence of an indirect effect such that childhood maltreatment was related to eating disorder symptoms through avoidant coping. Future research is needed to better understand factors that may promote development of adaptive coping patterns and prevention of eating disorder symptoms.

Readiness for weight change and its association with diet knowledge and skills, diet decision making and diet and exercise barriers in patients with type 2 diabetes

AIMS

this study aimed to investigate stages of weight change in type 2 diabetics and its associations with diet knowledge and skills, diet decision making, diet and exercise barriers.

MATERIALS AND METHODS

This was a cross-sectional study of 1139 patients with type 2 diabetes aged>18 years in East Azerbaijan, Iran. Data were collected using the Personal Diabetes Questionnaire (PDQ) and were analyzed using SPSS software (version 22) and descriptive statistics, Chi-square and one-way ANOVA tests.

RESULTS

48.1% of the patients were in the pre-contemplation stage. 7.5%, 14.6% and 29.8% of patients were in the stages of contemplation, preparation and action, respectively. Patients with a higher score in diet knowledge and skills and diet decision making were more likely to be involved in the action stage of weight loss process, while those who had more eating problems and exercise barriers were less likely to be involved in the action stage of weight loss.

CONCLUSION

The results of this study showed that a substantial percentage of patients are at the pre-contemplation stage, so proper measures are needed to inform patients about the consequences of obesity and overweight. It is also necessary to focus on people with poor incomes and education status and those living in rural areas. Improve diet knowledge and skills and diet decision making and the reduction of barriers to exercise can help patients to take action to lose weight.

Stages of change in obesity and weight management: factorial structure of the Italian version of the University of Rhode Island Change Assessment Scale

PURPOSE

To examine the factorial structure of the University of Rhode Island Change Assessment Scale (IT-URICA) for weight management in a sample of Italian overweight and obese patients enrolled in a nutritional rehabilitation program.

METHODS

334 inpatients completed the translated and adjusted version of the IT-URICA at admission to the hospital. Psychometric testing included confirmatory factor analysis and internal consistency (Cronbach's α).

RESULTS

The IT-URICA for weight management was successfully translated into Italian, and the factorial analysis confirmed the four-factor solution of the commonly accepted version of the measure.

CONCLUSION

High levels of RTC are considered critical to the long-term success of weight management, and the IT-URICA may be an appropriate measure of motivational readiness for use among Italian overweight and obese patients. Its use is, therefore, recommended for clinical and research purposes.

Does cognitive avoidance mediate the relation of anxiety and binge eating?

PURPOSE

Theory suggests that binge eating symptoms may develop in an attempt to avoid distressing states that arise in the context of negative affect. In light of its theoretical significance, including the "escape from awareness" model of binge eating, surprisingly few empirical evaluations have examined the empirical evidence for this variable in relation to anxiety and binge eating symptoms. In addition, although it is understood that anxiety is more prevalent among women than men, empirical investigations of gender differences in cognitive avoidance in binge eating are thus far absent from the published literature.

METHODS

Participants (N = 436) were recruited from diverse geographic regions across the United States to take part in an online study. Cognitive avoidance, anxiety, and binge eating measures were collected.

RESULTS

Cognitive avoidance partially mediated the relation between anxiety and binge eating in the full sample; however, results differed across genders. Specifically, cognitive avoidance was a mediator for women, but not for men.

CONCLUSIONS

Findings support the "escape from awareness" model of binge eating among women, and suggest that targeting cognitive avoidance in binge eating treatment may be a promising clinical avenue. Future research may benefit from exploring the broader construct of experiential avoidance to determine if the gender differences in cognitive avoidance observed in this study are indicative of a larger pattern of avoidance behavior, and if factors other than cognitive avoidance may have greater relevance for men.

The relation of anxiety, depression, and stress to binge eating behavior

This study aimed to extend the literature by examining several psychological factors (i.e. depression, anxiety, and stress) in relation to binge eating. Data were collected via online surveys from a community sample of men and women of diverse backgrounds. The main study hypotheses were supported, indicating a unique relation between anxiety and binge eating, and between stress and binge eating, independent of the impact of depression. Gender differences are discussed. The results of this study suggest a need for a more detailed examination of negative affect in binge eating. Furthermore, the role of anxiety may be important for future research.

Assessing Readiness to Lose Weight among Obese Women Attending the Nutrition Clinic

BACKGROUND

Assessing individual's readiness to change and targeting the inter-vention to the level of readiness may improve successful weight loss rates. This study aimed to assess readiness for weight loss in obese women using the trans theoretical model.

METHODS

A cross-sectional study was conducted on 90 volunteer apparently healthy obese women, in Ardabil, Iran. Participants completed the translated and validated University of Rhode Island Change Assessment questionnaire in their first visit. Subjects were categorized into one of the stages of change based on the highest of four z-transformed scale scores. The readiness to change score was calculated.

RESULTS

More than half of the participants were in early stages of weight loss and 24.5% were in the action stage. The readiness score in the precontemplation stage was significantly lower than the other stages, but no significant difference was observed among the contemplation, action and maintenance stages. The significant correlation was observed between the stages of change and waist-to-hip ratio (r=0.33, P<0.05).

CONCLUSION

Obese women attending the nutrition clinic are in different stages to change for weight loss. Understanding person specific stages of change ori-entates the dietitian to use the most appropriate counseling strategies. Hence the stages and readiness to change should be considered before implementing any intervention in clinical settings for optimal outcomes.

Stage of change and motivation to healthy diet and habitual physical activity in type 2 diabetes

Lifestyle changes to healthy diet (HD) and habitual physical activity (HPA) are recommended in type 2 diabetes mellitus (T2DM). Yet, for most people with diabetes, it may be difficult to start changing. We investigated the stage of change toward healthier lifestyles according to Prochaska's model, and the associated psychological factors in T2DM patients, as a prerequisite to improve strategies to implement behavior changes in the population. A total of 1,353 consecutive outpatients with T2DM attending 14 tertiary centers for diabetes treatment completed the validated EMME-3 questionnaire, consisting of two parallel sets of instruments to define the stage of change for HD and HPA, respectively. Logistic regression was used to determine the factors associated with stages that may hinder behavioral changes. A stage of change favoring progress to healthier behaviors was more common in the area of HD than in HPA, with higher scores in action and maintenance. Differences were observed in relation to gender, age and duration of disease. After adjustment for confounders, resistance to change toward HD was associated with higher body mass index (BMI) (odds ratio (OR) 1.05; 95 % confidence interval (CI) 1.02-1.08). Resistance to improve HPA also increased with BMI (OR 1.06; 95 % CI 1.03-1.10) and decreased with education level (OR 0.74; 95 % CI 0.64-0.92). Changing lifestyle, particularly in the area of HPA, is not perceived as an essential part of treatment by many subjects with T2DM. This evidence must be considered when planning behavioral programs, and specific interventions are needed to promote adherence to HPA.

An Internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial

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.

Internet-based motivation program for women with eating disorders: eating disorder pathology and depressive mood predict dropout

BACKGROUND

One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology.

OBJECTIVE

The aim of the present study was to identify predictors of dropout from this Web program.

METHODS

A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants' age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method.

RESULTS

The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout.

CONCLUSIONS

Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.

Assessing motivation to change in eating disorders: a systematic review

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.

Stage of change and motivation to healthier lifestyle in non-alcoholic fatty liver disease

BACKGROUNDS & AIMS

Healthy diet and physical activity are the treatment cornerstones of non-alcoholic fatty liver disease (NAFLD); their effectiveness is however limited by difficulties in implementing lifestyle changes. We aimed at determining the stage of change and associated psychological factors as a prerequisite to refine strategies to implement behavior changes.

METHODS

We studied 138 consecutive NAFLD patients (73% male, age 19-73 years). The diagnosis was confirmed by liver biopsy in 64 cases (steatohepatitis, 47%). All cases completed the validated EMME-3 questionnaire, consisting of two parallel sets of instruments (for diet and physical activity, respectively) and providing stages of change according to transtheoretical model. Logistic regression analysis was used to identify factors associated with stages making behavioral changes more demanding.

RESULTS

The individual profiles were variable; for diet, no cases had precontemplation as prevalent stage of change (highest score in individual profiles); 36% had contemplation. For physical activity, 50% were classified in either precontemplation or contemplation. Minor differences were recorded in relation to associated metabolic complications or steatohepatitis. Logistic regression identified male sex (odds ratio, 4.51; 95% confidence interval, 1.69-12.08) and age (1.70; 1.20-2.43 per decade) as the independent parameters predicting precontemplation or contemplation for diet. No predictors were identified for physical activity.

CONCLUSIONS

NAFLD cases have scarce readiness to lifestyle changes, particularly with regard to physical activity. Defining stages of change and motivation offers the opportunity to improve clinical care of NAFLD people through individual programs exploiting the powerful potential of behavioral counseling, an issue to be tested in longitudinal studies.

Motivação para mudança: análise fatorial da URICA para hábitos alimentares

O presente estudo objetivou realizar a adaptação da URICA para avaliação da motivação para a mudança de hábitos alimentares e posterior redução da versão de 32 para a de 24 itens, mediante análise fatorial exploratória e de índices de fidedignidade. Trata-se de um estudo de cunho instrumental, realizado com 175 participantes de programas de redução de peso do sul do Brasil. A análise fatorial apontou uma solução de 4 fatores, referentes aos 4 estágios de motivação para a mudança e apresentou um alpha de Cronbach total de 0,842, que variou de 0,813 a 0,940 entre os 4 domínios.

Influence of religiosity on 12-step participation and treatment response among substance-dependent adolescents

OBJECTIVE

Religious practices among adults are associated with more 12-step participation which, in turn, is linked to better treatment outcomes. Despite recommendations for adolescents to participate in mutual-help groups, little is known about how religious practices influence youth 12-step engagement and outcomes. This study examined the relationships among lifetime religiosity, during-treatment 12-step participation, and outcomes among adolescents, and tested whether any observed beneficial relation between higher religiosity and outcome could be explained by increased 12-step participation.

METHOD

Adolescents (n = 195; 52% female, ages 14-18) court-referred to a 2-month residential treatment were assessed at intake and discharge. Lifetime religiosity was assessed with the Religious Background and Behaviors Questionnaire; 12-step assessments measured meeting attendance, step work (General Alcoholics Anonymous Tools of Recovery), and Alcoholics Anonymous (AA)/Narcotics Anonymous (NA)-related helping. Substance-related outcomes and psychosocial outcomes were assessed with toxicology screens, the Adolescent-Obsessive Compulsive Drinking Scale, the Children's Global Assessment Scale, and the Narcissistic Personality Inventory.

RESULTS

Greater lifetime formal religious practices at intake were associated with increased step work and AA/NA-related helping during treatment, which in turn were linked to improved substance outcomes, global functioning, and reduced narcissistic entitlement. Increased step work mediated the effect of religious practices on increased abstinence, whereas AA/NA-related helping mediated the effect of religiosity on reduced craving and entitlement.

CONCLUSIONS

Findings extend the evidence for the protective effects of lifetime religious behaviors to an improved treatment response among adolescents and provide preliminary support for the 12-step proposition that helping others in recovery may lead to better outcomes. Youth with low or no lifetime religious practices may assimilate less well into 12-step-oriented treatment and may need additional 12-step facilitation, or a different approach, to enhance treatment response.

The efficacy of a brief motivational intervention for individuals with eating disorders: a randomized control trial

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.

Identifikation von erfolgsrelevanten Veränderungen im Prozess einer Körperbildtherapie

Zusammenfassung. Theoretischer Hintergrund: Mehrere Studien belegen gute Ergebnisse für Interventionen zur Verbesserung des Körperbildes bei Patientinnen mit Essstörungen; jedoch fehlen Prozessanalysen der relevanten Wirkfaktoren. Fragestellung: Erfolgsrelevante Veränderungen von Klärungs- und Bewältigungserfahrungen sowie symptomspezifische Intrasession-Veränderungen werden im Verlauf einer standardisierten Körperbildtherapie untersucht. Methode: 54 Patientinnen mit Essstörungen füllten vor und nach jeder Gruppensitzung die Body Image States Scale zur Erfassung der State-Körperunzufriedenheit und am Sitzungsende den Stundenbeurteilungsbogen mit den Wirkfaktoren „Einsicht/Klärung” und „Problembewältigung” aus. Ergebnisse: Bei gleichen Eingangswerten zeigten sich erfolgsabhängige Verläufe für die Körperunzufriedenheit nach Sitzungsende und die erlebte Problembewältigung. Sowohl Klärungs- als auch Problembewältigungsprozesse sind mit der Intrasession-Verbesserung der Körperunzufriedenheit assoziiert. Schlussfolgerungen: Während beide Erfolgsgruppen profitieren, bedarf der differenziell günstigere Verlauf der erfolgreicheren Patienten weiterer und erweiterter Forschung.

Cue exposure in the treatment of resistant adolescent bulimia nervosa

OBJECTIVE

A percentage of bulimic patients do not greatly improve with the usual treatment. Therefore, the objective was to further evaluate cue exposure (CE), in order to attain better results in clinical settings.

METHOD

Twenty-two adolescent patients who fulfilled DSM-IV diagnostic criteria for bulimia nervosa (mean age 16.7, SD 1.5) and who were resistant to the usual treatment followed a program of 12 CE sessions. Clinical characteristics were evaluated and different psychopathological scales were administered at the beginning and the end of the CE program and at 6 month follow-up. Subjective anxiety and physiological parameters were recorded during the sessions.

RESULTS

A significant decrease was observed in subjective anxiety (p = .023), heart rate (p < .001), and blood pressure (p = .001) during the first session. A decrease in these parameters was also recorded between the first and the last session. The number of binges per week (p = .005) and the mean score for the psychopathological scales decreased significantly from the beginning of the treatment, and were significantly lower at the end of the CE program and at follow-up. Purging behaviors per week only decreased significantly after the end of the CE session during the follow-up (p = .04).

CONCLUSION

Anxiety, binging, purging, and psychopathological scales improve with a CE program in resistant bulimia nervosa.

Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire

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.

Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect?

The current study evaluated whether difficulties regulating emotions explained unique variance in binge eating and examined which types of emotion regulation difficulties are most strongly associated with binge eating. The Eating Disorders Diagnostic Scale and the Difficulties in Emotion Regulation Scale were completed by 695 undergraduates. Hierarchical regression results indicated that difficulties regulating emotions accounted for a significant amount of the variance in binge eating over and above sex, food restriction, and over-evaluation of weight and shape. Results also indicated that greater difficulty identifying and making sense of emotional states, and limited access to emotion regulation strategies were primarily responsible for the link between emotion regulation difficulties and binge eating. This supports a model of binge eating that includes emotional vulnerability and a deficit of skills to functionally modulate negative moods.

University of Rhode Island Change Assessment-Trauma: preliminary psychometric properties in an alcohol-dependent PTSD sample

The co-occurrence of posttraumatic stress disorder with substance use disorders (PTSD-SUD) is common and is associated with poorer treatment outcomes. Attrition represents an ongoing, but poorly understood challenge in PTSD-SUD treatment research. The current study examined the initial psychometric properties of the University of Rhode Island Change Assessment-Trauma (URICA-T), a scale designed to assess attitudes and behaviors related to addressing trauma issues, in a sample of 42 individuals meeting diagnostic criteria for PTSD and alcohol dependence. Results suggest that the URICA-T may have acceptable psychometric properties as a continuous measure of motivational readiness in a PTSD-SUD sample. Preliminary data also suggests higher URICA-T scores are associated with retention of alcohol dependent-PTSD participants in a study utilizing trauma-focused exposure.

Assessing and achieving readiness to initiate HIV medication

OBJECTIVE

To summarise published HIV-specific research on readiness theories, factors influencing readiness, instruments to measure readiness and interventions to increase readiness for treatment.

METHODS

Medline and PsychInfo were searched until August 2004.

RESULTS

Two HIV-specific readiness theories were identified. Fear of side effects, emotions emerging from the diagnosis and lack of trust in the physician were some barriers to overcome in order to reach readiness. Of the three measurement instruments found, the index of readiness showed the most promise. Multi-step intervention programs to increase readiness for HIV treatment had been investigated.

CONCLUSION

Readiness instruments may be useful tools in clinical practice but the predictive validity of the instruments needs to be further established in the HIV-infected population.

PRACTICE IMPLICATIONS

Readiness instruments and practice placebo trials may serve as complements to routine care, since health care providers currently have no better than chance probability in identifying those patients who are ready to adhere.

Motivational enhancement therapy and self-help treatment for binge eaters

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.

Communicating effectively with patients suspected of having bulimia nervosa

BACKGROUND

The dental team often is confronted with the clinical appearance of erosion affecting the hard and soft oral tissues. An investigative process often is needed to determine the cause of such erosion, because factors other than eating disorders may be involved. The authors present a protocol that should be considered in the assessment of dental erosion. Guidelines provide direction for the clinician toward opening a dialogue with a patient when the suspected cause of erosion is an eating disorder.

TYPES OF STUDIES REVIEWED

The authors review publications related to the causes of dental erosion and the patterns that are involved with both chemical and mechanical destruction of oral tissues. They also discuss the oral-tissue effects related to eating disorders. The authors stress the importance of assisting parents in obtaining adequate treatment for pediatric patients.

RESULTS

Cases of eating disorders among female college students, athletes, preadolescent children and men are well-documented. However, dental staff members often do not feel comfortable beginning a dialogue with patients who are suspected of having an eating disorder. This article focuses on the proper protocol for approaching such patients and beginning a dialogue. In addition, the authors provide suggestions for limiting further erosive damage to the tissues. They also discuss other causes of erosion that should be considered when assessing any type of oral erosion.

CLINICAL IMPLICATIONS

The dental team is in a prime position to assist patients who have eating disorders. Timely treatment by mental health and other medical professionals is crucial. The authors suggest a dialogue for approaching these patients and offer educational material to reduce further tissue destruction.

Motivation to change in eating disorder patients: a conceptual clarification on the basis of self-determination theory

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.

The development of the P-CAN, a measure to operationalize the pros and cons of anorexia nervosa

OBJECTIVE

Research has suggested that a fundamental aspect of anorexia nervosa (AN) is its egosyntonic nature, the fact that it is often valued by individuals with the disorder. The current study describes the development of the P-CAN, a quantitative measure of both positive (valued) and negative aspects of AN.

METHOD

Items were derived from a previous qualitative study (Serpell, Treasure, Teasdale, & Sullivan. 1999. International Journal of Eating Disorders, 25, 177-186). Data from 233 women with AN were subjected to a principal components analysis.

RESULTS

Ten subscales were identified, six describing the pros of AN and four describing the cons of the illness.

DISCUSSION

The P-CAN shows good psychometric properties and should prove a useful tool for the measurement of attitudes towards AN, as well as offer insights into the maintenance of the disorder.

The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders

The transtheoretical stages of change model suffers from conceptual and empirical limitations, including problems of stage definition, measurement, and discreteness. Sequential transition across stages has not been established. The model lacks strong predictive utility, and there is little evidence that therapeutic interventions must be matched to stage to facilitate change. Initial tests applying the model to weight and eating disorders have been negative. Although the model is frequently associated with motivational interviewing (MI), no theory links the two. MI should be evaluated independently as a treatment for weight and eating disorders, to be used either alone or prior to treatments not explicitly addressing motivation. The conceptual compatibility and procedural overlap between cognitive behavioral therapy (CBT) and MI are analyzed.