Dancing with change: a qualitative exploration of in-session motivation to change in the treatment of anorexia nervosa

ABSTRACT

Objective

Motivation is considered essential in the treatment of anorexia nervosa (AN). However, the in-session nature of, and variables associated with, changes in motivation are only partially understood in this population. The aim of this study was to conduct an exploratory investigation of the in-session nature of motivation to change in people during cognitive behavioural therapy for anorexia nervosa (CBT-AN).

Method

Thirty-eight therapy-session transcripts from nine participants, collected as part of a larger multi-site randomised control trial, were analysed using inductive thematic analysis.

Results

Two superordinate themes were generated: (i) betwixt and between; and (ii) rhythms of motivation. Two concurrent yet distinct rhythms of motivation were observed within and across participant sessions, with shifts in motivation occurring alongside identity (re)negotiations.

Conclusions

Findings highlight the complex and multifaceted nature of the in-session processes of motivational change in persons with AN, and support previous literature suggesting factors independent of treatment may facilitate tipping points of change. Furthermore, this study proposes that an integrated or dual-wave model of motivation may assist clinicians in understanding how they can better facilitate and support motivation for change in clients with AN during treatment.

KEY POINTS

What is already known about this topic:

1. Enhancing motivation is considered essential for improving treatment outcomes.

2. Motivation is conceptualised as a dynamic process; however, it is typically assessed through quantitative self-report measures at set points during treatment.

3. The in-session dynamics of motivation to change are poorly understood.

What this topic adds:

1. In-session motivation to change is a complex, multifaceted process closely associated with individual identity (re)negotiations.

2. There may be dual processes of motivation occurring during treatment that are influenced by factors independent of treatment.

3. A proposal for an integrated model of motivation for anorexia nervosa.

KEYWORDS:

• Eating disorder
• anorexia nervosa
• motivation to change
• in-session motivation
• treatment
• qualitative

Disclosure statement

Rebekah Rankin is a doctoral student currently supported by the Western Sydney University Butterfly Foundation Postgraduate Research Scholarship which is jointly funded by Western Sydney University and the Butterfly Foundation. Phillipa Hay receives/has received sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and HETI (New South Wales and the former NSW Institute of Psychiatry) and royalties/honoraria from Hogrefe and Huber, McGraw Hill Education, and Blackwell Scientific Publications, Biomed Central and PlosMedicine and she has received research grants from the NHMRC and ARC. She is Chair of the National Eating Disorders Collaboration Steering Committee in Australia (2019-) and was Member of the ICD-11 Working Group for Eating Disorders and was Chair Clinical Practice Guidelines Project Working Group (Eating Disorders) of RANZCP (2012-2015). She has prepared a report under contract for Takeda (formerly Shire) Pharmaceuticals in regards to Binge Eating Disorder (July 2017) and is a consultant to Takeda Pharmaceuticals. All views in this paper are her own. Stephen Touyz is the Chair of the Takeda Virtual Clinical Advisory Committee on Binge Eating Disorders (BED). He has received honoraria for commissioned reports and public speaking engagements. Stephen Touyz has received research grant funding from Shire (now Takeda). He receives royalties from published material from Hogrefe and Huber, Taylor and Francis and McGraw Hill. He is a member of the Technical Advisory Group for Eating Disorders established by the Commonwealth of Australia. Stephen Touyz is also a mental health advisor to the Commonwealth Department of Veteran Affairs. Jon Arcelus has received researched Grants from the National Institute of Health Research in the UK. All other authors declare that they have no conflict of interests.

Additional information

Funding

The present study is a secondary paper from the LEAP trial ACTRN12610000585022 Prospectively registered 21/07/2010.