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


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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    • "All rights reserved. l'e ´ volution des troubles du comportement alimentaire et l'e ´ volution des symptômes dé pressifs et anxieux [2] [5] [39]. Par ailleurs, en ce qui a trait a ` la relation entre l'alliance thé rapeutique et la variable motivation, une e ´ tude portant sur les problè mes de dé pendance a ` l'alcool a dé montré qu'une trè s bonne relation thé rapeutique entre le patient et son thé rapeute permet de diminuer l'effet né gatif que peut avoir une faible motivation sur la ré duction de la consommation d'alcool. "
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    • "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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