ArticlePublisher preview available

Motivational enhancement therapy and self-help for binge eaters

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The aims of this study were to evaluate whether a single session of motivational enhancement therapy (MET) would increase participant readiness to change, improve the efficacy of self-help treatment for binge eaters, and improve participant compliance with the self-help manual. Participants with bulimia nervosa or binge eating disorder were randomly assigned either to attend a 1-hr MET session prior to receiving the self-help manual (n = 45) or to receive the self-help manual only (n = 45). Participants were followed for 4 months for assessment of self-reported eating disorder outcome and compliance. The MET intervention resulted in increased readiness to change for binge eating compared with the self-help-only (SH) condition. Few differences were found between the MET condition and the SH condition for changes in eating attitudes and frequency of binge eating and compensatory behaviors. No significant effects were found for compliance. This research adds to the literature regarding the use of brief motivational interventions to enhance readiness for change in populations with eating disorders.
Motivational Enhancement Therapy and Self-Help
Treatment for Binge Eaters
Erin C. Dunn, Clayton Neighbors, and Mary E. Larimer
University of Washington
Objective: The aims of this study were to evaluate whether a single session of motivational enhancement
therapy (MET) would increase participant readiness to change, improve the efficacy of self-help
treatment for binge eaters, and improve participant compliance with the self-help manual. Method:
Participants with bulimia nervosa or binge eating disorder were randomly assigned either to attend a 1-hr
MET session prior to receiving the self-help manual (n45) or to receive the self-help manual only (n
45). Participants were followed for 4 months for assessment of self-reported eating disorder outcome and
compliance. Results: The MET intervention resulted in increased readiness to change for binge eating
compared with the self-help-only (SH) condition. Few differences were found between the MET
condition and the SH condition for changes in eating attitudes and frequency of binge eating and
compensatory behaviors. No significant effects were found for compliance. Discussion: This research
adds to the literature regarding the use of brief motivational interventions to enhance readiness for change
in populations with eating disorders.
Keywords: eating disorders, motivational interviewing, bulimia nervosa, binge eating disorder, motiva-
tional enhancement therapy
Bulimia nervosa (BN) and binge eating disorder (BED) are
characterized by serious disturbances in eating, subjective distress,
and concern about body shape and weight. Numerous physical
complications result from these disorders, including diabetes, heart
and kidney problems, and obesity (Becker, Grinspoon, Klibanski,
& Herzog, 1999). These illnesses also are associated with mood,
anxiety, and personality disorders as well as substance abuse
(Dingemans, Bruna, & van Furth, 2002; Dunn, Larimer, & Neigh-
bors, 2002; Woodside et al., 2001).
Cognitive– behavioral therapy (CBT) is considered the treat-
ment of choice for individuals who engage in binge eating. CBT
has been shown to be as effective as or more effective than other
treatment approaches in reducing bingeing and improving psycho-
social functioning (Devlin, 2001; Peterson & Mitchell, 1999; Wil-
fley et al., 2002). However, because CBT is time consuming and
expensive, it has been proposed that a stepped-care approach may
be the most efficient use of expertise and resources for treating
individuals with BN and BED (Wilson, Vitousek, & Loeb, 2000).
A stepped-care approach starts with unsupervised self-help, pro-
ceeds to guided self-help or group meetings, and ends with indi-
vidual treatment.
Self-help programs are appealing because they are widely dis-
seminated, are inexpensive, and can be tailored to meet the pa-
tient’s needs. Self-help programs also may reach those who are
reluctant to ask for help and might serve as an important first step
toward seeking individual treatment (Wells, Garvin, Dohm, &
Striegel-Moore, 1997). Self-help programs have demonstrated ef-
ficacy in the treatment of individuals with BN in open clinical
trials (Cooper, Coker, & Fleming, 1994, 1996) and has been shown
to be comparable to CBT for the reduction of bulimic symptom-
ology (Thiels, Schmidt, Treasure, Garthe, & Troop, 1998; Treasure
et al., 1994, 1996) and for the treatment of BED (Peterson et al.,
2001).
However, patient noncompliance with self-help is a significant
barrier to its effectiveness. Little research has studied reasons for
noncompliance, but it is hypothesized that lack of motivation to
change plays an integral role (Thiels, Schmidt, Troop, Treasure, &
Garthe, 2001; Troop et al., 1996). Motivational interviewing (MI;
Miller & Rollnick, 2002) is one counseling approach designed to
increase the probability of initiation and continuation of treatment
by helping patients recognize their problem, build commitment,
and reach a decision to change. MI is a patient-centered, directive
style of interaction in which the therapist focuses on enhancing
patients’ intrinsic motivation to change by exploring and resolving
their ambivalence.
MI often has been combined with personal feedback of assess-
ment results; this combination is called motivational enhancement
therapy (MET; Miller, Zweben, DiClemente, & Rychtarik, 1992).
In MET, the therapist uses structured feedback regarding problems
associated with the target behavior and the patient’s level of
severity on each symptom, compared with the norms. MET is
delivered in a collaborative manner, in which the therapist uses MI
Erin C. Dunn, Department of Psychology, University of Washington;
Clayton Neighbors and Mary E. Larimer, Department of Psychiatry and
Behavioral Sciences, University of Washington.
Erin C. Dunn is now at the Department of Psychiatry, University of
British Columbia, British Columbia, Canada, and the Eating Disorders
Program, St. Paul’s Hospital, British Columbia, Canada.
Partial support for this research was provided by National Institute on
Alcohol Abuse and Alcoholism Grant NIAAA R01AA12547-04, awarded
to Mary E. Larimer.
Correspondence concerning this article should be addressed to Erin C.
Dunn, Eating Disorders Program, St. Paul’s Hospital, 1081 Burrard Street,
Vancouver, British Columbia V6Z 1Y6, Canada. E-mail: edunn@
providencehealth.bc.ca
Psychology of Addictive Behaviors Copyright 2006 by the American Psychological Association
2006, Vol. 20, No. 1, 44–52 0893-164X/06/$12.00 DOI: 10.1037/0893-164X.20.1.44
44
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
... Most participants received ED treatment concurrently with the interventions and were already enrolled in inpatient [28,45] or outpatient programs [37,38,40,43,46], with one study including both inpatients and outpatients [16]. Others did not receive ED treatment prior to or during the study, as they were either on a waitlist (WL) for treatment [29,44] or had been recruited from the broader community (a college, a university, and a large Canadian city) [41,42,47]. flowchart showing the steps of study inclusion [36]. ...
... The risk of bias was moderate to high in the included studies where three studies had some concerns [29,37,38], ten studies had a high risk of bias [16,28,[40][41][42][43][44][45][46][47], while none of the studies had a low risk of bias. Two protocols [37,40] and four registries [29,38,43,47] were available for the bias assessment, while the remaining articles were assessed using the methods and results sections. ...
... RecoveryMANTRA used in Cardi et al. differed from the rest as the intervention group received text-chat sessions based on MI instead of face-to-face interventions. The comparator groups also received various types of interventions SH [41,42], SH and psychoeducation (PE) [47], TAU [28,40,44,45], CBT [16,29,46], and Specialist Supportive Clinical Management (SSCM) [37,38], or WL [43]. ...
Article
Full-text available
Motivation to change behavior is seen as an important factor in achieving a better treatment effect in patients with eating disorders (ED). The aim of this systematic review was to assess whether motivational interviewing (MI) and motivational enhancement therapy (MET) might (1) increase motivation to change behavior and (2) improve eating disorder psychopathology (EDP) and body mass index (BMI) in patients with ED. To investigate this, a literature search was conducted on 9 March 2021 on four scientific databases: Cochrane, Embase (Ovid), MEDLINE (PubMed), and PsycInfo (EBSCO). A total of 2647 publications were identified and following a rigorous stepwise procedure to assess titles and abstracts and, thereafter, full texts of relevant publications, 13 studies were included in the data extraction and analyses. A few individual studies (n = 5) found a significant increase in motivation, two a decrease in ED symptoms (n = 2), while none found an effect on BMI. However, the meta-analysis of each outcome found effect sizes near zero, thereby confirming the results of previous narrative reviews that have described a lack of effect of MET/MI on motivation in ED. Since the individual studies differ substantially in design, and the outcomes were inconsistently assessed with regards to instruments and duration, the effect of MET/MI on motivation for behavioral change, ED psychopathology, and BMI is still unclear.
... Emerging adults One RCT with individuals with BN and BED compared a self-help only intervention (n = 45), consisting of a CBT-based book ('Overcoming Binge Eating') completed at the participants' own pace, to inperson MET sessions supplemented with the same CBTbased book (n = 45) [82]. The MET intervention resulted in increased readiness to change for binge eating and significantly more participants in the MET condition were abstinent from bingeing at follow-up, compared with the self-help only intervention, but otherwise there were few differences between conditions for eating attitudes and frequency of binge eating and compensatory behaviours. ...
... The MET intervention resulted in increased readiness to change for binge eating and significantly more participants in the MET condition were abstinent from bingeing at follow-up, compared with the self-help only intervention, but otherwise there were few differences between conditions for eating attitudes and frequency of binge eating and compensatory behaviours. With regard to eating behaviours, participants in both conditions had reduced frequencies of binge eating and compensatory behaviours, but withingroup effects indicated that individuals in the MET condition experienced significant reductions in binge eating, compensatory behaviours, and maladaptive attitudes, whereas changes in the self-help only condition were not significant [82]. ...
Article
Full-text available
Objective The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. Methods Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. Results Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. Conclusions Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.
... Urges people with ED's to make changes to their behaviors and cognitive processes [21]. Previous systematic reviews have demonstrated guided computer-based self-help platforms ± associated apps as effective in reducing ED core symptoms and ED-related behaviors by altering maladaptive behaviors and changing the individual perseverative thinking, thin idealization, body dissatisfaction, depression, quality of life, and lack of motivation to change [17,22]. ...
Article
Full-text available
Background: Access to psychological healthcare is extremely difficult, especially for individuals suffering from severely stigmatised disorders such as eating disorders (ED). There has been an increase in children, adolescents, and adults suffering from ED symptoms and ED, especially following the COVID-19 pandemic. Online self-help platforms allow people to bridge the treatment gap and receive support when in-person treatment is unavailable or not preferred. To the knowledge of the authors, this is the first systematic review evaluating the efficacy of solely online self-help platforms. Objective: The aim of this systematic review is to evaluate the effectiveness of online self-help platforms for EDs Methods: The proposed systematic review will follow the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The review has been registered to PROSPERO with the registration number: CRD42024520866. This review will report and evaluate the literature concerning the efficacy of self-help platforms for EDs. Two independent authors will utilise the search terms to conduct the initial search. The collated articles will then be screened by their titles and abstracts, and finally, full-text screenings will be conducted. The results will be discussed, and the final report will be submitted to a peer-reviewed journal. Data extraction will be conducted and included studies will undergo narrative synthesis. Results: The authors conducted a database search for articles that were published by the 31st of May 2024. Fourteen studies were included in the systematic review. Data charting will be completed on excel and data synthesis will be completed, and the result is expected to be published by the end of 2024. Overall, the systematic review found that online self-help platforms are effective in reducing global ED psychopathology and ED-related behaviours. Conclusions: Self-help platforms are helpful first-stage resources in a tiered healthcare system. Clinical Trial: PROSPERO (CRD42024520866)
... The results showed that neither group used the self-help manual to a large extent, with most participants reading the manual for less than 5 h in total and reading fewer than half the chapters. Other research has found that brief Motivation Enhancement Therapy did not result in increased use of a self-help manual compared to simply providing a selfhelp manual [40]. Furthermore, the hospital setting of the current study already provides a lot of written materials to patients. ...
Article
Full-text available
Background Our aim was to compare MI-oriented versus CBT-oriented adjunctive treatments to test whether an MI approach is superior in terms of improving therapeutic alliance and engagement among individuals with an eating disorder. The current study was a pilot randomized controlled trial with random allocation to either MI-oriented or a CBT-oriented adjunctive treatment group completed concurrently with a hospital-based group program for adults. Both adjunctive treatment conditions consisted of three individual therapy sessions and a self-help manual. Methods Sixty-five outpatients receiving hospital treatment for a diagnosed eating disorder were randomly assigned to a treatment group. Measures of working therapeutic alliance, engagement, treatment completion, and clinical impairment were completed at preadmission, mid-treatment, and at the end of treatment. Results Working alliance increased equivalently in both conditions over time in treatment. Similarly, there were no differences between conditions in terms of engagement. Regardless of therapy orientation, greater use of the self-help manual predicted lowered eating disorder risk; stronger patient ratings of therapeutic alliance predicted decreased feelings of both ineffectiveness and interpersonal problems. Conclusion This pilot RCT provides further evidence that both alliance and engagement are important for treatment of an eating disorder; however, there was no clear advantage of MI over CBT as an adjunctive treatment approach to improving alliance or engagement. Trial registration: ClinicalTrials.gov ID #NCT03643445 (proactive registration).
... Such responses were interesting to the researchers, as participants likely did not have knowledge of MI practice. These findings are similar to Dunn et al. (2006), where clients mentioned their clinician's supportive behavior was the most favorable part of a motivational intervention. Responses coded as mentor behavior are attributed to the high-quality MI provided during the meetings, as supported by scores from the MITI. ...
Research
Full-text available
During the Spring 2021 semester, 19 freshmen students on academic probation were recruited for a MI mentoring intervention. The mentor completed 45 hours of MI training and reached MI proficiency prior to the start of the intervention. Participants provided survey feedback, qualitative responses regarding the meetings, self-reported goal attainment scaling (GAS) at three time points, and the Self-Efficacy for Learning Form (SELF; Zimmerman & Kitsantas, 2005) before the intervention and after the second meeting. Findings suggest the intervention had a high level of satisfaction from all participants. Mean scores from the self-reported GAS percentages increased across the intervention. Time fixed effects was not significant in the mixed model. A paired-sample t-test compared the difference in participant SELF scores across the intervention (N = 18). There was a significant increase in the self-efficacy for learning from before the intervention (M = 7.38, SD = 1.35) to after the second meeting (M = 8.63, SD = 1.36), t(17) = -3.76, p = .001. Mechanisms of relational aspects of MI and the outcomes were also explored and discussed. Current findings of the small-scale feasibility pilot provide support for the MI mentoring intervention project, calling for more sophisticated design, exploration of MI mechanisms, and suggested revisions for the next iteration
... Regardless of whether they are considered adaptations of BASICS or new interventions, the BASICS approach and feedback protocol are often specifically referenced in applications of this approach to behaviors other than alcohol use. For example, Dunn et al. (2006) tested a single session of an intervention that wedded This document is copyrighted by the American Psychological Association or one of its allied publishers. ...
Article
Full-text available
The first clinical trial of the Brief Alcohol Screening and Intervention for College Students (BASICS) was launched at the University of Washington in 1990. Since that time, multiple trials have demonstrated the efficacy of BASICS and related approaches in a variety of young adult populations and this information has been widely disseminated. However, in practice BASICS implementation varies considerably, including formats and mediums (e.g., group, telehealth, written/electronic feedback alone) not studied in the original research. Even if delivered in an individual in-person format, implementation can stray substantially from the original design. Adaptations may be necessary to address campus resource constraints or other barriers to implementation but can have unknown impacts on intervention effectiveness. Thus, despite wide-scale efforts to disseminate and implement BASICS, challenges remain, and there are several critical research gaps that need to be addressed to support campuses in implementing BASICS successfully. The current manuscript reviews several ways in which BASICS has been adapted to address these challenges, and provides recommendations for best implementation practices as well as future research needed to improve implementation and effectiveness of BASICS going forward. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... To date, no research has ascertained motivation to change specific symptoms and differentiated between specific compensatory behaviors. Further, few studies have examined naturalistic motivation to change specific ED behaviors (e.g., Dunn et al., 2006). Approximately 5.8% of individuals with BN and 34.3% with AN receive treatment in any given year (Hoek & van Hoeken, 2003), and individuals may experience remission or recovery without treatment (Eddy et al., 2017), suggesting that individuals may change through their own efforts and strategies. ...
Article
We examined the naturalistic relations between motivation to change and change in four specific eating disorder (ED) beha- viors—binge eating (BE), purging, fasting, and driven exercise— in a community-based sample of individuals with EDs over two consecutive 6-week periods. We conducted cross-lagged general- ized estimating equations using the transtheoretical model’s four stages of change to predict changes in the ED behaviors 6 weeks later. Individuals reported lower pre-contemplation for behaviors typically associated with more distress (e.g., BE, purging) than they did for behaviors associated with less distress (e.g., fasting and driven exercise). Action predicted decreases in BE and pur- ging frequencies but not fasting or driven exercise frequencies. Naturalistic relations between ED behavior severity/frequency and motivation to change these features can be detected over 6-week intervals; that is, attempts at change in individuals’ natural environments can be successful over relatively brief periods of time, especially when individuals experience the motivation to change these features. The process of motivation to change ED behaviors is not linear, and our study highlights the movement between stages of change among individuals with EDs. Future research is needed to examine how much of the observed changes are sustained.
Preprint
Full-text available
BACKGROUND Access to psychological health care is extremely difficult, especially for individuals with severely stigmatized disorders such as eating disorders (EDs). There has been an increase in children, adolescents, and adults with ED symptoms and ED, especially following the COVID-19 pandemic. Computer-based self-help platforms (± associated apps) allow people to bridge the treatment gap and receive support when in-person treatment is unavailable or not preferred. OBJECTIVE The aim of this systematic review is to evaluate the effectiveness of computer-based self-help platforms for EDs, some of which may have associated apps. METHODS The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This review will report and evaluate the literature concerning the efficacy of self-help platforms for EDs. Articles were obtained from the Ovid MEDLINE, Embase, Global Health, and APA PsycInfo. The inclusion criteria included research with original data and gray literature; research evaluating the efficacy of web-based psychoeducational self-help platforms for EDs; people with an ED diagnosis, ED symptoms, at risk of developing EDs, or from the general population without ED-related behaviors; pre– and post–computer-based ± associated apps intervention clinical outcome of ED symptoms; pre– and post–computer-based ± associated apps intervention associated mental health difficulties; and literature in English. The exclusion criteria were solely guided self-help platforms, only in-person interventions with no computer-based ± associated apps comparison group, only in-person–delivered CBT, self-help platforms for conditions other than eating disorders, systematic reviews, meta-analyses, posters, leaflets, books, reviews, and research that only reported physical outcomes. Two independent authors used the search terms to conduct the initial search. The collated articles then were screened by their titles and abstracts, and finally, full-text screenings were conducted. The Cochrane Risk of Bias 2 tool will be used to assess the risks of bias in the included studies. Data extraction will be conducted, included studies will undergo narrative synthesis, and results will be presented in tables. The systematic review will be submitted to a peer-reviewed journal. RESULTS The authors conducted a database search for articles published by May 31, 2024. In total, 14 studies were included in the systematic review. Data charting, synthesis, and analysis were completed in Microsoft Excel by the end of July 2024. Results will be grouped based on the intervention stages. The results are expected to be published by the end of 2024. Overall, the systematic review found that computer-based self-help platforms are effective in reducing global ED psychopathology and ED-related behaviors. CONCLUSIONS Self-help platforms are helpful first-stage resource in a tiered health care system. CLINICALTRIAL PROSPERO CRD42024520866; https://tinyurl.com/5ys2unsw INTERNATIONAL REGISTERED REPORT DERR1-10.2196/60165
Article
Full-text available
The aim of this study was to evaluate the effectiveness of 2 methods of administering a cognitive–behavioral self-help program for binge eating disorder. The study was designed to reproduce many of the conditions that apply in settings in which self-help interventions are most relevant. Seventy-two women with binge eating disorder were randomly assigned to 1 of 3 conditions for 12 weeks: pure self-help (PSH), guided self-help (GSH), or a waiting list (WL) control condition (followed by PSH or GSH). They were then followed up for 6 months. Both PSH and GSH had a substantial and sustained impact with almost half the participants ceasing to binge eat. There was little change in the WL condition. Cognitive–behavioral self-help may be of value both as an initial treatment for binge eating disorder and as a form of secondary prevention.
Article
Full-text available
This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N = 367) and suggested that the diagnoses from this scale possessed temporal reliability (mean κ = .80) and criterion validity (with interview diagnoses; mean κ = .83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test–retest reliability (r = .87), internal consistency (mean α = .89), and convergent validity with extant eating-pathology scales. Results implied that this scale was reliable and valid in this investigation and that it may be useful for clinical and research applications.
Article
Eighteen patients with DSM-III-R bulimia nervosa were treated by providing them with supervision in the use of a self-help manual based on the cognitive behavioral treatment for the disorder. The patients were assessed before beginning the self-help program, and again 4 to 6 months later, using standardized measures of psychopathology. The findings were encouraging. At follow-up one half of the patients had ceased bulimic episodes and self-induced vomiting, and most of the remainder had made significant improvements. These preliminary findings, together with related published work, suggest that supervised self-help might be an appropriate first line treatment for patients with bulimia nervosa and that for many patients it could be sufficient. © 1994 by John Wiley & Sons, Inc.
Article
Research on the treatment of eating disorders has focused primarily on cognitive-behavioral therapy (CBT) and, more recently, interpersonal psychotherapy (IPT). Numerous studies have shown that CBT is helpful in reducing symptoms of bulimia nervosa and binge-eating disorder. In addition, CBT has been found to be superior or comparable to other psychotherapies in reducing bulimic symptoms. Preliminary findings indicate that CBT and IPT produce similar results at follow-up for bulimia nervosa and binge-eating disorder. Antidepressant medications are also useful in the treatment bf bulimia nervosa and binge-eating disorder, but are less likely to result in remission of symptoms than CBT. The results from comparison studies are inconsistent, with modest evidence that combining antidepressant medication and psychotherapy produces greater improvement in bulimic symptoms. Limited research has been conducted on the treatment of anorexia nervosa. although preliminary studies suggest that psychotherapy and fluoxetine may be helpful in preventing relapse after weight restoration. (C) 1999 John Wiley & Sons, Inc.