title: Application of Prochaska's transtheoretical model of change to patients with eating disorders.
abstract: OBJECTIVE
  Although eating disorders cause severe somatic and psychological sequelae, a majority of affected patients are not motivated for treatment. The aim of this study was to assess stages of change in patients with eating disorders and to analyze their correlations with clinical characteristics and treatment processes using Prochaska's transtheoretical model of change.
  
  
  METHODS
  A consecutive sample (N=88) including outpatients suffering from anorexia (n=29), bulimia (n=32), and eating disorders not otherwise specified (n=27) was recruited from an eating disorders clinic with a low-threshold access. The patients' readiness to change their eating behavior was assessed by a self-rating scale (URICA), and a score for each participant on each subscale (precontemplation, contemplation, action) was derived from the scale. Patients were introduced to a set of eight treatment processes over the course of four treatment sessions. During the four sessions, therapists rated whether or not patients appeared to be using each of the treatment processes.
  
  
  RESULTS
  While diagnostic subtype, age, illness duration, and previous treatments were not associated with motivational stages, self-referral was positively correlated to treatment motivation. Emotional involvement, specific behavioral change processes, and beginning a continuing treatment were correlated with more advanced stages of change.
  
  
  CONCLUSIONS
  This study supports the notion of the stages of change as an independent dimension that is relevant for the treatment of eating disorders. The lack of impact of previous, presumably nonspecific treatments on the stages of change underlines the importance to assess and to improve specifically patients' motivation. Therapeutic work towards the mobilisation of emotions with regard to their eating problem as a means to improve readiness to change should be examined in future studies.
authors.affiliation: Psychiatric Department, Zürich University Hospital, Zürich, Switzerland. g.hasler@bluewin.ch
authors.forename: Gregor
authors.initials: G
authors.lastname: Hasler
authors.forename: Aba
authors.initials: A
authors.lastname: Delsignore
authors.forename: Gabriella
authors.initials: G
authors.lastname: Milos
authors.forename: Claus
authors.initials: C
authors.lastname: Buddeberg
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schnyder
mesh_terms: D000328:Adult; D000339:Affect; D001294:Attitude to Health; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D009042:Motivation; D011582:Psychological Theory; D011613:Psychotherapy / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012647:Self-Assessment