Title:	Measuring and enhancing motivation to change in women with eating disorders
Authors:	von Brachel, Ruth Elisabeth
Thesis advisor:	Prof. Dr. Silja Vocks
Thesis referee:	Prof. Dr. Henning Schöttke
Abstract:	Background: Motivation to change is a core variable in understanding and treating women with both anorexia and bulimia nervosa. The transtheoretical model (TTM) has been put forward as a framework for the assessment and treatment of motivation to change for a variety of disorders, including eating disorders. Even though motivation and ambivalence should be assessed with regard to specific symptoms in eating disorders, there is a lack of validated measures in the German language. Due to the importance of motivation to change in women with eating disorders, several studies have used the TTM to develop, and test the effectiveness of face-to-face motivational programs for this clientele. However, no randomized controlled trial for an internet-based program enhancing motivation to change has been conducted. The present thesis aimed to establish symptom-specific measures of motivation to change and ambivalence, and to develop and evaluate an internet-based therapy program for women with eating disorders. Methods: Two observational studies and one randomized controlled trial including a total of N=460 women with eating disorders were performed. The first study tested the psychometric properties (reliability and validity) of a questionnaire assessing motivation to change in a sample of N= 63 inpatients. In the second study, the psychometric properties of a questionnaire assessing ambivalence in a sample of N =195 women with eating disorders were investigated. The third study comprised a randomized controlled trial with N =202 women assessing the effectiveness of an internet-based motivational program for women with eating disorders. The fourth study systematically investigated the dropout from this program using survival analysis. Results: In the observational studies, the questionnaires showed satisfactory psychometric properties, with good reliabilities and validities. The randomized controlled trial showed significant time x group interactions, demonstrating that the internet-based program was effective in enhancing motivation to change, and in reducing some eating disorder symptoms. However, the dropout from the program was 51 %, with participants with more severe eating disorder pathology and depressive mood being more likely to terminate the program prematurely. Discussion: The results demonstrate the feasibility of both symptom-specific assessment of motivation to change and measurements of ambivalence across eating disorder diagnoses, enabling novel research questions and supporting clinical work. Evidence for the efficacy of the internet-based program in enhancing participants’ motivation to change and reducing eating disorder symptoms support the wider adoption of such programs. The results from the dropout analysis offer new perspectives for future research on additional treatment modulesm for women at risk of terminating treatment prematurely.
URL:	https://osnadocs.ub.uni-osnabrueck.de/handle/urn:nbn:de:gbv:700-2014081812724
Subject Keywords:	eating disorders; motivation; readiness; assessment; anorexia nervosa; bulimia nervosa; internet intervention; dropout
Issue Date:	18-Aug-2014
Type of publication:	Dissertation oder Habilitation [doctoralThesis]
Appears in Collections:	FB08 - E-Dissertationen

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