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Experiential acceptance, motivation for recovery, and treatment outcome in eating disorders

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

This study sought to test whether the relationship between experiential acceptance (EA) and treatment outcome among eating disorder (ED) patients was mediated by motivation.

Methods

Upon admission to a residential ED treatment facility, female patients completed measures of EA, motivation, and baseline ED symptom severity (covariate); symptom severity was reassessed at discharge.

Results

Higher levels of baseline EA predicted significantly greater symptom reduction during treatment. Moreover, results from bootstrapped mediation analyses indicated that the relationship between EA and treatment outcome was partially mediated by motivation: increased EA was associated with greater motivation to give up ED behaviors at the beginning of treatment, and this led to greater symptom reduction from admission to discharge.

Conclusions

Motivation appears to be one mechanism by which EA facilitates improved treatment outcomes in EDs. Further development of interventions that promote EA as a means for improving motivation and subsequent ED treatment response may be warranted.

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References

  1. Posse PR, Nemeroff CB (2012) The problem of treatment-resistant psychiatric disorders. In: Nemeroff CB (ed) Management of treatment-resistant major psychiatric disorders. Oxford University Press, New York. doi:10.1093/med/9780199739981.003.0001

  2. Knowles L, Anokhina A, Serpell L (2013) Motivational interventions in the eating disorders: what is the evidence? Int J Eat Disord 46(2):97–107. doi:10.1002/eat.22053

    Article  PubMed  Google Scholar 

  3. Ålgars M, Ramberg C, Moszny J, Hagman J, Rintala H, Santtila P (2015) Readiness and motivation for change among young women with broadly defined eating disorders. Eat Disord 23(3):242–252. doi:10.1080/10640266.2014.1000100

    Article  PubMed  Google Scholar 

  4. Carter JC, Kelly AC (2014) Autonomous and controlled motivation for eating disorders treatment: baseline predictors and relationship to treatment outcome. Brit J Clin Psychol. doi:10.1111/bjc.12062

    Google Scholar 

  5. Perkins S, Schmidt U, Eisler I, Treasure J, Berelowitz M, Dodge E, Frost S, Jenkins M, Johnson-Sabine E, Keville S (2007) Motivation to change in recent onset and long-standing bulimia nervosa: are there differences? Eat Weight Disord St 12(2):61–69. doi:10.1007/bf03327580

    Article  CAS  Google Scholar 

  6. Serpell L, Teasdale JD, Troop NA, Treasure J (2004) The development of the P-CAN, a measure to operationalize the pros and cons of anorexia nervosa. Int J Eat Disord 36(4):416–433. doi:10.1002/eat.20040

    Article  PubMed  Google Scholar 

  7. Roncero M, Belloch A, Perpiñá C, Treasure J (2013) Ego-syntonicity and ego-dystonicity of eating-related intrusive thoughts in patients with eating disorders. Psychiatr Res 208(1):67–73

    Article  Google Scholar 

  8. Serpell L, Treasure J (2002) Bulimia nervosa: friend or foe? The pros and cons of bulimia nervosa. Int J Eat Disord 32(2):164–170. doi:10.1016/j.psychres.2013.01.006

    Article  PubMed  Google Scholar 

  9. Serpell L, Treasure J, Teasdale J, Sullivan V (1999) Anorexia nervosa: friend or foe? Int J Eat Disord 25(2):177–186. doi:10.1002/(SICI)1098-108X(199903)25:2<177:AID-EAT7>3.0.CO;2-D

    Article  CAS  PubMed  Google Scholar 

  10. Berg KC, Crosby RD, Cao L, Peterson CB, Engel SG, Mitchell JE, Wonderlich SA (2013) Facets of negative affect prior to and following binge-only, purge-only, and binge/purge events in women with bulimia nervosa. J Abnorm Psychol 122(1):111. doi:10.1037/a0029703

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wedig MM, Nock MK (2010) The functional assessment of maladaptive behaviors: a preliminary evaluation of binge eating and purging among women. Psychiatr Res 178(3):518–524. doi:10.1016/j.psychres.2009.05.010

    Article  Google Scholar 

  12. Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K (1996) Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol 64(6):1152. doi:10.1037/0022-006x.64.6.1152

    Article  CAS  PubMed  Google Scholar 

  13. Manlick CF, Cochran SV, Koon J (2013) Acceptance and commitment therapy for eating disorders: rationale and literature review. J Contemp Psychother 43(2):115–122. doi:10.1007/s10879-012-9223-7

    Article  Google Scholar 

  14. Rawal A, Park RJ, Williams JMG (2010) Rumination, experiential avoidance, and dysfunctional thinking in eating disorders. Behav Res Ther 48(9):851–859. doi:10.1016/j.brat.2010.05.009

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hayes SC, Strosahl KD, Wilson KG (1999) Acceptance and commitment therapy: an experiential approach to behavior change. Guilford Press, New York

  16. Wilson KG, Roberts M (2002) Core principles in acceptance and commitment therapy: an application to anorexia. Cogn Behav Pract 9(3):237–243. doi:10.1016/s1077-7229(02)80054-2

    Article  Google Scholar 

  17. Berman M, Boutelle K, Crow S (2009) A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa. Eur Eat Disord Rev 17(6):426–434. doi:10.1002/erv.962

    Article  CAS  PubMed  Google Scholar 

  18. Fulton JJ, Lavender JM, Tull MT, Klein AS, Muehlenkamp JJ, Gratz KL (2012) The relationship between anxiety sensitivity and disordered eating: the mediating role of experiential avoidance. Eat Behav 13(2):166–169. doi:10.1016/j.eatbeh.2011.12.003

    Article  PubMed  Google Scholar 

  19. Butryn ML, Juarascio A, Shaw J, Kerrigan SG, Clark V, O’Planick A, Forman EM (2013) Mindfulness and its relationship with eating disorders symptomatology in women receiving residential treatment. Eat Behav 14(1):13–16. doi:10.1016/j.eatbeh.2012.10.005

    Article  PubMed  Google Scholar 

  20. Timko CA, Zucker NL, Herbert JD, Rodriguez D, Merwin RM (2015) An open trial of acceptance-based separated family treatment (ASFT) for adolescents with anorexia nervosa. Behav Res Ther 69:63–74. doi:10.1016/j.brat.2015.03.011

    Article  PubMed  Google Scholar 

  21. Juarascio A, Shaw J, Forman E, Timko CA, Herbert J, Butryn M, Bunnell D, Matteucci A, Lowe M (2013) Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation. Behav Modif 37(4):459–489. doi:10.1177/0145445513478633

    Article  PubMed  Google Scholar 

  22. Vitousek K, Watson S, Wilson GT (1998) Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev 18(4):391–420. doi:10.1016/s0272-7358(98)00012-9

    Article  CAS  PubMed  Google Scholar 

  23. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, Waltz T, Zettle RD (2011) Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther 42(4):676–688. doi:10.1016/j.beth.2011.03.007

    Article  PubMed  Google Scholar 

  24. Fairburn CG, Beglin SJ (2008) Eating Disorder Examination-Questionnaire (6.0). In: Fairburn CG (ed) Cognitive behavior therapy and eating disorders. Guilford Press, New York. doi:10.1080/07317100902910703

  25. Martinez E, Castro J, Bigorra A, Morer A, Calvo R, Vila M, Toro J, Rieger E (2007) Assessing motivation to change in bulimia nervosa: the bulimia nervosa stages of change questionnaire. Eur Eat Disord Rev 15(1):13–23. doi:10.1002/erv.725

    Article  PubMed  Google Scholar 

  26. Rieger E, Touyz SW, Beumont PJ (2002) The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ): information regarding its psychometric properties. Int J Eat Disord 32(1):24–38. doi:10.1002/eat.10056

    Article  PubMed  Google Scholar 

  27. Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40(3):879–891. doi:10.3758/brm.40.3.879

    Article  PubMed  Google Scholar 

  28. Wildes JE, Marcus MD, Cheng Y, McCabe EB, Gaskill JA (2014) Emotion acceptance behavior therapy for anorexia nervosa: a pilot study. Int J Eat Disord 47(8):870–873. doi:10.1002/eat.20826

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mallinckrodt B, Abraham WT, Wei M, Russell DW (2006) Advances in testing the statistical significance of mediation effects. J Couns Psychol 53(3):372. doi:10.1037/0022-0167.53.3.372

    Article  Google Scholar 

  30. Cockell SJ, Geller J, Linden W (2003) Decisional balance in anorexia nervosa: capitalizing on ambivalence. Eur Eat Disord Rev 11(2):75–89. doi:10.1002/erv.493

    Article  Google Scholar 

  31. Mansour S, Bruce KR, Steiger H, Zuroff DC, Horowitz S, Anestin AS, Sycz L (2012) Autonomous motivation: a predictor of treatment outcome in bulimia-spectrum eating disorders. Eur Eat Disord Rev 20(3):e116–e122. doi:10.1002/erv.2154

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street, Suite 119, Philadelphia, PA, 19104, USA

    Hallie M. Espel, Stephanie P. Goldstein, Stephanie M. Manasse & Adrienne S. Juarascio

Authors
  1. Hallie M. Espel
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  2. Stephanie P. Goldstein
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  3. Stephanie M. Manasse
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  4. Adrienne S. Juarascio
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Corresponding author

Correspondence to Hallie M. Espel.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The authors affirm that this research complied with the Helsinki declaration and was approved by the researchers’ Institutional Review Board and the treatment facility’s internal Institutional Review Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Espel, H.M., Goldstein, S.P., Manasse, S.M. et al. Experiential acceptance, motivation for recovery, and treatment outcome in eating disorders. Eat Weight Disord 21, 205–210 (2016). https://doi.org/10.1007/s40519-015-0235-7

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  • DOI: https://doi.org/10.1007/s40519-015-0235-7

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