Readiness for change and short-term outcomes of female adolescents in residential treatment for Anorexia Nervosa

The Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
International Journal of Eating Disorders (Impact Factor: 3.13). 11/2007; 40(7):602-12. DOI: 10.1002/eat.20425
Source: PubMed


To determine if readiness for change (RFC) at admission predicted length of stay (LOS) and short-term outcomes among female adolescents in residential treatment for anorexia nervosa (AN).
Using a prospective cohort design to collect data from participants (N = 65) at admission and discharge, Kaplan-Meier survival analysis and Cox regression tested whether RFC on admission predicted time in LOS to a favorable short-term outcome--a composite endpoint based on minimum criteria for weight gain, drive for thinness, depression, anxiety, and health-related quality of life (HRQOL).
Participants with low RFC had a mean survival time to a favorable short-term outcome of 59.4 days compared to 34.1 days for those with high RFC (log rank = 8.44, df = 1, p = .003). The probability of a favorable short-term outcome was 5.30 times greater for participants with high RFC.
Readiness for change is a useful predictor of a favorable short-term outcome and should be considered in the assessment profile of patients with AN.

Full-text preview

Available from:
  • 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. "
    [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
    • "They found not only that readiness to change eating and weight, as measured after four weeks in the program, predicted intensive treatment completion, but also that readiness to change fully mediated the relationship between ED symptomatology at admission to the program and later treatment completion. Similar findings were demonstrated in an adolescent population treated in an intensive hospital-based treatment program [11]. Other research has shown than individuals with BN who are more motivated to change at baseline experience a greater reduction in binge eating during therapy than do those who are initially less motivated to change [12,13], and that motivation to change has been shown to be a predictor of relapse in individuals with BN [14,15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Engaging patients with an eating disorder in change is difficult and intensive treatment programs have high drop-out rates. The purpose of the study was to determine whether Motivational Interviewing (MI) in the form of a brief, pre-treatment intervention would be associated with higher completion rates in subsequent intensive treatment for an eating disorder. Thirty-two participants diagnosed with an eating disorder participated in the study. All participants were on the waitlist for admission to an intensive, hospital-based treatment program. Sixteen participants were randomly assigned to four individual sessions of MI that began prior to entrance into the treatment program (MI condition) and 16 participants were assigned to treatment as usual (control condition). The main outcome was completion of the intensive treatment program. Participants also completed self-report measures of motivation to change. Results Participants in the MI condition were significantly more likely to complete intensive treatment (69% completion rate) than were those in the control condition (31%). Conclusions MI can be a useful intervention to engage individuals with severe eating disorders prior to participation in intensive treatment. MI as a brief prelude to hospital-based treatment for an eating disorder may help to improve completion rates in such programs. Further research is required to determine the precise therapeutic mechanisms of change in MI.
    Full-text · Article · Aug 2013 · International Journal of Eating Disorders
  • Source
    • "To our knowledge, there are currently only three studies published on the predictive value of stage of change on treatment outcome in AN patients [16-18], two of which were conducted in adolescent samples. All of them report on a global score of stages of change as an indicator of motivation to change and identified this global score as a positive predictor of weight gain, improvement of eating disorder pathology, and composite improvement outcome at discharge [17,18] as well as of weight maintenance after discharge [16]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Anorexia nervosa (AN) is associated with high rates of chronicity and relapse risk is a considerable therapeutic challenge in the disorder. The aim of the present study was to investigate the association of stages of change and outcome with a focus on the relapse struggle in the maintenance stage in patients with predominantly chronic AN. Further, therapeutic alliance and stages of change associations were explored. Methods As an instrument measuring relapse struggle in the maintenance stage, we applied the short form of the University of Rhode Island Change Assessment-Short (URICA-S). We assessed stages of change in 39 patients with a predominantly chronic course of AN in early, middle, and late stages of inpatient psychotherapy. General symptom severity as assessed by the SCL-90-R and weight change were investigated as outcome measures. Results In-line with earlier evidence, contemplation significantly predicted therapeutic alliance. Further, we demonstrated that relapse risk as operationalized by URICA-S maintenance is an important predictor of general psychopathology. BMI change was not predicted by stages of change. Conclusions The URICA-S maintenance scale might be applied to help identify patients at relapse risk. High URICA-S maintenance scores could be considered as one critical aspect of AN patients who might especially benefit from relapse-preventing aftercare programs.
    Full-text · Article · Apr 2013 · BMC Psychiatry
Show more