Motivation to Change and Reduction of Symptoms

¶ … Motivation to Change and Reduction of Symptoms in Adolescents Suffering from Bulimia Nervosa

In research published by Castro-Fornieles (et al., 2011) the relationship between recovery from bulimia nervosa and motivation to change in adolescence sufferers is examined. The authors of the research had not found any similar research which had looked at this specific area of study. However, the research is based on previous research where strong links between behavioral changes in adults suffering from eating disorders and level of motivational for change. The importance of motivation has been generally accepted as an important influence and predictor of successful change in a range of health issues, such as smoking, which rely on patients implementing and maintaining behavioral changes. When looking specifically as bulimia nervosa, further research has found that relapses are more likely where adults suffering from the condition. In adolescents there has also been research examining motivation and the relationship between recovery from anorexia nervosa which has established a positive correlation between motivation levels and better treatment responses. While there appear to be some commonalities there are also differences; the adults level of motivations appears to be positive correlated to age, in the adolescents with anorexia nervosa age does not appear to be a significant influence. The aim of the research presented in this paper was to analyze the relationship between the level of motivation present during the first assessment and the subsequent decreased level of symptoms in adolescent bulimic patients. It was hypothesized that there would be a direct connection between the motivation to change and response to treatment, with motivational level being a predictor of the patients' behavioral response to their treatment.

Research was undertaken with a sample of patients diagnosed with bulimia nervosa according to DSM-IV. In all cases the diagnosis was undertaken by the same psychologist and staff group. The initial sample size was 40, which was heavily skewed towards female patients, who made up 39 of the sample. The patient ages ranged between 14 and 18 years old, with a mean age of 6.2 years, and a standard deviation of 1.1 years. All of the patients were of the Hospital Clinic Universitari in Barcelona attending the Eating Disorders Unit of the Child and Adolescent Psychiatry and Psychology Department.

The patients were assessed at two stages, on the first assessment in the hospital department, and subsequently at between the six-month an eight-month mark. The patients were evaluated using a number of generally accepted tools which were applied at both of these assessments. The tools utilized where the Bulimia Nervosa Stages of Change Questionnaire

(BNSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI). All patients that participated did so voluntarily, with assurances that any their responses would remain confidential. Only 31 patients were subject to the second evaluation, the remaining nine patients had withdrawn from the treatment program. These nine patients were similar to those who remained in the study, so the departure does not appear to have biased the research.

In all cases the subject underwent the same basic treatment approach, which consisted of a multidisciplinary approach designed to help improve the eating patterns of the patients and reduce compensatory behaviors with the majority of the bulimic adolescents being seen as outpatients. 31 of the patients (77.5%) were treated as outpatients. Treatments varied slightly, and could include cognitive treatment on either a group or an individual basis, and parent counseling. In moderate and severe cases some patients may have received pharmacological treatment; this amounted to 29 (72.5%) of the cases in this study.

Once the results were gathered from the 31 subjects completed both sets of evaluations, the results were analyzed statistically using the computer program SPSS (version 16), comparing the two sets of questionnaires in order to identify differences. MANOVA was used to compare the psychopathological scales used to compare the two assessments. The association between motivation to change and the outcome was assessed by examining the level of motivation within the initial assessment, and comparing this to the overall improvement in the patient, assessed on a change in both clinical and psychological symptoms over the treatment period. This is examined utilizing a Pearson product-movement correlation. The results are analyzed utilizing multiple linear regression analysis which looked at the correlation between the initial motivation to change and clinical improvement, with the inclusion of multiple factors including other potential confounding variables, including depression symptoms as assessed with the Beck Depression Index. It was determined for there to be confirmation of any statistically significant relationship between the motivation level and the clinical outcome there would need to be a p-value lower than 0.05.

The research indicated that there was no significant difference clinical outcome between patients who receiving the pharmacological treatment, and those who were not. There was found to be a direct positive correlation between the initially assessed motivation to change and the clinical outcome, with a p value resulted with statistical analysis of p = 0.007. A significant correlation was found in the decrease in the number of binges and vomits per week that took place. Other factors were also examined, including the duration of the disorder, and body mass index, but no statistically they should was found between a decrease in symptoms and these potential influences.

The research appears to support the hypothesis, that motivation at initial assessment is a predictor of the patients behavioral response to treatment, and that higher levels of motivation present in the patient at the initial assessment are likely to result in decreased bulimia symptoms following participation in the standardized treatment.

The research approach appears to be extremely well-designed, with a sample of similar patients entering the same program, which helps to reduce the potential for extraneous or confounding influences remain unidentified. However, this does not mean there is the total elimination of external factors. One aspect of the research design which may require some consideration is the choice of the sample. The sample was predominantly female, with only one male participant. While it is generally recognized that bulimia nervosa is more prevalent in females, the inclusion of only a single male may indicate a skewing biasing of the results, or invalidate the results for males. Therefore, a study on a greater scale, with the inclusion of a larger number of male participants may be very useful, especially in assessing the condition with reference to gender.