A preview of this full-text is provided by American Psychological Association.
Content available from Psychology of Addictive Behaviors
This content is subject to copyright. Terms and conditions apply.
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 (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. 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.