Reprinted from Eating Disorders Review
July/August 2001 Volume 12, Number 4
©2001 Gürze Books
Patients with eating disorders are often difficult to treat because of their ambivalence about therapy and lack of motivation to change. Typically they reluctantly enter therapy only after strong pressure by their families, friends, and physicians. Afterward, it’s not unusual for them to drop out of treatment prematurely.
The goal of motivational interviewing is to help clients decide to change by recognizing the discrepancy between their present behavior and their life goals or values. The client, not the therapist, poses the arguments for change. This approach has proved helpful for people who are ambivalent about treatment because the decision to change is not imposed on them by someone else.
Five stages of change
Dr. D. Blake Woodside and colleagues at Toronto General Hospital and the University of Toronto recently designed a pilot group program to increase motivation to change among 38 patients with eating disorders (Int J Eat Disord 2001; 29:393). The program involved motivational enhancement therapy (MET), which is based upon the transtheoretical model of change. This model identifies 5 stages clients pass through while trying to change (pre-contemplation, contemplation, preparation, action, and maintenance). The goal is to identify which stages the clients are in, to help them move through and to achieve lasting change.
The MET intervention was based on a treatment manual designed for this study, and consisted of 4 hour-long sessions over 4 consecutive weeks. Some topics included the benefits and costs of having an eating disorder and predicting what life would be like in 5 years with and without the disorder.
After intervention, many sought treatment
Nineteen patients completed the study protocol. The only statistically significant difference between those who completed treatment and those who did not was the prevalence of purging: 79% of those who dropped out of the study purged, compared with 42% of those who completed the study.
After the intervention, participants recognized that their disordered eating was a problem; there were decreases in depressive symptoms and interpersonal distrust and an increase in overall self-esteem. After 6 weeks, most of the group members had entered a treatment program.
One of the challenges for the researchers was recruiting patients for the program. Of the initial 38 patients who were assessed for this study, only 27 entered the intervention study. According to the authors, relatively high dropout rate is a good reflection of the very ambivalence and lack of motivation of this study population. The authors suggest that a controlled study with a larger number of participants and longer-term follow-up will help determine if the intervention program can help motivate patients to enter and remain in treatment programs.