Improving motivation to change amongst individuals with eating disorders: A systematic review

Denison-Day, James; Appleton, Katherine; Newell, Ciarán; Muir, Sarah

doi:10.1002/eat.22945

Cited by 32 publications

(30 citation statements)

References 78 publications

(182 reference statements)

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“…This contemplation group intervention did not aim to improve participants' motivation for treatment directly, however, as the results of this evaluation show, the group seems to have led to an increase in motivation for some patients. This is in line with a recent study which showed that interventions that do not solely focus on motivation might be as effective at improving levels of motivation as interventions aimed specifically at motivation [24]. There have recently been some research proposals to review whether motivation to change is a useful indicator of treatment outcomes [25], as the literature currently offers mixed views on this [11,25].…”

Section: Discussionsupporting

confidence: 80%

To contemplate or not to contemplate evaluating a preliminary intervention proposal in an outpatient setting: the contemplation therapy group

Sanford-Opatz

Woodward

O’Reilly³

et al. 2018

Eat Weight Disord

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Purpose: The concept for the Contemplation Group Intervention was derived from Motivational Interviewing (MI) to support people suffering from an eating disorder who are reluctant to engage with treatment. This evaluation focuses on the contemplation group run by the eating disorder services in the Cardiff and Vale area between 2012 and 2016 to investigate the outcomes for participants and implications for working with people suffering from an eating disorder who are ambivalent about change. Method: Quantitative measures were used to assess eating disorder symptomatology, motivation to change and location within the stages of change model. A brief qualitative evaluation of client experiences was also included. Results: While dropout was high, a number of patients displayed increased readiness for treatment at the end of the group or even started to engage in change focussed therapy. Participants who completed the group described it as challenging but helpful. Conclusions: This evaluation shows that explorative contemplation of their ambivalence towards their eating disorder and treatment was helpful for the participants of the group and supported them in achieving more clarity and decisiveness regarding whether to engage in treatment or not. Further research is needed to evaluate long-term outcomes for patients who feel ambivalent towards treatment, and to explore what interventions can be used to help them. Manuscript Click here to access/download;Manuscript;24-10-18 Contemplation paper-revised submission.docx Click here to view linked References Evidence Level: Level V: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

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Section: Discussionsupporting

confidence: 80%

To contemplate or not to contemplate evaluating a preliminary intervention proposal in an outpatient setting: the contemplation therapy group

Sanford-Opatz

Woodward

O’Reilly³

et al. 2018

Eat Weight Disord

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“…Digital interventions have been identified as a potential approach to improving motivation to change among people with eating disorders [27]; our findings do not rule out this approach to addressing issues regarding low levels of treatment attendance. Indeed, both participants in the case studies suggested that, while MotivATE may not in and of itself be the solution, at least in its current form, the underlying concept remained a positive one.…”

Section: Discussioncontrasting

confidence: 73%

A Web-Based Intervention (MotivATE) to Increase Attendance at an Eating Disorder Service Assessment Appointment: Zelen Randomized Controlled Trial

Denison-Day¹,

Muir²,

Newell³

et al. 2019

J Med Internet Res

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BackgroundEarly assessment and treatment of eating disorder patients is important for patient outcomes. However, up to a third of people referred for treatment do not access services and 16.4% do not attend their first scheduled assessment appointment. MotivATE is a fully automated, novel, Web-based program intended to increase motivation to change eating disorder behaviors, designed for delivery at the point of invitation to an eating disorder service, with the aim of increasing service attendance.ObjectiveThis paper assesses the impact of MotivATE on attendance at assessment when compared with treatment-as-usual.MethodsA Zelen randomized controlled design was used. All individuals referred to a specialist eating disorder service, Kimmeridge Court in Dorset, UK, over the course of a year (October 24, 2016-October 23, 2017) were randomized to treatment-as-usual only or treatment-as-usual plus an additional letter offering access to MotivATE. Attendance at the initial scheduled assessment appointment was documented. Logistic regression analysis assessed the impact of MotivATE on attendance at assessment. Additional analyses based on levels of engagement with MotivATE were also undertaken.ResultsA total of 313 participants took part: 156 (49.8%) were randomized to treatment-as-usual and 157 (50.2%) were randomized to receive the additional offer to access MotivATE. Intention-to-treat analysis between conditions showed no impact of MotivATE on attendance at assessment (odds ratio [OR] 1.35, 95% CI 0.69-2.66, P=.38). Examination of the usage data indicated that only 53 of 157 participants (33.8%) in the MotivATE condition registered with the Web-based intervention. An analysis comparing those that registered with the intervention with those that did not found greater attendance at assessment in those that had registered (OR 9.46, 95% CI 1.22-73.38, P=.03).ConclusionsOur primary analyses suggest no impact of MotivATE on attendance at the first scheduled assessment appointment, but secondary analyses revealed limited engagement with the program and improved attendance in those who did engage. It is unclear, however, if engagement with the program increased motivation and, in turn, attendance or if more motivated individuals were more likely to access the intervention. Further research is required to facilitate engagement with Web-based interventions and to understand the full value of MotivATE for users.Trial RegistrationClinicalTrials.gov NCT02777944; https://clinicaltrials.gov/ct2/show/NCT02777944 (Archived by WebCite at http://www.webcitation.org/75VDEFZZ4)

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“…However, the attrition observed in the group condition (37.5%) appears higher than previous ED prevention groups (1–17%; McMillan, Stice, & Rohde, 2011; Stice, Butryn, Rohde, Shaw, & Marti, 2013). This could be because, compared with prior research, this study involved a lengthier time commitment (eight sessions vs. three to four) and lower participant incentive amounts ($5–15 compared with, for example, $30–150 per assessment; Denison‐Day, Appleton, Newell, & Muir, 2018; Stice, Rohde, Butryn, Shaw, & Marti, 2015, Stice, Shaw, Burton, & Wade, 2006).…”

Section: Discussionmentioning

confidence: 98%

An uncontrolled pilot feasibility trial of an intuitive eating intervention for college women with disordered eating delivered through group and guided self‐help modalities

Burnette

Mazzeo

2020

Intl J Eating Disorders

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Objective College women engage in high rates of disordered eating behaviors (DEBs), and most do not receive treatment. Campuses lack resources to meet this need, thus accessible and affordable treatment options are important. Intuitive eating (IE) is gaining mainstream interest, but intervention research is scarce, with no known clinical trials in college women. This uncontrolled pilot trial examined the feasibility, acceptability, and preliminary efficacy of an eight‐week IE intervention delivered through two potentially accessible and affordable modalities: group and guided self‐help (GSH). Method Racially and ethnically diverse college women (N = 71; <50% White) were recruited from a large public Mid‐Atlantic university and randomized to group (n = 40) or GSH (n = 31). Assessments occurred at 0 (pre‐test), 8 (post‐test), and 16 weeks (follow‐up). Group participants attended eight weekly 1.5‐hour sessions. GSH participants engaged in self‐study and had eight weekly 20‐minute phone calls. Results Both conditions demonstrated feasibility, with superior retention and attendance in GSH. Over 90% of those attending at least one session in either condition were retained through follow‐up. Both conditions were highly acceptable, and produced medium to large reductions in DEBs, body dissatisfaction, and weight‐bias internalization, and improvements in body appreciation, IE, and satisfaction with life from pre‐ to post‐test, which were maintained at follow‐up. Discussion Results of this pilot are encouraging and support the development of a larger randomized controlled trial. Avenues for refinement include strategies to improve feasibility of the group condition, and conducting longer‐term follow‐up to examine maintenance of effects and the intervention's eating disorder prevention potential.

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Improving motivation to change amongst individuals with eating disorders: A systematic review

Abstract: Motivation was found to increase across treatments in general, whether or not the focus of the intervention was on enhancing motivation. It is unclear if interventions specifically targeting motivation to change provide additional benefit over and above established treatment approaches.

Cited by 32 publications

References 78 publications

To contemplate or not to contemplate evaluating a preliminary intervention proposal in an outpatient setting: the contemplation therapy group

To contemplate or not to contemplate evaluating a preliminary intervention proposal in an outpatient setting: the contemplation therapy group

A Web-Based Intervention (MotivATE) to Increase Attendance at an Eating Disorder Service Assessment Appointment: Zelen Randomized Controlled Trial

An uncontrolled pilot feasibility trial of an intuitive eating intervention for college women with disordered eating delivered through group and guided self‐help modalities

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