Search

Objective: We examined the psychometric properties of the Eating Disorder Readiness Ruler a simple self-report instrument designed to enable rapid assessment of readiness to change problematic eating behaviours in people with clinical eating disorders., Method: We administered the ED-RR, the Eating Disorders Examination Questionnaire and a measure of autonomous and controlled motivation for change to 206 individuals receiving outpatient treatment for an eating disorder., Results: A principal axis factoring analysis of the ED-RR yielded a significant two-factor solution (explaining 59% of variance)-one factor pertaining to restriction and body image preoccupation (four items), the other to binge-eating and vomiting symptoms (two items). The ED-RR showed good internal consistency (alpha coefficients for the two factors being .77 and .84 respectively). Furthermore, individuals reporting higher readiness showed higher scores on independent measures of autonomous motivation and greater symptom reductions over time., Discussion: Results suggest that the ED-RR is a psychometrically sound tool with potential clinical utility. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association., (Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.)

Background: Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth., Methods: From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13-17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children's hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined., Discussion: As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families' needs.

Clinical acumen is often used to assess families' motivation prior to initiating pediatric obesity management due to a lack of available tools. The purpose of this pilot study was to (i) develop and (ii) pilot test the "Readiness and Motivation Interview for Families" (RMI-Family) in pediatric weight management. We conducted 5 focus groups with parents (n = 15), youth with obesity (n = 11), and health care providers (n = 8) to explore perceptions of barriers to making healthy behaviour changes, which led to the creation of the RMI-Family as a semi-structured interview. Five domains (treat foods, overeating, emotional eating, total physical activity, and screen time) emerged from the focus groups to inform the development of the RMI-Family, which was then pilot tested with a sample of youth with obesity and their parents (n = 11 dyads). Interviewers administered the RMI-Family to youth (age 12.8 ± 1.7 years; body mass index [BMI] z-score: 2.71 ± 0.43) and parents (age 47.1 ± 3.7 years; BMI: 33.5 ± 10.1 kg/m(2)). The RMI-Family was feasible to administer, easily understood by families, and may be a useful tool for assessing families' motivation. Research is underway to determine the psychometric properties and utility of the RMI-Family in predicting clinical outcomes in pediatric weight management.

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.

Objective: Reluctance to recover may explain poor treatment outcome and high dropout and relapse rates in the treatment of anorexia nervosa (AN). This study systematically explored what AN patients describe as interfering with their wish to recover., Method: Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological study design. Interviews were tape recorded, transcribed and analysed using QSR-NVivo7 (QSR International, Melbourne, Australia) software., Results: Seven core obstacles were found to interfere with informants' wish to recover as follows: (i) 'perceiving judgements'; (ii) 'feeling stuck'; (iii) 'feeling distressed'; (iv) 'denying AN'; (v) 'eating'; (vi) 'gaining weight'; and (vii) 'appreciating the benefits'., Conclusion: The wish to recover is an autonomously based, fundamental motivational requirement for becoming ready to change. Understanding factors that contribute to this wish adds to the clinician's toolbox in motivational work with AN patients., (Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.)

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., (Copyright © 2010 Wiley Periodicals, Inc.)

Dropout and recidivism from addiction treatment has been found to be associated with individuals' readiness for change. Motivation for treatment among participants entering the North American Opiate Medication Initiative (NAOMI) randomized controlled trial, which compared heroin assisted treatment (HAT) to optimized methadone maintenance treatment (MMT), was assessed. Through multivariate regression, we aimed to determine whether baseline motivational status was predictive of four treatment outcomes: early dropout, 12-month retention, 12-month response to treatment, and time to discontinuation of treatment. Among the 251 out-of-treatment chronic opioid dependent patients recruited in Montreal, Quebec and Vancouver, British Columbia, 52% reported having a high level of motivation for treatment. HAT was statistically significantly more effective than MMT on each of the outcomes assessed. Baseline motivational status did not predict retention or time to discontinuation in either HAT or MMT. However, while patients were retained in HAT regardless of motivational status, motivated patients showed a more favourable response to treatment in terms of decreases in crime and illicit drug use. These results suggest that HAT successfully retains opioid dependent patients who otherwise may not have been attracted into existing treatment options, and may enhance the odds of successful rehabilitation among patients motivated for treatment., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

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., (2008 by Wiley Periodicals, Inc.)

Objective: Motivational approaches to anorexia nervosa (AN) have mainly concerned motivational quality and quantity. We investigated the content of patients' wish to recover., Method: Eighteen women, aged 18-39, with AN were interviewed in depth using a phenomenological study design. Interviews were tape-recorded, transcribed, and analyzed using the QSR-N*Vivo software program., Results: Four motivational content areas characterized informants' wishes to recover: "Sense of vitality" (e.g., joy, concentration, spontaneity, energy); "Sense of autonomy" (e.g., choosing to recover, new methods of mastery, self-determination); "Sense of insight" (e.g., awareness, seeing nuances, limitation of goals, self-knowledge); and "Negative consequences" (e.g., loss of future, costs to own children, feeling sick or thin, social costs, physical costs)., Conclusion: Our sample of AN patients' motivation to recover may be described using three dimensions: content, quality, and quantity, and may also include motives with no behavioral intention. Sustained therapeutic success may rest upon the therapist's ability to identify and ally with the patient's motives to recover.

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning.

This article describes a model for change that draws upon motivational and cognitive-behavioural theories. It is suggested that maladaptive beliefs hold individuals captive in destructive self-perpetuating cycles dominated by the illness. In the context of a trusting therapeutic relationship, inquiry and experimentation can lead to the reformulation of maladaptive beliefs, and to the development, reprioritization and/or strengthening of higher values. A clear cohesive system of higher values allows individuals to make autonomous life decisions, which reduces the need for maladaptive coping strategies.

Objective: This research compared the relative ability of clients, clinicians, and research assessors in estimating readiness for change in individuals with anorexia nervosa., Method: Fifty-six individuals with a current or past diagnosis of anorexia nervosa made ratings of the extent to which they perceived themselves to be ready for treatment and recovery. Clinicians and research assessors made the same ratings based on their impressions following clinical and research assessments, respectively. The outcome variables included questionnaire measures of change activities, assigned behavioral tasks, and clients' decision to accept intensive treatment., Results: While research assessor and client ratings predicted questionnaire recovery activities, only research assessor ratings predicted completion of behavioral tasks and clients' decision to accept intensive treatment. Clinician ratings were not related to any of the questionnaire or behavioral recovery activity measures., Discussion: Conditions favoring the accurate prediction of readiness for treatment and recovery are discussed, and implications for clinical practice are addressed., (Copyright 2002 by Wiley Periodicals, Inc.)

Objective: While stage of change has been shown to be a robust predictor of eating disorder treatment outcome, little attention has been paid to the role of confidence. This study sought to better understand the role of confidence and the possible interaction it may have with stage of change in promoting eating disorder symptom change. Method: Participants were adult women in inpatient treatment for eating disorders. They completed measures of motivation for change, which assessed precontemplation, action, confidence and internality (changing for oneself vs. others) and eating disorder symptom severity at pretreatment (N = 159) and posttreatment (n = 59). Only treatment completer analyses were used. Results: Precontemplation and confidence had significant effects on pretreatment and posttreatment symptom severity, while action only had a significant effect on pretreatment symptoms. Confidence was shown to moderate relations between both measures of stage of change (i.e., precontemplation and action) and symptoms posttreatment. Follow‐up analyses indicated that high precontemplation was associated with poor outcome, irrespective of confidence, however, low precontemplation was associated with better outcome at high levels of confidence. The interaction between confidence and action was also significant at very high levels of confidence. That is, among individuals who had high action at baseline, those with low confidence had significantly poorer outcomes relative to those with high confidence. Discussion: Findings indicate that stage of change and confidence are both important prognostic factors and suggest that early behavior change in the absence of confidence may not guarantee best outcomes in inpatient eating disorder treatment. [ABSTRACT FROM AUTHOR]

Previous research has shown that unlike two-factor solutions found in other populations, the Decisional Balance (DB) scale for anorexia nervosa consists of three factors: Benefits (Pros), Burdens (Cons), and Functional Avoidance. Objective The purpose of this study was to examine the psychometric properties of the DB scale for anorexia nervosa and to investigate relationships between DB scores and pre-action stages of change. Method Eighty women with anorexia nervosa were recruited from consecutive referrals to an eating disorder clinic. Participants completed the DB scale, as well as measures to assess validity. Results The DB scale demonstrated good convergent and discriminant validity. Furthermore, relative to individuals in precontemplation, individuals in contemplation reported more disadvantages of anorexia nervosa (i.e. higher Burdens) and more insight regarding how anorexia nervosa provides a means to avoid (i.e. higher Functional Avoidance). Benefits of anorexia nervosa did not change between pre-action stages. Discussion The clinical implications for enhancing readiness to change are addressed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a Decisional Balance (DB) measure of readiness for change in anorexia nervosa. A total of 246 women with anorexia nervosa completed a 60-item DB scale. A 3-factor solution provided the best fit for the DB data, which reduced the scale to 30 items. Two of these, namely Burdens and Benefits, resembled the pro and con factors found in previous research. The third factor, Functional Avoidance, was unique to the decisional balance literature; it included items reflecting the ways that anorexia nervosa provides a way to avoid dealing with aversive emotions, challenges, and responsibilities. The DB demonstrated good internal consistency and acceptable test–retest reliability. This measure could be used to help us better understand the shifts that occur as individuals with anorexia nervosa develop a desire to change. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Ambivalence about recovery is a central feature of anorexia nervosa, and resistance to recovery in the eating disorders is common. Careful assessment of motivation and readiness may be useful in treatment planning in order to reduce the likelihood of dropout and treatment noncompliance. This paper describes the Readiness and Motivation Interview for Eating Disorders (RMI), a semi-structured assessment tool that elicits information on individuals' experience of, and attachment to their symptoms. The RMI allows for readiness and motivation for change status to be determined, and assesses the extent to which change, when occurring, is for internal versus external reasons. In contrast to more commonly used global measures of stage of change, the RMI provides detailed symptom-specific information about readiness and motivation in the eating disorders. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]