title: Stages of change, treatment outcome and therapeutic alliance in adult inpatients with chronic anorexia nervosa.
abstract: BACKGROUND
  Anorexia nervosa (AN) is associated with high rates of chronicity and relapse risk is a considerable therapeutic challenge in the disorder. The aim of the present study was to investigate the association of stages of change and outcome with a focus on the relapse struggle in the maintenance stage in patients with predominantly chronic AN. Further, therapeutic alliance and stages of change associations were explored.
  
  
  METHODS
  As an instrument measuring relapse struggle in the maintenance stage, we applied the short form of the University of Rhode Island Change Assessment-Short (URICA-S). We assessed stages of change in 39 patients with a predominantly chronic course of AN in early, middle, and late stages of inpatient psychotherapy. General symptom severity as assessed by the SCL-90-R and weight change were investigated as outcome measures.
  
  
  RESULTS
  In-line with earlier evidence, contemplation significantly predicted therapeutic alliance. Further, we demonstrated that relapse risk as operationalized by URICA-S maintenance is an important predictor of general psychopathology. BMI change was not predicted by stages of change.
  
  
  CONCLUSIONS
  The URICA-S maintenance scale might be applied to help identify patients at relapse risk. High URICA-S maintenance scores could be considered as one critical aspect of AN patients who might especially benefit from relapse-preventing aftercare programs.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr, Tübingen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mander
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
authors.forename: Katharina
authors.initials: K
authors.lastname: Keifenheim
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.forename: Katrin Elisabeth
authors.initials: KE
authors.lastname: Giel
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D009042:Motivation; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D012008:Recurrence; D016896:Treatment Outcome