The myths of motivation: Time for a fresh look at some received wisdom in the eating disorders?

Abstract

The eating disorders typically involve poor motivation to change. This article reviews the evidence behind many of our beliefs about motivation and whether we need a different conceptual framework for understanding why patients commonly get "stuck." The outcome literature is reviewed, and demonstrates that there is little evidence that we are effective in enhancing motivation to induce changes in symptoms. Indeed, there are suggestions that commonly used models are unhelpful. Verbal expressions of motivation are not the best indicator of likely treatment response, and can best be understood as providing a "manifesto," which has functions that can obstruct recovery from the eating disorder. A behavioral analysis of motivation is likely to be more effective. Cognitive, emotional, and behavioral methods for enhancing motivation are outlined, with the aim of bypassing the motivational manifesto and encouraging positive therapeutic change.

Clinicians' concerns about delivering cognitive-behavioural therapy for eating disorders

“…The elements of CBT were selected because they are Clinicians' concerns about using CBT techniques 6 reported to be used routinely in clinical practice . However, it is acknowledged that some of the elements lack an evidence base (e.g., mindfulness) and others have been demonstrated to have little or no value (e.g., pre-therapy motivational enhancement work) in work with the eating disorders (e.g., Waller, 2012;.…”

The effect of pre-treatment psychoeducation on eating disorder pathology among patients with anorexia nervosa and bulimia nervosa

“…These interventions have the potential advantage of preparing patients for treatment with the aim of increasing treatment uptake and retention during treatment. A widely used example of such an approach is the provision of pre-treatment motivational interventions though the evidence base provides little support for this approach (e.g., Dray & Wade, 2012;Waller, 2012). Less well-researched is the provision and impact of pre-treatment psychoeducation.…”

Towards a Comprehensive Model of Recovery

“…Experiential studies (Pettersen, 2007;Pettersen et al 2008;2011) show that mixed feelings range from shame to pride. Shame is related to symptoms and compensatory and concealing strategies.…”

“…Still it is important to notice that interventions aiming to increase motivation have a far less impact on recovery than the motivation that is created by taking part in evidence based treatments (Waller, 2011;Geller et al, 2011). …”

“…The effect is thus to break vicious circles of dieting, bingeing and purging. A problem with this theory is that although the succession of stages may seem logical and selfevident, patients actually may move back and forth in a very situation-dependent way (Waller, 2011). Another major problem is that being in an action stage does not tell us anything about whether the action (e.g.…”