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.

Download full-text


Available from: Janet L Treasure
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The study of factors involved in the process of weight loss is of great interest to researchers. Specialists in the domain of weight management encourage the reduction of calorie intake by the change of eating habits, physical exercise and in certain cases of morbid obesity, by bariatric surgery. Most often the treatment of weight loss is perceived and addressed mainly from the medical and physiological perspective; obesity and overweight are considered in terms of surplus fat that may increase the risk of harmful health consequences. However, considering the problem of excessive weight and its treatment as only a biological issue fails to grasp the complexity of the issues. Research in the field of obesity has shown a significant relationship between obesity and psychological difficulties. These psychological factors appear to be related to a variable that has been extensively studied in research on psychotherapy process and outcome, namely the therapeutic alliance. However, in the field of weight management, few studies have addressed this issue. Thus, the present study aimed to investigate the interaction between development of the therapeutic alliance over the course of weight loss treatment, along with changes in psychological variables and weight loss.
    Full-text · Article · May 2015 · Annales Médico-psychologiques revue psychiatrique
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Feb 2015 · Eating Disorders
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Oct 2013 · International Journal of Eating Disorders
Show more