Suja Srikameswaran

Readiness to Change Dietary Restriction Predicts Outcomes in the Eating Disorders

This study examined the relationship between readiness and motivation to change eating disorder symptoms and clinical outcomes during and following intensive residential eating disorder treatment. Sixty-four women completed the Readiness and Motivation Interview (RMI) at baseline, and a subset of participants were reassessed at post-treatment (n=45) and at 6month follow-up (n=38). The RMI provides readiness scores for each of four symptom domains: restriction, cognitive, bingeing, and compensatory strategies. RMI scores were used to predict decision to enroll in treatment, dropout, symptom change following treatment, and maintenance of symptom change at six-month follow-up. The extent to which participants did not want to make changes to their dietary restriction at baseline (restriction precontemplation) was the most consistent predictor of short-term clinical outcome. The extent to which participants reported changing their restriction for themselves versus others (restriction internality) predicted outcome at 6-month follow-up. These preliminary findings suggest that assessing client readiness and motivation to change dietary restriction is most useful in predicting short and long-term clinical outcomes.

An epidemiologic study of maladaptive eating attitudes in a Canadian school age population

Although cases of anorexia nervosa and bulimia are being seen increasingly by health care professionals, little data is available on the prevalence of these disorders in the general population of school age children. Using a validated eating attitude test (EAT), a total of 5150 students, aged 12–20, from public schools and one university in the Province of Manitoba were surveyed. Overall, 5% of males and 22% of females scored 30 or above on the scale, suggesting significant concerns and attitudes regarding eating. These concerns were somewhat higher in urban versus rural settings and seemed to increase between the ages of 12 and 13 and remain high thereafter. Many of the students who scored high on the EAT were overweight, suggesting that these attitudes or concerns are not specific to anorexia nervosa and/or bulimia.

Tracking Readiness and Motivation for Change in Individuals with Eating Disorders Over the Course of Treatment

Ambivalence about recovery is a key aspect of the symptom presentation of individuals with eating disorders and increased attention has focused on understanding readiness for change in this group. This research examined shifts in global and symptom-specific readiness and motivation for change during residential eating disorders treatment. Forty-two participants completed the Readiness and Motivation Interview (RMI) prior to treatment, at week 7, and following the 12–15 week program. Demographic and symptom severity measures were completed at pre and at post. Overall, increases in readiness to change behavioral symptoms occurred prior to increases in readiness to change cognitive symptoms. Shifts in locus of control for change were less pronounced during treatment, and occurred only for the cognitive symptom domain. Subgroup analyses revealed that relative to the other eating disorder diagnostic groups (bulimia nervosa and eating disorder not otherwise specified), readiness for change in individuals with anorexia nervosa shifted less over the course of treatment.

Assessment of shape- and weight-based self-esteem in adolescents

OBJECTIVES The Adolescent version of the Shape and Weight-Based Self-Esteem (SAWBS-A) Inventory provides a contextual measure of the importance of shape and weight to overall feelings of self-worth. The psychometric properties of the adult SAWBS Inventory have been previously established. The present research examined the psychometric properties of this measure in adolescent females, and compared structural aspects of self-concept in symptomatic and nonsymptomatic individuals. METHOD A school sample of 197 adolescents completed the SAWBS-A Inventory and measures to assess concurrent and discriminant validity. A subsample completed the SAWBS-A Inventory a second time, 1 week later. RESULTS SAWBS-A scores were stable over 1 week and correlated with measures of eating disorder symptomatology. The scores also discriminated between adolescents reporting few or no disturbed eating symptoms and possible/probable cases. Comparison of self-esteem profiles in these two groups revealed that in addition to body, the groups differed in the extent to which facial appearance contributed to feelings of self-worth. CONCLUSIONS The SAWBS-A Inventory may be useful in examining structural dimensions of self-esteem in adolescents.

The efficacy of a brief motivational intervention for individuals with eating disorders: a randomized control trial.

OBJECTIVE Individuals with eating disorders are often ambivalent about recovery, and previous research has shown that readiness for change predicts enrollment in intensive treatment, symptom change, dropout, and relapse. Given the demonstrated importance of readiness for change, researchers and clinicians have turned to investigating interventions designed to enhance motivation. The purpose of this research was to determine the efficacy of Readiness and Motivation Therapy (RMT), a five-session individual preparatory intervention for individuals with eating disorders. METHOD Participants completed the Readiness and Motivation Interview and measures of eating disorder symptomatology, self-esteem, and psychiatric symptoms at intake. One hundred eighty-one participants were randomly assigned to the treatment (RMT) or wait-list control condition and were reassessed at 6-week and 3-month follow-up; 113 completed assessments at all three time points and primary analyses were based on these individuals. RESULTS Surprisingly, improvements in readiness for change, depression, drive for thinness, and bulimia symptoms occurred over time in both RMT and control conditions. However, at post and at follow-up, individuals who received RMT were less likely to have high ambivalence than were those from the control condition. DISCUSSION RMT may be of benefit to highly reluctant, clinically challenging patients and help them make better use of future, action-oriented treatment.

Factors associated with improvements in readiness for change: Low vs. normal BMI eating disorders

OBJECTIVE To examine factors associated with improvements in readiness for change as a function of body mass index (BMI) in individuals assessed for eating disorders treatment. METHOD Participants (n = 128) completed the Readiness and Motivation Interview (RMI) and measures of psychiatric and eating disorder symptoms, quality of life, and self-esteem at baseline and at 5-month follow-up. RESULTS Participants whose readiness for change showed improvements in psychiatric symptom severity, global self-esteem, and in the importance of friendships as a determinant of self-esteem. Only those with a normal baseline BMI (20 kg/m(2) or greater) improved in eating disorder symptoms and quality of life, and reported increased importance of personal development and decreased importance of shape and weight as determinants of self-esteem. CONCLUSION Correlates of readiness differed between low and normal BMI participants, suggesting that weight status may be an important variable to consider in preparing highly ambivalent individuals for treatment.

The psychometric properties of the Readiness and Motivation Questionnaire: a symptom-specific measure of readiness for change in the eating disorders.

Readiness for change, as assessed by the readiness and motivation interview (RMI), predicts a number of clinical outcome variables in eating disorders including enrollment in intensive treatment, symptom change, dropout, and relapse. Although clinically useful, the training and administration of the RMI is time consuming. The purpose of this research was to (a) develop a self-report, symptom-specific version of the RMI, the readiness and motivation questionnaire (RMQ), that can be used to assess readiness for change across all eating disorder diagnoses and (b) establish its psychometric properties. The RMQ provides stage of change, internality, and confidence scores for each of 4 eating disorder symptom domains (restriction, bingeing, and cognitive and compensatory behaviors). Individuals (N = 244) with current eating disorder diagnoses completed the RMQ and measures of convergent, discriminant, and criterion validity. Similar to the RMI scores, readiness scores on the RMQ differed according to symptom domain. Regarding criterion validity, RMQ scores were significantly associated with ratings of anticipated difficulty of recovery activities and completion of recovery activities. The RMQ contributed significant unique variance to anticipated difficulty of recovery activities, beyond those accounted for by the RMI and a questionnaire measure of global readiness. The RMQ is thus an acceptable alternative to the RMI, providing global and domain-specific readiness information when time or cost prohibits use of an interview.

Support stance in carers of adults with eating disorders: Factors associated with collaborative versus directive approaches

The support provided by family and friends is integral to patient motivation and clinical outcomes across health care populations. However, little is known about factors that promote or interfere with the type of support offered. OBJECTIVE This research examined factors associated with collaborative versus directive support among carers of adults with eating disorders. METHOD Participants were mothers, fathers, partners, friends, and siblings (N = 141) of eating disorder patients in hospital or residential treatment. Two methodologies were used to assess directive and collaborative support stance: a questionnaire of support behaviors and coded responses to clinical vignettes. Measures of interpersonal functioning, psychiatric distress, caregiving experience, and closeness with their loved one were also completed. RESULTS Although carers rated a collaborative stance as more helpful than a directive stance, 60% of responses to the clinical vignettes were directive. Across both methodologies, collaborative support behaviors were associated with beliefs about helpful support and with a less vindictive and cold interpersonal style. Whereas use of a directive support stance was exclusively associated with negative caregiving experiences, collaborative responses were associated with both positive and negative experiences. DISCUSSION Although the benefits of collaborative support have been well established, this is the first study to examine factors associated with the use of support stance. Findings suggest a number of ways to help carers create and maintain collaborative relationships, including addressing beliefs and interpersonal style and capitalizing on both positive and negative experiences with their loved one.

Resilience to shape and weight concerns and disordered eating: the role of self-compassion

Objective: This research examined applications of self-compassion (SC), an emotionally positive self-attitude in times of hardship, to shape and weight concerns and disordered eating. Methods: The Self-Compassion Scale (SCS) assesses Self-Kindness vs. Self-Judgement, Common Humanity vs. Isolation, and Mindfulness vs. Over-Identification. Women from the community (N = 131) completed measures of shape and weight concerns, disordered eating, depression, and global distress. Results: After controlling for demographic variables, SCS Self-Kindness, Self-Judgement and Isolation subscales accounted for additional unique variance in shape and weight concern measures, while the SCS Over-Identification subscale accounted for variance in disordered eating. The SCS Mindfulness subscale moderated the relation between distress and disordered eating, such that higher distress was associated with more disordered eating in individuals with low, but not high, Mindfulness. Discussion: Whereas a kind non-judgemental self-attitude may be most strongly related to shape and weight esteem, Mindfulness, and lack of Over-Identification may be more central to healthy eating.

Translating research into clinical practice across the developmental spectrum: Examining the clinical utility of the short treatment allocation tool for eating disorders: GELLER et al.

St. Paul’s Hospital Eating Disorders Program, Vancouver, British Columbia, Canada Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada B.C. Children’s Hospital Provincial Specialized Eating Disorders Program for Children & Adolescents, Vancouver, British Columbia, Canada Department of Pediatrics, Division of Adolescent Medicine, University of British Columbia, Vancouver, British Columbia, Canada Department of Education, University of British Columbia, Vancouver, British Columbia, Canada Children’s Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada Correspondence Josie Geller, St. Paul’s Hospital Eating Disorders Program, Vancouver, British Columbia, Canada. Email: jgeller@providencehealth.bc.ca