Prognostic value of autonomous and controlled motivation in outpatient eating‐disorder treatment

Sansfaçon, Jeanne; Gauvin, Lise; Fletcher, Émilie; Cottier, Danaëlle; Rossi, Erika; Kahan, Esther; Israël, Mimi; Steiger, Howard

doi:10.1002/eat.22901

Cited by 12 publications

(14 citation statements)

References 34 publications

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“…The majority of included studies (38 out of 42) were based on DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria. Two recent studies (Cardi et al, 2020; Pellizzer, Waller, & Wade, 2018) used DSM‐5 criteria, whereas two studies (Riesco et al, 2018; Sansfaçon et al, 2018) included individuals that were admitted using either DSM‐IV‐TR or DSM‐5 criteria (depending on the exact date of admission), and re‐assigned the DSM‐5 diagnosis retrospectively.…”

Section: Methodsmentioning

confidence: 99%

“…Twenty‐five authors were contacted on at least two occasions pertaining to missing results in 27 of our included articles. Seven authors responded and kindly agreed to send unpublished data (Bustin, Lane‐Loney, Hollenbeak, & Ornstein, 2013; Geller et al, 2004; Geller, Cockell, & Drab, 2001; Pauli, Aebi, Winkler Metzke, & Steinhausen, 2017; Rieger et al, 2000; Sansfaçon et al, 2018; Schreyer, 2012; Thaler et al, 2016).…”

Section: Methodsmentioning

confidence: 99%

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Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta‐analysis

Sansfaçon

Booij

Gauvin

et al. 2020

Intl J Eating Disorders

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Objective: Identifying modifiable predictors of outcomes following treatment for eating disorders may help to tailor interventions to patients' individual needs, improve treatment efficacy, and develop new interventions. The goal of this meta-analysis was to quantify the association between pretreatment motivation and posttreatment changes in eating disorder symptomology. Method: We reviewed 196 longitudinal studies reporting on change on indices of overall eating-disorder symptomatology, weight gain, binge-eating, vomiting, anxiety/depression, and treatment adherence. Meta-analyses were performed using two complementary approaches: (a) combined probability analysis using the added Z's method; (b) effect size analyses. Using random-effect models, effect sizes were pooled when there were at least three studies with the same type of statistical design and reporting statistics on the same outcome. Heterogeneity in study outcome was evaluated using Q and I 2 statistics. Studies were reviewed qualitatively when the number of studies or reported data were insufficient to perform a meta-analysis. Results: Forty-two articles were included. Although samples and treatments differed substantially across studies, results across studies were remarkably consistent. Both combined-probability and effect-size analyses indicated positive effects of pretreatment motivation on improvement in general eating-disorder symptoms (Cohen's r = .17), and an absence of effects on anxiety/depression symptoms. Remaining outcome indices were subject to selective reporting and/or small sample size bias. Discussion: Our findings underscore the importance of incorporating treatment engagement approaches in the treatment of eating disorders. Optimal reporting of study findings and improving study quality would improve future efforts to obtain an in-depth understanding of the relationship between motivation and eating disorder symptoms.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta‐analysis

Sansfaçon

Booij

Gauvin

et al. 2020

Intl J Eating Disorders

Self Cite

View full text Add to dashboard Cite

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“…In a sample of 463 women with a diagnosed eating disorder, the internal consistency of the ACMTQ autonomous motivation subscale was α = 0.85, and α = 0.80 for the controlled motivation subscale, with a test‐retest reliability of 0.73 for both (Sansfaçon et al., 2019). For the current study, only the autonomous motivation subscale was used, due to previous studies not finding significant results with the controlled motivation subscale (Sansfacon et al., 2018; Thaler et al., 2016). In the current study, the reliability of the ACMTQ, measured by Cronbach's Alpha, was α = 0.837 for the autonomous motivation subscale.…”

Section: Methodsmentioning

confidence: 99%

Predictors of non‐completion of a day treatment program for adults with eating disorders

Thaler

Booij

Burnham

et al. 2021

Euro Eating Disorders Rev

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Although treatment dropout is common among patients with eating disorders, very few studies have examined predictors of non-completion in day treatment. We investigated various potential predictors of dropout from adult day treatment. Participants were 295 adult patients with a diagnosis of Anorexia Nervosa (restricting or binge-eating/purging subtype), Bulimia Nervosa (BN), Other Specified Feeding or Eating Disorder, or Avoidant Restrictive Food Intake Disorder. Predictors included eating-disorder characteristics, motivation at the commencement of treatment, Body Mass Index (BMI), time spent in treatment and personality dimensions. Logistic regression analyses showed that for patients with a BMI of less than 20 at the start of treatment, low BMI was a significant predictor of staff-initiated termination due to not meeting weight gain goals. Furthermore, completing less than 6 weeks of treatment was associated with staff-initiated termination. For the whole sample, those with higher changes in weight over the course of treatment were less likely to terminate prematurely. None of the other predictor variables yielded significant results. Results of the current study highlight characteristics of patients who are more likely not to complete day treatment and can help identify patients who may be at risk for not succeeding in multi-diagnostic day treatment programs.

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“…Accumulating evidence associates autonomous motivation with better responses to treatment for various problems. The importance of autonomous motivation for eating disorder (ED) treatment has been studied in various populations and treatment contexts and here, too, findings suggest that patients who are more autonomously motivated show better treatment response (Carter & Kelly, ; Mansour et al, ; Sansfaçon et al, ; Steiger et al, ; van der Kaap‐Deeder et al, ; Vansteenkiste, Soenens, & Vandereycken, ). The preceding seems to be true even for patients treated in inpatient settings, where external (vs. internal) factors may be thought to more strongly influence outcome (Thaler et al, ).…”

Section: Autonomous Motivation For Treatmentmentioning

confidence: 95%

A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome?

Hodge

Gauvin

St‐Hilaire

et al. 2019

Intl J Eating Disorders

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Objective Although hospitalization is sometimes necessary when treating individuals with anorexia nervosa, the available literature provides limited guidance to inform decisions surrounding optimal components or duration of inpatient treatments. We report observational data comparing outcomes of two inpatient treatments. The first was longer and more strictly structured around a Contingency Management Protocol (CMP) emphasizing external incentives for achieving weight‐restoration goals; the second was a shorter Autonomy Support Protocol (ASP) that progressively increased patient autonomy around meal management without external incentives. Method We compared data from 41 patients who participated in the ASP to a historical sample of 41 patients treated using the CMP. At admission, discharge, and post‐treatment follow‐up, participants completed the Eating Disorder Examination Questionnaire and the Behavior and Symptom Identification Scale‐32, and we measured height and weight to compute body mass index. Results Multilevel modeling analyses that controlled for time in treatment and time in follow‐up indicated the two protocols yielded equivalent in‐treatment gains and post‐treatment loss of gains. Discussion Our results indicate that shorter inpatient stays emphasizing autonomous control over eating behavior may yield outcomes that are equivalent to those of lengthier, more stringent, and more costly approaches implicating external incentives and controls.

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Prognostic value of autonomous and controlled motivation in outpatient eating‐disorder treatment

Abstract: Our results suggest that autonomous motivation has trans-diagnostic influence upon response to various intensities of treatment for an eating disorder. In support of an autonomy supportive approach to treatment, findings link autonomous motivation with more favorable outcome.

Cited by 12 publications

References 34 publications

Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta‐analysis

Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta‐analysis

Predictors of non‐completion of a day treatment program for adults with eating disorders

A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome?

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