The impact of a motivational assessment interview on initial response to treatment in adolescent anorexia nervosa

Abstract

This study was a pilot for a larger study to evaluate a time-limited outpatient programme for adolescent anorexia nervosa, to explore the ability of an assessment interview to change self-reported motivation and ascertain the extent to which this predicted engagement with treatment and early behavioural change. Fortytwo adolescents with anorexia nervosa rated their motivation for change before and after attending a new-style assessment interview. Initial (6 week) effectiveness of the programme was evaluated by measuring engagement with treatment, weight change, clinician (HoNOSCA) and self-rated (EDI, MFQ, HoNOSCA-SR) outcome measures, overall and in relation to motivational status. The assessment interview significantly improved motivation. Motivational category after interview was unrelated to physical status, cognition or general functioning but predicted engagement with treatment. Whilst for the whole sample, treatment produced physical, cognitive and general improvements at 6 weeks, motivational status was a powerful predictor of weight gain. A clientcentred assessment interview engaged 80% in an outpatient programme based on CBT. Motivational enhancement may improve engagement and specifically result in behavioural change and early weight gain.

Denial and minimization in adolescents with anorexia nervosa

“…In fact, a recent study examining an interview for assessing motivation for change was able to discriminate between patients with AN who were likely to engage well in individual treatment and produce early weight gain compared with those in whom an individual approach was ineffective. 10 Future research on whether denial is a moderator of outcome for family or individual approaches would be beneficial.…”

Emotion Regulation in Youth with Emotional Disorders: Implications for a Unified Treatment Approach

“…Rather, some adolescents had been encouraged to seek services because some other person or agency believed it necessary (e.g., parents, school counselor). Techniques based on the seminal work by Miller and Rollnick (2002) have been included in the protocol as motivational enhancement techniques have proven useful with youth in other forms of treatment (e.g., Gowers and Smyth 2004). Although this material is described as an optional treatment section, it is conceptualized as a set of techniques therapists may opt to use at any point throughout treatment.…”

Readiness to recover in anorexia nervosa: what does it depend on in female inpatients?

“…Weight gain, a superficially appealing candidate for prospective prediction, particularly given its relationship to motivational status in adolescent outpatients (Gowers & Smyth, 2004), was not chosen. With an inpatient admission, in contrast to outpatient treatment, weight gain is strongly influenced by an array of factors unrelated to the patient's readiness for recovery (Rushford, 2006).…”