Engagement and outcome in the treatment of Bulimia Nervosa: First phase of a sequential design comparing motivation enhancement therapy and cognitive behavioral therapy

Eating Disorders Unit, Maudsley Hospital, Denmark Hill, London, United Kingdom.
Behaviour Research and Therapy (Impact Factor: 3.85). 06/1999; 37(5):405-18. DOI: 10.1016/S0005-7967(98)00149-1
Source: PubMed

ABSTRACT Despite the major advances in the development of treatments for bulimia nervosa, drop-outs and a lack of engagement in treatment, continue to be problems. Recent studies suggest that the transtheoretical model of change may be applicable to bulimia nervosa. The aim of this study was to examine the roles of readiness to change and therapeutic alliance in determining engagement and outcome in the first phase of treatment. One hundred and twenty five consecutive female patients meeting DSM-IV criteria for bulimia nervosa took part in a randomised controlled treatment trial. The first phase of the sequential treatment compared four sessions of either cognitive behavioural therapy (CBT) or motivational enhancement therapy (MET) in engaging patients in treatment and reducing symptoms. Patients in the action stage showed greater improvement in symptoms of binge eating than did patients in the contemplation stage. Higher pretreatment scores on action were also related to the development of a better therapeutic alliance (as perceived by patients) after four weeks. However, pretreatment stage of change did not predict who dropped out of treatment. There were no differences between MET and CBT in terms of reducing bulimic symptoms or in terms of developing a therapeutic alliance or increasing readiness to change. The results suggest that the transtheoretical model of change may have some validity in the treatment of bulimia nervosa although current measures of readiness to change may require modification. Overall, readiness to change is more strongly related to improvement and the development of a therapeutic alliance than the specific type of treatment.

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Available from: Janet L Treasure, Aug 30, 2015
    • "Readiness and motivation for change among individuals with EDs has been shown to be predictive for treatment outcome (Gusella, Butler, Nichols, & Bird, 2003b; McHugh, 2007; Treasure et al., 1999). It has also been shown that ED treatment, such as partial hospitalization (Bustin, Lane- Loney, Hollenbeak, & Ornstein, 2013), Cognitive Behavioral Therapy (CBT) (Treasure et al., 1999), and group therapy (Gusella et al., 2003b) can increase readiness and motivation for change. In a review investigating adaptions of motivational interviewing (AMI), Knowles, Anokhina, and Serpell (2013) found mixed results regarding the efficacy of AMIs in improving motivation in eating disorders. "
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    ABSTRACT: Readiness and motivation for change were examined in 32 women with broadly defined eating disorders who took part in a 10-week Cognitive Behavioral Therapy (CBT)-based group intervention. Readiness for change and eating disorder psychopathology were assessed before and after the intervention. The results revealed significant negative associations between degree of eating disorder symptoms and degree of readiness for change before the intervention started. In particular, higher levels of eating concern, shape concern, and body dissatisfaction were associated with lower motivation for change. No significant associations between degree of readiness for change before the intervention started and changes in eating disorder symptoms at the end of intervention were found. Readiness for change increased from the beginning to the end of the intervention, indicating that group CBT may be a cost-effective and time-efficient way of enhancing readiness and motivation for change in individuals with eating psychopathology.
    Eating Disorders 02/2015; 23(3):1-11. DOI:10.1080/10640266.2014.1000100
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    • "On the one hand, the eating disorder is perceived as a burden, but on the other hand, it also provides reasons to hold on to it [2]. Consequently, patients with eating disorders often display a low motivation to change [3-5]. This low motivation to change is often viewed as the cause for the high dropout rates or lack of engagement which are major problems in the treatment of anorexia and bulimia nervosa [6,7]. "
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    ABSTRACT: 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. This paper reviews existing instruments assessing motivation to change in eating disorders. 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’. 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. 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.
    International Journal of Eating Disorders 10/2013; 1(1):38. DOI:10.1186/2050-2974-1-38 · 3.03 Impact Factor
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    • "Similar findings were demonstrated in an adolescent population treated in an intensive hospital-based treatment program [11]. Other research has shown than individuals with BN who are more motivated to change at baseline experience a greater reduction in binge eating during therapy than do those who are initially less motivated to change [12,13], and that motivation to change has been shown to be a predictor of relapse in individuals with BN [14,15]. In sum, there is strong evidence that readiness for change impacts the course of treatment for an eating disorder. "
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    ABSTRACT: Background Engaging patients with an eating disorder in change is difficult and intensive treatment programs have high drop-out rates. The purpose of the study was to determine whether Motivational Interviewing (MI) in the form of a brief, pre-treatment intervention would be associated with higher completion rates in subsequent intensive treatment for an eating disorder. Thirty-two participants diagnosed with an eating disorder participated in the study. All participants were on the waitlist for admission to an intensive, hospital-based treatment program. Sixteen participants were randomly assigned to four individual sessions of MI that began prior to entrance into the treatment program (MI condition) and 16 participants were assigned to treatment as usual (control condition). The main outcome was completion of the intensive treatment program. Participants also completed self-report measures of motivation to change. Results Participants in the MI condition were significantly more likely to complete intensive treatment (69% completion rate) than were those in the control condition (31%). Conclusions MI can be a useful intervention to engage individuals with severe eating disorders prior to participation in intensive treatment. MI as a brief prelude to hospital-based treatment for an eating disorder may help to improve completion rates in such programs. Further research is required to determine the precise therapeutic mechanisms of change in MI.
    International Journal of Eating Disorders 08/2013; 1:34. DOI:10.1186/2050-2974-1-34 · 3.03 Impact Factor
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