Do symptom-specific stages of change predict eating disorder treatment outcome?
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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.
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.
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.
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.
KeywordsEating disorder Anorexia nervosa Bulimia nervosa Eating disorder not otherwise specified Stages of change Treatment outcome Depression Anxiety
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.
- 5.Prochaska JO, DiClemente CO (1984) The transtheoretical approach: crossing traditional boundaries of therapy. Dorsey Press, HomewoodGoogle Scholar
- 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
- 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
- 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
- 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
- 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.Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II. Psychological Corporation, San AntonioGoogle Scholar
- 26.Robinson JP, Shaver PR, Wrightsman LS (1991) Measures of personality and social psychological attitudes. Academic Press, San DiegoGoogle Scholar
- 27.Spielberger CD (2003) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo AltoGoogle Scholar
- 28.Hollander M, Wolfe DA (1999) Nonparametric statistical methods, 2nd edn. John Wiley & Sons, New YorkGoogle Scholar