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Do symptom-specific stages of change predict eating disorder treatment outcome?

  • Diann M. AckardEmail author
  • Catherine L. Cronemeyer
  • Sara Richter
  • Amber Egan
Original Article

Abstract

Purpose

Interview methods to assess stages of change (SOC) in eating disorders (ED) indicate that SOC are positively correlated with symptom improvement over time. However, interviews require significant time and staff training and global measures of SOC do not capture varying levels of motivation across ED symptoms. This study used a self-report, ED symptom-specific SOC measure to determine prevalence of stages across symptoms and identify if SOC predict treatment outcome.

Methods

Participants [N = 182; age 13–58 years; 92 % Caucasian; 96 % female; average BMI 21.7 (SD = 5.9); 50 % ED not otherwise specified (EDNOS), 30.8 % bulimia nervosa (BN), 19.2 % anorexia nervosa (AN)] seeking ED treatment at a diverse-milieu multi-disciplinary facility in the United States completed stages of change, behavioral (ED symptom use and frequency) and psychological (ED concerns, anxiety, depression) measures at intake assessment and at 3, 6 and 12 months thereafter. Descriptive summaries were generated using ANOVA or Kruskal–Wallis (continuous) and χ 2 (categorical) tests. Repeated measures linear regression models with autoregressive correlation structure predicted treatment outcome.

Results

At intake assessment, 53.3 % of AN, 34.0 % of BN and 18.1 % of EDNOS patients were in Preparation/Action. Readiness to change specific symptoms was highest for binge-eating (57.8 %) and vomiting (56.5 %). Frequency of fasting and restricting behaviors, and scores on all eating disorder and psychological measures improved over time regardless of SOC at intake assessment. Symptom-specific SOC did not predict reductions in ED symptom frequency. Overall SOC predicted neither improvement in Eating Disorder Examination Questionnaire (EDE-Q) scores nor reduction in depression or trait anxiety; however, higher overall SOC predicted lower state anxiety across follow-up.

Conclusions

Readiness to change ED behaviors varies considerably. Most patients reduced eating disorder behaviors and increased psychological functioning regardless of stages of change, indicating the benefits of treatment and effectiveness of treatment-as-usual for overall psychiatric improvement.

Keywords

Eating disorder Anorexia nervosa Bulimia nervosa Eating disorder not otherwise specified Stages of change Treatment outcome Depression Anxiety 

Notes

Acknowledgments

Funding for this study was provided by an Innovation Grant from the Park Nicollet Foundation. The Park Nicollet Foundation had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Prochaska JJ, Velicer WF, Prochaska JO, Delucchi K, Hall SM (2006) Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks. Health Psych 25:380–388. doi: 10.1037/0278-6133.25.3.380 CrossRefGoogle Scholar
  2. 2.
    Jeffery RW, French SA, Rothman AJ (1999) Stage of change as a predictor of success in weight control in adult women. Health Psych 18:543–546. doi: 10.1037/0278-6133.18.5.543 CrossRefGoogle Scholar
  3. 3.
    O’Hea EL, Boudreau ED, Jeffries SK, Carmack Taylor CL, Scarinci IC, Brantley PJ (2004) Stage of change movement across three health behaviors: the role of self-efficacy. Am J Health Promot 19:94–102. doi: 10.4278/0890-1171-19.2.94 CrossRefPubMedGoogle Scholar
  4. 4.
    Prochaska JO, DiClemente CO (1982) Transtheoretical therapy: toward a more integrative model of change. Psychother Theory Res Pract 19:276–288. doi: 10.1037/h0088437 CrossRefGoogle Scholar
  5. 5.
    Prochaska JO, DiClemente CO (1984) The transtheoretical approach: crossing traditional boundaries of therapy. Dorsey Press, HomewoodGoogle Scholar
  6. 6.
    Prochaska JO, DiClemente CO, Norcross JC (1992) In search of how people change: applications to addictive behaviors. Am Psych 47:1102–1114. doi: 10.1037/0003-066X.47.9.1102 CrossRefGoogle Scholar
  7. 7.
    Wade TD, Frayne A, Edwards S-A, Robertson T, Gilchrist P (2009) Motivational change in an inpatient anorexia nervosa population and implications for treatment. R Aus N Z Coll Psychiatr 43:235–243. doi: 10.1080/00048670802653356 CrossRefGoogle Scholar
  8. 8.
    Franko D (1997) Ready or not? Stages of change as predictors of brief group therapy outcome in bulimia nervosa. Group 21:39–45. doi: 10.1007/BF02872753 CrossRefGoogle Scholar
  9. 9.
    Geller J, Drab-Hudson DL, Whisenhunt BL, Srikameswaran S (2004) Readiness to change dietary restriction predicts outcomes in the eating disorders. Eat Disord 12:209–224. doi: 10.1080/10640260490490438 CrossRefPubMedGoogle Scholar
  10. 10.
    Treasure JL, Katzman M, Schmidt U, Troop N, Todd G, deSilva P (1999) Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy. Behav Res Ther 37:405–418. doi: 10.1016/S0005-7967(98)00149-1 CrossRefPubMedGoogle Scholar
  11. 11.
    Wolk SL, Devlin MJ (2001) Stage of change as a predictor of response to psychotherapy for bulimia nervosa. Int J Eat Disord 30:96–100. doi: 10.1002/eat.1058 CrossRefPubMedGoogle Scholar
  12. 12.
    McHugh MD (2007) Readiness for change and short-term outcomes of female adolescents in residential treatment for anorexia nervosa. Int J Eat Disord 40:602–612. doi: 10.1002/eat.20425 CrossRefPubMedGoogle Scholar
  13. 13.
    Bewell CV, Carter JC (2008) Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa. Int J Eat Disord 41:368–371. doi: 10.1002/eat.20513 CrossRefPubMedGoogle Scholar
  14. 14.
    Allen KL, Fursland A, Raykos B, Steele A, Watson H, Byrne SM (2011) Motivation-focused treatment for eating disorders: a sequential trial of enhanced cognitive behaviour therapy with and without preceding motivation-focused therapy. Eur Eat Disord Rev 20:232–239. doi: 10.1002/erv.1131 CrossRefPubMedGoogle Scholar
  15. 15.
    Geller J, Brown KE, Srikameswaran S (2011) The efficacy of a brief motivational intervention for individuals with eating disorders: a randomized control trial. Int J Eat Disord 44:497–505. doi: 10.1002/eat.20847 CrossRefPubMedGoogle Scholar
  16. 16.
    Geller J, Cockell SJ, Drab DL (2001) Assessing readiness for change in the eating disorders: the psychometric properties of the readiness and motivation interview. Psych Assess 13:189–198. doi: 10.1037/1040-3590.13.2.189 CrossRefGoogle Scholar
  17. 17.
    Geller J, Drab DL (1999) The Readiness and Motivation Interview: a symptom-specific measure of readiness of change in the eating disorders. Eur Eat Disord Rev 7:259–278. doi: 10.1002/(SICI)1099-0968(199908)7:4<259:AID-ERV295>3.0.CO;2-6 CrossRefGoogle Scholar
  18. 18.
    Ackard DM, Croll JK, Richter S, Adlis S, Wonderlich A (2009) A self-report instrument measuring readiness to change disordered eating behaviors: the eating disorders stage of change. Eat Weight Disord 14:e66–e76. doi: 10.1007/BF03327802 CrossRefPubMedGoogle Scholar
  19. 19.
    Fairburn CG, Cooper Z (1993) The eating disorder examination. In: Fairburn CG, Wilson GT (eds) Binge eating: nature, assessment and treatment, 12th edn. Guilford Press, New YorkGoogle Scholar
  20. 20.
    Mond JM, Hay PJ, Rodgers B, Owen C (2006) Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women. Behav Res Ther 44:53–62. doi: 10.1016/j.brat.2004.12.003 CrossRefPubMedGoogle Scholar
  21. 21.
    Luce KH, Crowther JH, Pole M (2008) Eating Disorder Examination Questionnaire (EDE-Q): norms for undergraduate women. Int J Eat Disord 41:273–276. doi: 10.1002/eat.20504 CrossRefPubMedGoogle Scholar
  22. 22.
    Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJ (2004) Temporal stability of the Eating Disorders Examination Questionnaire. Int J Eat Disord 36:195–203. doi: 10.1002/eat.20017 CrossRefPubMedGoogle Scholar
  23. 23.
    Luce KH, Crowther JH (1999) The reliability of the Eating Disorder Examination Self-Report Questionnaire version (EDE-Q). Int J Eat Disord 25:349–351. doi: 10.1002/(SICI)1098-108X(199904)25:3<349:AID-EAT15>3.0.CO;2-M CrossRefPubMedGoogle Scholar
  24. 24.
    Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II. Psychological Corporation, San AntonioGoogle Scholar
  25. 25.
    Osman A, Kopper B, Barrios F, Gutierrez P, Bagge C (2004) Reliability and validity of the Beck Depression Inventory-II with adolescent psychiatric inpatients. Psych Assess 16:120–132. doi: 10.1037/1040-3590.16.2.120 CrossRefGoogle Scholar
  26. 26.
    Robinson JP, Shaver PR, Wrightsman LS (1991) Measures of personality and social psychological attitudes. Academic Press, San DiegoGoogle Scholar
  27. 27.
    Spielberger CD (2003) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo AltoGoogle Scholar
  28. 28.
    Hollander M, Wolfe DA (1999) Nonparametric statistical methods, 2nd edn. John Wiley & Sons, New YorkGoogle Scholar
  29. 29.
    Dray J, Wade TD (2012) Is the transtheoretical model and motivational interviewing approach applicable to the treatment of eating disorders? A review. Clin Psychol Rev 32:558–565. doi: 10.1016/j.cpr.2012.06.005 CrossRefPubMedGoogle Scholar
  30. 30.
    Touyz S, Thornton C, Rieger E, George L, Beumont P (2003) The incorporation of the stage of change model in the day hospital treatment of patients with anorexia nervosa. Eur Child Adolesc Psychiatry 12:i65–i71. doi: 10.1007/s00787-003-1109-5 CrossRefPubMedGoogle Scholar
  31. 31.
    Willinge AC, Touyz SW, Thornton C (2010) An evaluation of the effectiveness and short-term stability of an innovative Australian day patient programme for eating disorders. Eur Eat Disord Rev 18:220–233. doi: 10.1002/erv.997 CrossRefPubMedGoogle Scholar
  32. 32.
    Field AE, Herzog DB, Keller MB, West J, Nussbaum K, Colditz GA (1997) Distinguishing recovery from remission in a cohort of bulimic women: how should asymptomatic periods be described? J Clin Epi 50:1339–1345. doi: 10.1016/S0895-4356(97)00220-5 CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Diann M. Ackard
    • 1
    • 2
    Email author
  • Catherine L. Cronemeyer
    • 2
  • Sara Richter
    • 3
  • Amber Egan
    • 3
  1. 1.Golden ValleyUSA
  2. 2.Park Nicollet Melrose CenterSt Louis ParkUSA
  3. 3.Park Nicollet InstituteSt Louis ParkUSA

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