Motivation to change among residential treatment patients with an eating disorder: Assessment of the multidimensionality of motivation and its relation to treatment outcome

Klarman Eating Disorders Center, McLean Hospital, Belmont, Massachusetts, USA.
International Journal of Eating Disorders (Impact Factor: 3.13). 05/2011; 44(4):340-8. DOI: 10.1002/eat.20809
Source: PubMed


To examine the multidimensional nature of motivation to change in an adolescent sample in residential eating disorder (ED) treatment and relate it to outcome.
To determine whether different dimensions of motivation (benefits, burdens, and functional avoidance) are differentially associated with symptom severity and outcome, we assessed eating pathology and motivation to change in consecutively admitted female patients (n = 67) with AN, BN, and EDNOS in a residential ED program with the Eating Disorder Examination Questionnaire (EDE-Q) and the Decisional Balance Scale (DB).
Pretreatment DB benefits and functional avoidance subscales were correlated with ED and comorbid psychopathology. Admission to discharge change in DB benefits-but not other measured dimensions of motivation was significantly associated with post-treatment EDE-Q global scores.
Our findings support that motivation to change is a multidimensional construct among ED patients. A reduction in perceived benefits of illness is associated with less severe post-treatment eating pathology.

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    • "These findings are in contrast to past research asking sufferers’ to evaluate the impact (positive and negative) of their eating disorder on their lives. Where such beliefs are concerned, it is the strength of positive rather than negative ED cognitions that predict resistance to treatment [8,26] and lesser motivation to change [27]. At an experiential level, however, it is the strength of predominantly negative self-talk that predicts ED severity. "
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    ABSTRACT: Background: The objective was to determine whether motivation to change is significantly altered over the course of partial hospitalization in children and adolescents with eating disorders (EDs). Method: This study was a retrospective chart review of 30 sets of adolescents and their parents who completed the Motivational Stage of Change for Adolescents Recovering from an Eating Disorder (MSCARED) at both intake and discharge from partial hospitalization. The main outcome variables included change in stage of change (SOC) for patients and their parents. Secondary outcomes included correlations between SOC and other baseline variables, as well as changes in SOC and psychological test scores. Results: The SOC was significantly higher at discharge than at intake in both the patients and parents, but the two groups were not in agreement at discharge. The change in the SOC was correlated with change in Children's Eating Attitudes Test scores. Assessment of decisional balance showed correlations with SOC. Age, change in weight, and psychiatric diagnoses did not correlate with initial SOC. Conclusion: The MSCARED may be a useful tool for monitoring young ED patients' psychological improvements with day treatment. Initial SOC is not predictive of treatment outcomes.
    International journal of adolescent medicine and health 01/2013; 25(2):1-6. DOI:10.1515/ijamh-2013-0023
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    ABSTRACT: The aim of this multi-method qualitative study was to explore the eating behaviors and food choices of nine purposively sampled low-income women aged 29 to 40 years who were engaged in a residential substance use disorders recovery program. Findings were limited to photo-elicitation interviews with the women that focused on nutritional choices and issues outside their family context. Consensual data analysis revealed a recovery process that began with cognitive reawakening and an increased focus on and desire for healthier nutrition-related decisions and lifestyle, particularly in the area of weight gain that many of the women experienced. Keywords: Substance use disorder, women, residential recovery program, photo-elicitation, qualitative, nutrition
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