Assessing readiness for change in adolescents with eating disorders.

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational subtypes and continuous measures of readiness for change: Concurrent and predictive validity.

This study compared the concurrent and predictive validity of motivational subtypes versus a continuous measure of readiness for change as measured by the University of Rhode Island Change Assessment Scale (URICA; E. A. McConnaughy, J. O. Prochaska. & W. F. Velicer, 1983) in 252 individuals participating in a substance abuse treatment study (38% female; mean age = 36). Hierarchical cluster analysis identified a 2-cluster solution. Consistent with previous research, both the motivational subtypes and the continuous readiness measure exhibited good concurrent validity with both baseline characteristics and change process variables. Neither readiness-for-change measure predicted end treatment outcomes. Measures of readiness for change based on the URICA exhibit limited clinical utility, because they are not able to predict future behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of readiness for drug abuse treatment on client retention and assessment of process

AIMS: This study examined client motivation as a predictor of retention and therapeutic engagement across the major types of treatment settings represented in the third national drug abuse treatment outcome study (DATOS) conducted in the United States. DESIGN: Sequential admissions during 1991-93 to 37 programs provided representative samples of community-based treatment populations. Based on this naturalistic non-experimental evaluation design, hierarchical linear model (HLM) analysis for nested data was used to control for systematic variations in retention rates and client attributes among programs within modalities. SETTING: The data were collected from long-term residential (LTR), outpatient methadone (OMT) and outpatient drug-free (ODF) programs located in 11 large cities. PARTICIPANTS: A total of 2265 clients in 18 LTR, 981 clients in 13 OMT and 1791 clients in 16 ODF programs were studied. MEASUREMENTS: Pre-treatment variables included problem recognition and treatment readiness (two stages of motivation), socio-demographic indicators, drug use history and dependence, criminality, co-morbid psychiatric diagnosis and previous treatment. Retention and engagement (based on ratings of client and counselor relationships) served as outcome criteria. FINDINGS: Pre-treatment motivation was related to retention in all three modalities, and the treatment readiness scale was the strongest predictor in LTR and OMT. Higher treatment readiness also was significantly related to early therapeutic engagement in each modality. CONCLUSIONS: Indicators of intrinsic motivation--especially readiness for treatment--were not only significant predictors of engagement and retention, but were more important than socio-demographic, drug use and other background variables. Improved assessments and planning of interventions that focus on stages of readiness for change and recovery should help improve treatment systems.     

Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder.

This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N?=?367) and suggested that the diagnoses from this scale possessed temporal reliability (mean κ?=?.80) and criterion validity (with interview diagnoses; mean κ?=?.83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test–retest reliability (r?=?.87), internal consistency (mean α?=?.89), and convergent validity with extant eating-pathology scales. Results implied that this scale was reliable and valid in this investigation and that it may be useful for clinical and research applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational enhancement therapy and self-help treatment for binge eaters.

The aims of this study were to evaluate whether a single session of motivational enhancement therapy (MET) would increase participant readiness to change, improve the efficacy of self-help treatment for binge eaters, and improve participant compliance with the self-help manual. Method: Participants with bulimia nervosa or binge eating disorder were randomly assigned either to attend a 1-hr MET session prior to receiving the self-help manual (n = 45) or to receive the self-help manual only (n = 45). Participants were followed for 4 months for assessment of self-reported eating disorder outcome and compliance. Results: The MET intervention resulted in increased readiness to change for binge eating compared with the self-help-only (SH) condition. Few differences were found between the MET condition and the SH condition for changes in eating attitudes and frequency of binge eating and compensatory behaviors. No significant effects were found for compliance. Discussion: This research adds to the literature regarding the use of brief motivational interventions to enhance readiness for change in populations with eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Interview for the Diagnosis of Eating Disorders—IV: Application to DSM–IV diagnostic criteria.

The authors describe the psychometric development of the fourth revision of the Interview for Diagnosis of Eating Disorders (IDED–IV). The IDED–IV was tested for the purpose of differential diagnosis of eating disorders, that is, anorexia nervosa, bulimia nervosa, and binge eating disorder. Evidence for internal consistency was found for symptom ratings relevant to anorexia nervosa, bulimia nervosa, and binge eating disorder. Support was found for the content validity as well as the concurrent and discriminant validity of the IDED–IV. Finally, tests of the interrater agreement for differential diagnosis of eating disorders found the IDED–IV to yield very reliable data. The authors conclude that the IDED–IV yields sufficiently reliable and valid data to be used for determining diagnoses in research studies and clinics specializing in the treatment of eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological assessment as a therapeutic intervention in patients hospitalized with eating disorders.

As most psychologists are aware, there are many difficulties associated with the assessment and treatment of hospitalized individuals with eating disorders and their family members. Problems such as denial or minimization of the eating disorder, lack of motivation for change, treatment resistance, and lack of insight are common, and techniques that can diminish or eliminate these challenges are sorely needed. This article describes the clinical utility of therapeutic assessment, which is a nontraditional, collaborative approach to psychological evaluation, as an early step in overcoming assessment and treatment difficulties encountered in this population. Case examples are provided to illustrate the assessment method as a brief intervention. Possible mechanisms underlying the therapeutic effects are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescents' thoughts about abstinence curb the return of marijuana use during and after treatment.

Despite evidence showing that readiness to change substance use predicts reductions in substance use among treated adolescents, there is little research on changes in thoughts about abstinence and marijuana use during and after treatment. The current study tested whether time-varying changes in adolescents’ motivation to abstain and perceived difficulty to abstain from marijuana use hinder the return of regular marijuana use during and after treatment. Monthly data on thoughts about abstinence, marijuana use, and treatment utilization were collected over 6 months from 142 adolescents recruited from intensive outpatient substance use treatment. Results indicated that higher motivation to abstain (but not perceived difficulty) predicted fewer days of marijuana use, over and above the individual’s average trajectory of marijuana use, the initial severity of marijuana involvement, and the effects of treatment utilization. Moreover, past-month marijuana use influenced both motivation to abstain and perceived difficulty to abstain. Findings highlight the importance of abstinence-related cognitions as a target of intervention during and after treatment and underscore the importance of considering recovery from substance use disorders as a dynamic process of change over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief group psychoeducation for bulimia nervosa: Assessing the clinical significance of change.

41 women with bulimia nervosa completed a brief intervention that was designed to promote symptom management. Cutoff scores for the determination of reliable and clinically significant change were calculated for several psychometric instruments that are commonly used as outcome measures in the field of eating disorders. Using these statistical procedures to assess therapeutic change, this study documents the diversity of outcomes that individuals reported following their participation in the intervention. As expected, there was a differential reporting of clinically significant change in favor of specific eating psychopathology relative to personality features and associated psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic discontinuation in chronic insomnia: Impact of psychological distress, readiness to change, and self-efficacy.

Objective: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. Design: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. Main Outcome Measures: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. Results: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. Conclusions: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and psychometric properties of the Early Development Instrument (EDI): A measure of children's school readiness.

The Early Development Instrument (EDI), a teacher-completed measure of children's school readiness at entry to Grade 1, was designed to provide communities with an informative, inexpensive and psychometrically sound tool to assess outcomes of early development as reflected in children's school readiness. Its psychometric properties at individual level were evaluated in two studies. Five a priori domains--physical health and well-being, social competence, emotional maturity, language and communication, and cognitive development and general knowledge--were tested in a factor analysis of data on over 16,000 kindergarten children. The factor analyses upheld the first three domains, but revealed the need to develop two new ones, resulting in the final version of the EDI consisting of: physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge domains. These final domains showed good reliability levels, comparable with other instruments. A separate study (N = 82) demonstrated consistent agreements in parent-teacher, interrater reliabilities, concurrent validity, and convergent validity. These results establish the EDI as a psychometrically adequate indicator of child well-being at school entry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The "presyrinx" state: a reversible myelopathic condition that may precede syringomyelia

The purpose of this investigation was to develop a brief self-report inventory which could be used to evaluate treatment outcome for anorexia and bulimia nervosa. The Multifactorial Assessment of Eating Disorders Symptoms (MAEDS) was constructed to measure six symptom clusters which have been found to be central to the eating disorders: depression, binge eating, purgative behavior, fear of fatness, restrictive eating, and avoidance of forbidden foods. The factor structure of the MAEDS was found to be stable and it was found to have satisfactory reliability and validity. Normative data were collected so that raw scores could be converted to standardized scores. While still in the experimental stages, the MAEDS shows promise as a valid and economical measure of treatment interventions for anorexia and bulimia nervosa.     

Correction to Stice et al. (2000).

Reports 2 errors in the original article by E. Stice et al (Psychological Assessment , 2000, vol 12[2], 123–131). On page 130 in Appendix A under heading "Bulimia Nervosa," EDDS Item 8 response should be "greater than or equal to 2." Under heading "Binge-Eating Disorder," EDDS Item 7 response should be "greater than or equal to 2." (The following abstract of this article originally appeared in record 2000-03952-002.): This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N?=?367) and suggested that the diagnoses from this scale possessed temporal reliability (mean κ?=?.80) and criterion validity (with interview diagnoses; mean κ?=?.83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test–retest reliability (r?=?.87), internal consistency (mean α?=?.89), and convergent validity… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of readiness to change in response to treatment of adolescent depression.

The effect of readiness to change on treatment outcome was examined among 332 adolescents (46% male, 74% Caucasian), ages 12 through 17 years (M = 14.6, SD = 1.5), with major depressive disorder who were participating in the Treatment for Adolescents With Depression Study (TADS). TADS is a randomized clinical trial comparing the effectiveness of fluoxetine (an antidepressant medication), cognitive–behavioral therapy, their combination, and a pill placebo. An abbreviated Stages of Change Questionnaire was used to obtain 4 readiness to change scores: precontemplation, contemplation, action, and maintenance. The association between each readiness score and depression severity across 12 weeks of acute treatment for depression, as measured by the Children’s Depression Rating Scale—Revised, was examined. Although treatment response was not moderated by any of the readiness scores, baseline action scores predicted outcome: Higher action scores were associated with better outcome regardless of treatment modality. Furthermore, treatment effects were mediated by change in action scores during the first 6 weeks of treatment, with increases in action scores related to greater improvement in depression. Assessing readiness to change may have implications for tailoring treatments for depressed adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of attachment theory and research for the assessment and treatment of eating disorders.

In this paper, we review the research literature on attachment and eating disorders and suggest a framework for assessing and treating attachment functioning in patients with an eating disorder. Treatment outcomes for individuals with eating disorders tend to be moderate. Those with attachment-associated insecurities are likely to be the least to benefit from current symptom-focused therapies. We describe the common attachment categories (secure, avoidant, anxious), and then describe domains of attachment functioning within each category: affect regulation, interpersonal style, coherence of mind, and reflective functioning. We also note the impact of disorganized mental states related to loss or trauma. Assessing these domains of attachment functioning can guide focused interventions in the psychotherapy of eating disorders. Case examples are presented to illustrate assessment, case formulation, and group psychotherapy of eating disorders that are informed by attachment theory. Tailoring treatments to improve attachment functioning for patients with an eating disorder will likely result in better outcomes for those suffering from these particularly burdensome disorders. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Dietary and Dietary-Depressive Subtypes of Bulimia Nervosa Show Differential Symptom Presentation, Social Impairment, Comorbidity, and Course of Illness.

Research suggests that women with bulimia nervosa can be classified into dietary and dietary-depressive subtypes and that the latter show greater eating pathology, social impairment, comorbidity, and treatment nonresponse. The authors sought to replicate this subtyping scheme with an independent sample and to generate further evidence for the validity of this distinction. Analysis revealed dietary and dietary-depressive subtypes and indicated that the latter reported more current eating pathology, social impairment, and treatment seeking as well as greater psychiatric comorbidity and bulimic symptom persistence over a 5-year follow-up. This subtyping scheme had stronger concurrent and predictive validity than the purging-nonpurging distinction. Results provide further evidence for the reliability and validity of this subtyping scheme and suggest it has important clinical implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking behavior and readiness to change in male veterans with spinal cord injuries.

Objectives: Little is known about psychological factors associated with tobacco use in persons with spinal cord injuries and disorders (SCI&D). Method: Veterans with SCI&D who were current or past smokers were mailed survey questions about physical dependence on nicotine, motivation to smoke, readiness to quit, and use of tobacco cessation methods. Results: Of 684 respondents, 19% were current smokers. They were younger (Ms = 56.4 vs. 63.3 years; p     

The measure of stage of readiness to change: Some psychometric considerations.

Previous research in the smoking cessation literature has shown that the key component of the transtheoretical model of change, the stage of readiness to change, is a valid independent measure (C. C. DiClemente & J. O. Prochaska, 1985; C. C. DiClemente et al., 1991; W. F. Velicer, J. S. Rossi, J. O. Prochaska, & C. C. DiClemente, 1996). Recently, however, other health service researchers (e.g., A. J. Farkas et al., 1996b) have begun to question the utility of this model; especially its predictive validity (e.g., A. J. Farkas et al., 1996a). However, no research to date has examined the reliability and stability of the stage of readiness to change measure. In this study, the longitudinal measurement of stage of readiness to change was treated as a quasi-simplex model (K. G. J?reskog, 1970). Estimates of the stability and reliability for 261 female smokers in a general community sample were obtained. Results indicate that the stage of change measure has desirable psychometric properties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Value priorities and readiness for out-group social contact.

Relations of individuals' value priorities to their readiness for out-group social contact were examined in dominant and minority groups. Study 1 examined readiness of 151 Israeli Jewish teachers (dominant group) for contact with Israeli Arabs (minority). Readiness correlated positively with emphasizing universalism and self-direction values and negatively with emphasizing tradition, security, and conformity values. This confirmed an integrated set of hypotheses from S. H. Schwartz's (1992) value theory. Study 2 examined readiness of Israeli Arab Muslim (N?=?111) and Christian (N?=?88) teachers for contact with Israeli Jews. Hypotheses took account of differences between the two Arab minorities in motivation to integrate into the dominant society versus to preserve their uniqueness. Correlations with values confirmed most hypotheses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of the Job Diagnostic Survey.

Describes the Job Diagnostic Survey (JDS) which is intended to (a) diagnose existing jobs to determine whether (and how) they might be redesigned to improve employee motivation and productivity and (b) evaluate the effects of job changes on employees. The instrument is based on a specific theory of how job design affects work motivation, and provides measures of (a) objective job dimensions, (b) individual psychological states resulting from these dimensions, (c) affective reactions of employees to the job and work setting, and (d) individual growth need strength (interpreted as the readiness of individuals to respond to "enriched" jobs). Reliability and validity data are summarized for 658 employees on 62 different jobs in 7 organizations who responded to a revised version of the instrument. (PsycINFO Database Record (c) 2010 APA, all rights reserved)