title: Assessing motivation to change in eating disorders: a systematic review.
abstract: BACKGROUND
  Patients with anorexia and bulimia nervosa are often ambivalent about their eating disorder symptoms. Therefore, a lack of motivation to change is a frequent problem in the treatment of eating disorders. This is of high relevance, as a low motivation to change is a predictor of an unfavourable treatment outcome and high treatment dropout rates. In order to quantify the degree of motivation to change, valid and reliable instruments are required in research and practice. The transtheoretical model of behaviour change (TTM) offers a framework for these measurements.
  
  
  OBJECTIVE
  This paper reviews existing instruments assessing motivation to change in eating disorders.
  
  
  METHODS
  We screened N = 119 studies from the databases Medline and Psycinfo found by combinations of the search keywords 'eating disorder', 'anorexia nervosa', 'bulimia nervosa', 'motivation', 'readiness to change', 'assessment', 'measurement', and 'questionnaire'.
  
  
  RESULTS
  Ultimately, n = 15 studies investigating psychometric properties of different assessment tools of motivation to change in eating disorders were identified. Reviewed instruments can be divided into those assessing the stages of change according to the TTM (6 instruments) and those capturing decisional balance (3 instruments). Overall, the psychometric properties of these instruments are satisfactory to good.
  
  
  CONCLUSIONS
  Advantages, disadvantages, and limitations of the reviewed assessment tools are discussed. So far, the TTM provides the only framework to assess motivation to change in eating disorders.
authors.affiliation: Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany ; Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Hoetzel
authors.affiliation: Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany ; Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: von Brachel
authors.affiliation: Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Schlossmacher
authors.affiliation: Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany.
authors.forename: Silja
authors.initials: S
authors.lastname: Vocks
keywords: Anorexia nervosa; Assessment; Bulimia nervosa; Interview; Motivation to change; Questionnaire