Article

Motivational Change in an Inpatient Anorexia Nervosa Population and Implications for Treatment

School of Psychology, Flinders University, Adelaide, SA, Australia.
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.77). 04/2009; 43(3):235-43. DOI: 10.1080/00048670802653356
Source: PubMed

ABSTRACT The relationship between motivation and recovery in anorexia nervosa has received increased attention in the research literature although few controlled investigations of increasing motivation in this population exist. Three questions were therefore examined in an inpatient anorexia nervosa population: (i) does baseline motivation predict change in eating pathology; (ii) does change in motivation predict change in eating pathology; and (iii) can we increase motivation to recover in this group?
Inpatients (n=47) in a specialist weight disorder unit with a mean age of 21.85 years (SD=5.37) were randomly allocated to receive four sessions of motivational interviewing with a novice therapist in addition to treatment as usual (n=22) or treatment as usual alone (n=25). Assessment of eating pathology and motivation to recover was conducted on three occasions: at admission (baseline), and at 2- and 6 week follow up. Eating pathology was assessed using the Eating Disorder Examination and self-reported motivation was assessed using the Anorexia Nervosa Stages of Change Questionnaire and six Likert scales.
Higher baseline motivation across five of the seven measures predicted significant decreases in eating pathology, and increased Anorexia Nervosa Stages of Change Questionnaire scores between baseline and 2 week follow up predicted significant improvement in eating pathology between baseline and 6 week follow up. Significantly more patients were lost to follow up from the treatment as usual compared to the motivational interviewing group. More patients in the motivational interviewing condition moved from low readiness to change at baseline to high readiness to change at 2 and 6 week follow up.
Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that motivation can be improved in this population. Further investigations, however, of ways of improving motivation in this population need to be conducted, along with the impact of motivational changes on treatment outcome.

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Available from: Tracey D Wade, Nov 07, 2014
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    • "These findings are consistent with the more general criticism of the model as failing to predict behaviour (beyond the scope of this paper; however, for relevant reviews see Armitage, 2009; Armitage & Arden, 2002; Freeman & Dolan, 2001), and suggest that the TTM may be limited in its utility to understand motivation and to predict recovery from an ED. Consequently, this raises questions regarding the suitability of measures of motivation derived from the TTM, and emphasises the need to continue to investigate and develop valid, reliable tools for assessing motivation to change in AN (Wade et al., 2009). Due to the focus on stage of change conceptualisations of motivation in AN, there has been limited consideration of other factors that may impact desire for recovery. "
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    ABSTRACT: Anorexia nervosa (AN) is a difficult to treat mental illness associated with low motivation for change. Despite criticisms of the transtheoretical stages of change model, both generally and in the eating disorders (EDs), this remains the only model to have been applied to the understanding of motivation to recover from AN. The aim of this pilot study was to determine whether the theory of planned behaviour (TPB) would provide a good fit for understanding and predicting motivation to recover from AN. Two studies were conducted – in the first study eight women who had recovered from chronic AN were interviewed about their experiences of recovery. The interview data were subsequently used to inform the development of a purpose-designed questionnaire to measure the components of the TPB in relation to recovery. In the second study, the resultant measure was administered to 67 females with a current diagnosis of AN, along with measures of eating disorder psychopathology, psychological symptoms, and an existing measure of motivation to recover (based on the transtheoretical model). Data from the interview study confirmed that the TPB is an appropriate model for understanding the factors that influence motivation to recover from AN. The results of the questionnaire study indicated that the pre-intention variables of the TPB accounted for large proportions of variance in the intention to recover (72%), and more specifically the intention to eat normally and gain weight (51%). Perceived behavioural control was the strongest predictor of intention to recover, while attitudes were more important in the prediction of the intention to eat normally/gain weight. The positive results suggest that the TPB is an appropriate model for understanding and predicting motivation in AN. Implications for theory and practice are discussed.
    Appetite 11/2014; 84. DOI:10.1016/j.appet.2014.10.028 · 2.69 Impact Factor
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    • "There are several ways in which treatment could be focused on those factors that might modify the response to inpatient care. Strategies to improve confidence to change such as motivational interviewing may be of value to improve outcome [44-46]. Targeting interpersonal relationships with interventions that reduce expressed emotion [47,48] may be of benefit. "
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    ABSTRACT: Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored. Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177). One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control. Overall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour contributed to the response to inpatient care as did social functioning and confidence to change.
    BMC Psychiatry 11/2013; 13(1):287. DOI:10.1186/1471-244X-13-287 · 2.24 Impact Factor
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    • "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]. Further indications of the high clinical relevance of motivation to change in eating disorders are provided by several studies suggesting a positive association between a high motivation to change and several desirable clinical indices (such as continuing treatment, decreases in eating pathology, increases in weight, and weight maintenance) [8-11]. Based on these results, several studies have been conducted in order to assess the effects of interventions aiming at an enhancement of motivation to change in eating disorders (for an overview, see [12]). "
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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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