Motivation-focused Treatment for Eating Disorders: A Sequential Trial of Enhanced Cognitive Behaviour Therapy with and without Preceding Motivation-Focused Therapy
To evaluate the effectiveness of a motivation-focused intervention prior to individual cognitive behavioural eating disorder treatment. Enhanced cognitive-behavioural therapy (CBT-E) in its usual form was compared with CBT-E preceded by four sessions of motivation-focused therapy (MFT) (MFT + CBT-E). Participants were adult outpatients seen at a specialist eating disorder clinic in Western Australia, who met criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition eating disorder. A sequential trial of CBT-E as usual (n = 43) and MFT + CBT-E (n = 52) was conducted over a 40-month period. The MFT phase was associated with significant increases in readiness to change. There were no significant between-group differences in treatment completion rates, and treatment completers in both conditions reported comparable reductions in eating disorder symptoms over time. In this sample, MFT + CBT-E was not associated with superior treatment outcome when compared with CBT-E as usual.
[Show abstract] [Hide abstract] ABSTRACT: In this study the author reviews the current empirical research regarding Enhanced Cognitive Behavioral Therapy (CBT-E) in the treatment of the full range of eating disorders (EDs): anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. All peer-reviewed outcome studies identified through electronic bibliographic databases and manual searches of article reference lists are reviewed. A total of six studies (n = 6) were found. The author reports the results of these studies consisting of open-trials of CBT-E applied to different ED diagnoses, comparing two forms of CBT-E (focused and broad) to waitlist, and comparing CBT-E plus Motivation Focused Therapy. There is evidence to support the use of CBT-E for the treatment of EDs; however, this evidence is tentative as CBT-E is still in its early phases of empirical testing. No trials found CBT-E to be ineffective. Although these research designs are not randomized control trials, these results are promising for ED research. There are few efficacious treatments for EDs, especially for those with "chronic" EDs and adults with anorexia nervosa. CBT-E is one of the first interventions that focuses on particular symptomatic behaviors of EDs manifested in individual clients rather than treating ED diagnoses generically.0Comments 1Citation
- "Christopher G. Fairburn is the primary developer of CBT-E and its accompanying treatment guide and along with five additional contributors to the treatment guide (Kristin Bohn, Zafra Cooper, Riccardo Dalle Grave, Deborah M. Hawker, and Marianne E. O'Connor) is an author and researcher of three of the six studies here reviewed: These three studies (Fairburn et al., 2009; Dalle Grave et al., 2013; Fairburn et al., 2013) also received funding under grants provided by the Wellcome Trust, a global charitable foundation (www.wellcome.ac.uk/index.htm). The remaining three studies (Bryne et al., 2011; Allen et al., 2012; Watson et al., 2012) also share authorships; however, it is unclear if they have specific ties to the CBT-E intervention developers. These three studies do not cite any sources of funding. "
[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.0Comments 7Citations
- "To prevent misunderstandings while filling out questionnaires, and in order to build a more collaborative therapeutic relationship , an interview procedure like the RMI seems to be highly suitable if a time-consuming application is possible. However, most studies on motivation to change in eating disorders conducted to date exclusively applied questionnaires [4,9,50,54555657 and many [4,58] used the University of Rhode Island Change Assessment Scale (URICA [59,60]), which is not specifically addressed at patients with eating disorders but rather at problem behaviours in general. Moreover, the URICA can be criticised for measuring motivation to change a problem behaviour in general terms and not in a symptom-specific manner with each symptom domain being assessed sepa- rately . "
- [Show abstract] [Hide abstract] ABSTRACT: The primary objectives for this study were to establish normative data for the EDE-Q in a nationally representative sample of women and to investigate the unique and relative effects of age and BMI. A community sample of 3000 women aged 16-50 was randomly selected from the Norwegian National Population Register. Mean global EDE-Q was 1.27 (SD=1.19). EDE-Q scores decreased significantly with age yet increased with BMI. In the regression model, BMI and age accounted for 19% versus 2%, respectively, of the global EDE-Q. Extreme shape and weight concerns appeared to drive the higher global EDE-Q scores for individuals with overweight or obesity, with 30-40% scoring above the recommended clinical cut-off for Shape and Weight Concern. Higher EDE-Q scores, largely driven by elevated shape and weight concerns, appear normative among individuals with obesity in a nationally representative population. BMI should be routinely considered when establishing criteria for defining recovery and determining clinical significance using the EDE-Q.0Comments 20Citations