Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T12:41:28.947Z Has data issue: false hasContentIssue false
  • English
  • Français

An internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial

Published online by Cambridge University Press:  16 October 2013

K. Hötzel ,
R. von Brachel ,
U. Schmidt ,
E. Rieger ,
J. Kosfelder ,
T. Hechler ,
D. Schulte  and
S. Vocks
K. Hötzel*
Affiliation:
Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Germany Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Germany
R. von Brachel
Affiliation:
Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Germany Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Germany
U. Schmidt
Affiliation:
Section of Eating Disorders, Institute of Psychiatry, King's College London, UK
E. Rieger
Affiliation:
Research School of Psychology, Australian National University, Australia
J. Kosfelder
Affiliation:
Department of Social Sciences and Cultural Studies, University of Applied Sciences Düsseldorf, Germany
T. Hechler
Affiliation:
German Pediatric Pain Center, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
D. Schulte
Affiliation:
Department of Psychology, Clinical Psychology and Psychotherapy, Ruhr-University Bochum, Germany
S. Vocks
Affiliation:
Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Germany
*
* Address for correspondence: K. Hötzel, Dipl.-Psych. Osnabrück University, Department of Psychology, Clinical Psychology and Psychotherapy, Knollstraße 15, 49069 Osnabrück, Germany. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Previous research has demonstrated an association between low motivation to change and an unfavorable treatment outcome in patients with an eating disorder. Consequently, various studies have examined the effects of motivational enhancement therapy (MET) on motivation to change and treatment outcome in eating disorders. In each of these studies, MET was administered in a face-to-face setting. However, because of its anonymity and ease of access, the internet provides several advantages as the format for such an intervention. Therefore, the current study investigated the effects of an internet-based program (‘ESS-KIMO’) to enhance motivation to change in eating disorders.

Method

In total, 212 females were accepted for participation and assigned randomly to the intervention condition (n = 103) or waiting-list control condition (n = 109). The intervention consisted of six online MET sessions. Before and after the intervention or waiting period respectively, participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED), the Pros and Cons of Eating Disorders Scale (P-CED), the Self-Efficacy Scale (SES), and the Rosenberg Self-Esteem Scale (RSES). A total of 125 participants completed the assessment post-treatment. Completer analyses and intent-to-treat analyses were performed.

Results

Significant time × group interactions were found, indicating a stronger increase in motivational aspects and self-esteem, in addition to a stronger symptom reduction on some measures from pre- to post-treatment in the intervention group compared to the control group.

Conclusions

Internet-based approaches can be considered as useful for enhancing motivation to change in eating disorders and for yielding initial symptomatic improvement.

Keywords

Anorexia nervosabulimia nervosainternet interventionmotivation to changemotivational interviewing
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 9 , July 2014 , pp. 1947 - 1963
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abt, K (1987). Descriptive data analysis: a concept between confirmatory and exploratory data analysis. Methods of Information in Medicine 26, 77–88.Google Scholar
Ackard, DM, Croll, JK, Richter, S, Adlis, S, Wonderlich, A (2009). A self-report instrument measuring readiness to change disordered eating behaviors: the Eating Disorders Stage of Change. Eating and Weight Disorders 14, 66–76.Google Scholar
Allen, KL, Fursland, A, Raykos, B, Steele, A, Watson, H, Byrne, SM (2012). Motivation-focused treatment for eating disorders: a sequential trial of enhanced cognitive behaviour therapy with and without preceding motivation-focused therapy. European Eating Disorders Review 20, 232–239.Google Scholar
Ametller, L, Castro, J, Serrano, E, Martínez, E, Toro, J (2005). Readiness to recover in adolescent anorexia nervosa: prediction of hospital admission. Journal of Child Psychology and Psychiatry 46, 394–400.Google Scholar
Andersson, G, Carlbring, P (2003). Internet and cognitive behaviour therapy: new opportunities for treatment and assessment. Cognitive Behaviour Therapy 32, 97–99.Google Scholar
Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG (2001). AUDIT. The Alcohol Use Disorders Identification Test: Guideline for Use in Primary Care, 2nd edn. World Health Organization: Geneva.Google Scholar
Bandini, S, Antonelli, G, Moretti, P, Pampanelli, S, Quartesan, R, Perriello, G (2006). Factors affecting dropout in outpatient eating disorder treatment. Eating and Weight Disorders 11, 179–184.Google Scholar
Barak, A, Hen, L, Boniel-Nissim, M, Shapira, N (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services 26, 109–160.Google Scholar
Bauer, S, Winn, S, Schmidt, U, Kordy, H (2005). Construction, scoring and validation of the Short Evaluation of Eating Disorders (SEED). European Eating Disorders Review 13, 191–200.CrossRefGoogle Scholar
Becker, AE, Arrindell, AH, Perloe, A, Fay, K, Striegel-Moore, R (2010). A qualitative study of perceived social barriers to care for eating disorders: perspectives from ethnically diverse health care consumers. International Journal of Eating Disorders 43, 633–647.CrossRefGoogle ScholarPubMed
Berman, AH, Bergman, H, Palmstierna, T, Schlyter, F (2005). Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. European Addiction Research 11, 22–31.Google Scholar
Bewell, CV, Carter, JC (2008). Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa. International Journal of Eating Disorders 41, 368–371.Google Scholar
Blake, W, Turnbull, S, Treasure, J (1997). Stages and processes of change in eating disorders: implications for therapy. Clinical Psychology and Psychotherapy 4, 186–191.3.0.CO;2-5>CrossRefGoogle Scholar
Casasnovas, C, Fernández-Aranda, F, Granero, R, Krug, I, Jiménez-Murcia, S, Bulik, CM, Vallejo-Ruiloba, J (2007). Motivation to change in eating disorders: clinical and therapeutic implications. European Eating Disorders Review 15, 449–456.CrossRefGoogle ScholarPubMed
Castro-Fornieles, J, Bigorra, A, Martinez-Mallen, E, Gonzalez, L, Moreno, E, Font, E, Toro, J (2011). Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment. European Eating Disorders Review 19, 46–54.Google Scholar
Christensen, H, Griffiths, KM, Farrer, L (2009). Adherence in internet interventions for anxiety and depression: systematic review. Journal of Medical Internet Research 11, e13.Google Scholar
Cockell, SJ, Geller, J, Linden, W (2003). Decisional balance in anorexia nervosa: capitalizing on ambivalence. European Eating Disorders Review 11, 75–89.CrossRefGoogle Scholar
Dean, HY, Touyz, SW, Rieger, E, Thornton, CE (2008). Group motivational enhancement therapy as an adjunct to inpatient treatment for eating disorders: a preliminary study. European Eating Disorders Review 16, 256–267.Google Scholar
DeJong, H, Broadbent, H, Schmidt, U (2012). A systematic review of dropout from treatment in outpatients with anorexia nervosa. International Journal of Eating Disorders 45, 635–647.Google Scholar
Dray, J, Wade, T (2012). Is the transtheoretical model and motivational interviewing approach applicable to the treatment of eating disorders? A review. Clinical Psychology Review 32, 558–565.Google Scholar
Dunn, EC, Neighbors, C, Larimer, ME (2003). Assessing readiness to change binge eating and compensatory behaviors. Eating Behaviors 4, 305–314.Google Scholar
Dunn, EC, Neighbors, C, Larimer, ME (2006). Motivational enhancement therapy and self-help treatment for binge-eaters. Psychology of Addictive Behaviors 20, 44–52.CrossRefGoogle ScholarPubMed
Evans, EJ, Hay, PJ, Mond, J, Paxton, SJ, Quirk, F, Rodgers, B, Jhajj, AK, Sawoniewska, MA (2011). Barriers to help-seeking in young women with eating disorders: a qualitative exploration in a longitudinal community survey. Eating Disorders 19, 270–285.Google Scholar
Eysenbach, G (2005). The law of attrition. Journal of Medical Internet Research 7, e11.Google Scholar
Fairburn, CG (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press: New York.Google Scholar
Fairburn, CG, Beglin, SJ (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders 16, 363–370.Google Scholar
Fairburn, CG, Cooper, Z, Shafran, R (2003). Cognitive behavior therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy 41, 509–528.Google Scholar
Faul, F, Erdfelder, E, Lang, AG, Buchner, A (2007). G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 39, 175–191.CrossRefGoogle ScholarPubMed
Gale, C, Holliday, J, Troop, NA, Serpell, L, Treasure, J (2006). The pros and cons of change in individuals with eating disorders: a broader perspective. International Journal of Eating Disorders 39, 394–403.Google Scholar
Garner, DM, Olmstead, MP, Polivy, J (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders 2, 15–34.Google Scholar
Geller, J, Brown, KE, Srikameswaran, S (2011). The efficacy of a brief motivational intervention for individuals with eating disorders: a randomized control trial. International Journal of Eating Disorders 44, 497–505.Google Scholar
Geller, J, Brown, KE, Zaitsoff, SL, Menna, R, Bates, ME, Dunn, EC (2008). Assessing readiness for change in adolescents with eating disorders. Psychological Assessment 20, 63–69.CrossRefGoogle ScholarPubMed
Geller, J, Drab-Hudson, DL, Whisenhunt, BL, Srikameswaran, S (2004). Readiness to change dietary restriction predicts outcomes in the eating disorders. Eating Disorders 12, 209–224.Google Scholar
Geller, J, Dunn, EC (2011). Integrating motivational interviewing and cognitive behavioral therapy in the treatment of eating disorders: tailoring interventions to patient readiness for change. Cognitive and Behavioral Practice 18, 5–15.Google Scholar
Geller, J, Zaitsoff, SL, Srikameswaran, S (2005). Tracking readiness and motivation for change in individuals with eating disorders over the course of treatment. Cognitive Therapy and Research 29, 611–625.CrossRefGoogle Scholar
Grover, M, Naumann, U, Mohammad-Dar, L, Glennon, D, Ringwood, S, Eisler, I, Williams, C, Treasure, J, Schmidt, U (2011). A randomized controlled trial of an Internet-based cognitive-behavioural skills package for carers of people with anorexia nervosa. Psychological Medicine 41, 2581–2591.Google Scholar
Gulec, H, Moessner, M, Mezei, A, Kohls, E, Túry, F, Bauer, S (2011). Internet-based maintenance treatment for patients with eating disorders. Professional Psychology: Research and Practice 42, 479–486.Google Scholar
Hilbert, A, Tuschen-Caffier, B (2006). Eating Disorder Examination: German Translation [in German]. Verlag für Psychotherapie: Münster.Google Scholar
Hilbert, A, Tuschen-Caffier, B, Karwautz, A, Niederhofer, H, Munsch, S (2007). Eating Disorder Examination Questionnaire: evaluation of the German translation [in German]. Diagnostica 53, 144–154.Google Scholar
Hoek, HW, van Hoeken, D (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders 34, 383–396.Google Scholar
Jacobi, C, Hayward, C, de Zwaan, M, Kraemer, HC, Agras, WS (2004). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin 130, 19–65.Google Scholar
Karno, M, Granholm, E, Lin, A (2000). Factor structure of the Alcohol Use Disorders Identification Test (AUDIT) in a mental health clinic sample. Journal of Studies on Alcohol 61, 751–758.Google Scholar
Katzman, MA, Bara-Carril, N, Rabe-Hesketh, S, Schmidt, U, Troop, N, Treasure, J (2010). A randomized controlled two-stage trial in the treatment of bulimia nervosa, comparing CBT versus motivational enhancement in phase 1 followed by group versus individual CBT in phase 2. Psychosomatic Medicine 72, 656–663.Google Scholar
Keski-Rahkonen, A, Hoek, HW, Linna, MS, Raevuori, A, Sihvola, E, Bulik, CM, Rissanen, A, Kaprio, J (2009). Incidence and outcomes of bulimia nervosa: a nationwide population-based study. Psychological Medicine 39, 823–831.CrossRefGoogle ScholarPubMed
Keski-Rahkonen, A, Hoek, HW, Susser, ES, Linna, MS, Sihvola, E, Raevuori, A, Bulik, CM, Kaprio, J, Rissanen, A (2007). Epidemiology and course of anorexia nervosa in the community. American Journal of Psychiatry 164, 1259–1265.CrossRefGoogle ScholarPubMed
Lange, A, Schrieken, B, Blankers, M, van de Ven, JP, Slot, M (2000 a). Construction and validation of the sensory perception inventory: a tool to detect psychosis [in German]. Directieve Therapie 20, 162–173.Google Scholar
Lange, A, Schrieken, B, van de Ven, JP, Bredeweg, B, Emmelkamp, PMG, van der Kolk, J, Lydsdottir, L, Massaro, M, Reuvers, A (2000 b). ‘INTERAPY’: the effects of a short protocolled treatment of post-traumatic stress and pathological grief through the Internet. Behavioural and Cognitive Psychotherapy 28, 175–192.Google Scholar
Leung, SF, Ma, J, Russell, J (2013). Enhancing motivation to change in eating disorders with an online self-help program. International Journal of Mental Health Nursing 22, 329–339.Google Scholar
Macdonald, P, Hibbs, R, Corfield, F, Treasure, J (2012). The use of motivational interviewing in eating disorders: a systematic review. Psychiatry Research 200, 1–11.CrossRefGoogle ScholarPubMed
Martínez, E, Castro, J, Bigorra, A, Morer, A, Calvo, R, Vila, M, Toro, J, Rieger, E (2007). Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire. European Eating Disorder Review 15, 13–23.CrossRefGoogle ScholarPubMed
Melville, KM, Casey, LM, Kavanagh, DJ (2010). Dropout from Internet-based treatment for psychological disorders. British Journal of Clinical Psychology 49, 455–471.CrossRefGoogle ScholarPubMed
Miller, WR, Rollnick, S (2002). Motivational Interviewing: Preparing People for Change, 2nd edn. Guilford Press: New York.Google Scholar
Miller, WR, Zweben, A, DiClemente, CC, Rychtarik, RG (1992). Motivational Enhancement Therapy Manual. National Institute on Alcohol Abuse and Alcoholism: Rockville, MD. Google Scholar
Nijenhuis, ER, Spinhoven, P, van Dyck, R, van der Hart, O, Vanderlinden, J (1997). The development of the Somatoform Dissociation Questionnaire (SDQ-5) as a screening instrument for dissociative disorders. Acta Psychiatrica Scandinavica 96, 311–318.CrossRefGoogle ScholarPubMed
Ochsner, S, Scholz, U, Hornung, R (2013). Testing phase-specific self-efficacy beliefs in the context of dietary behaviour change. Applied Psychology: Health and Well-Being 5, 99–117.Google ScholarPubMed
Parkinson, K, Drewett, RF, Le Couteur, AS, Adamson, AJ (2012). Earlier predictors of eating disorder symptoms in 9-year-old children. A longitudinal study. Appetite 59, 161–167.Google Scholar
Perkins, S, Schmidt, U, Eisler, I, Treasure, J, Berelowitz, M, Dodge, E, Frost, S, Jenkins, M, Johnson-Sabine, E, Keville, S, Murphy, R, Robinson, P, Winn, S, Yi, I (2007). Motivation to change in recent onset and long-standing bulimia nervosa: are there differences? Journal of Eating and Weight Disorders 12, 61–69.Google Scholar
Prochaska, JO, DiClemente, CC (1992). Stages of change in the modification of problem behaviors. In Progress in Behavior Modification (ed. Hersen, M., Eisler, R. M. and Miller, P. M.), pp. 184–214. Sycamore: Sycamore, IL.Google Scholar
Radloff, LS (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.Google Scholar
Reas, DL, Williamson, DA, Martin, CK, Zucker, NL (2000). Duration of illness predicts outcome for bulimia nervosa: a long-term follow-up study. International Journal of Eating Disorders 27, 428–434.Google Scholar
Reinert, DF, Allen, JP (2007). The Alcohol Use Disorders Identification Test: an update of research findings. Alcoholism: Clinical and Experimental Research 31, 185–199.Google Scholar
Richard, M, Bauer, S, Kordy, H (2005). Relapse in anorexia and bulimia nervosa: a 2.5-year follow-up study. European Eating Disorders Review 13, 180–190.Google Scholar
Rieger, E, Touyz, S (2006). An investigation of the factorial structure of motivation to recover in anorexia nervosa using the Anorexia Nervosa Stages of Change Questionnaire. European Eating Disorders Review 14, 269–275.Google Scholar
Rieger, E, Touyz, S, Schotte, D, Beaumont, P, Russel, J, Clarke, S, Kohn, M, Griffiths, R (2000). Development of an instrument to assess readiness to recover in anorexia nervosa. International Journal of Eating Disorders 28, 387–396.Google Scholar
Rieger, E, Touyz, SW, Beumont, PJV (2002). The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ): information regarding its psychometric properties. International Journal of Eating Disorders 32, 24–38.Google Scholar
Ritterband, LM, Cox, DJ, Gordon, TL, Borowitz, SM, Kovatchev, BP, Walker, LS, Sutphen, JL (2006). Examining the added value of audio, graphics, and interactivity in an Internet intervention for pediatric encopresis. Children's Health Care 35, 47–59.CrossRefGoogle Scholar
Rosenberg, M (1965). Society and the Adolescent Self-Image. Princeton University Press: Princeton, NJ.Google Scholar
Rumpf, HJ, Hapke, U, Meyer, C, John, U (2002). Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires. Alcohol and Alcoholism 37, 261–268.CrossRefGoogle ScholarPubMed
Rumpf, HJ, Meyer, C, Hapke, U, John, U (2010). German version of the Alcohol Use Disorders Identification Test (AUDIT-G-L). In Elektronisches Handbuch zu Erhebungsinstrumenten im Suchtbereich (EHES). Version 4.00 [in German] (ed. Glöckner-Rist, A. and Rist, F.). GESIS: Bonn.Google Scholar
Ruwaard, J, Lange, A, Broeksteeg, J, Renteria-Agirre, A, Schrieken, B, Dolan, CV, Emmelkamp, P (2013). Online cognitive-behavioural treatment of bulimic symptoms: a randomized controlled trial. Clinical Psychology and Psychotherapy 20, 308–318.Google Scholar
Sánchez-Ortiz, VC, Munro, C, Stahl, D, House, J, Startup, H, Treasure, J, Williams, C, Schmidt, U (2011). A randomized controlled trial of Internet-based cognitive-behavioural therapy for bulimia nervosa or related disorders in a student population. Psychological Medicine 41, 407–417.Google Scholar
Schmidt, U, Landau, S, Pombo-Carril, MG, Bara-Carril, N, Reid, Y, Murray, K, Treasure, J, Katzman, M (2006). Does personalized feedback improve the outcome of cognitive-behavioural guide self-care in bulimia nervosa? A preliminary randomized controlled trial. British Journal of Clinical Psychology 45, 111–121.Google Scholar
Schmidt, U, Treasure, J (1997). A Clinician's Guide to Management of Bulimia Nervosa: Motivational Enhancement Therapy for Bulimia Nervosa. Psychology Press: Hove, Sussex.Google Scholar
Schmidt, U, Treasure, J (2006). Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology 45, 343–366.Google Scholar
Schulz, KF, Altman, DG, Moher, D, the CONSORT Group (2010). CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine 8, 18.CrossRefGoogle ScholarPubMed
Schwarzer, R, Jerusalem, M (eds) (1999). Skalen zur Erfassung von Lehrer- und Schülermerkmalen. Dokumentation der psychometrischen Verfahren im Rahmen der Wissenschaftlichen Begleitung des Modellversuchs Selbstwirksame Schulen. Freie Universität Berlin: Berlin.Google Scholar
Schwarzer, R, Mueller, J, Greenglass, E (1999). Assessment of perceived general self-efficacy on the Internet: data collection in cyberspace. Anxiety, Stress, and Coping 12, 145–161.Google Scholar
Serpell, L, Teasdale, JD, Troop, NA, Treasure, J (2004). The development of the P-CAN, a measure to operationalize the pros and cons of anorexia nervosa. International Journal of Eating Disorders 36, 416–433.Google Scholar
Serpell, L, Treasure, J (2002). Bulimia nervosa: friend or foe? The pros and cons of bulimia nervosa. International Journal of Eating Disorders 32, 164–170.Google Scholar
Skipsey, K, Burleson, JA, Kranzler, HR (1997). Utility of the AUDIT for identification of hazardous or harmful drinking in drug-dependent patients. Drug and Alcohol Dependence 45, 157–163.CrossRefGoogle ScholarPubMed
Treasure, J, Katzman, M, Schmidt, S, Troop, N, Todd, G, de Silva, P (1999). Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy. Behaviour Research and Therapy 37, 405–418.Google Scholar
van Eimeren, B, Frees, B (2011). Ergebnisse der ARD/ZDF-Onlinestudie 2011: Drei von vier Deutschen im Netz – ein Ende des digitalen Grabens in Sicht? Media Perspektiven 7–8, 334–349.Google Scholar
von Brachel, R, Hötzel, K, Schloßmacher, L, Hechler, T, Kosfelder, J, Rieger, E, Rueddel, H, Braks, K, Huber, TJ, Vocks, S (2012). Development and validation of a German questionnaire assessing motivation to change in eating disorders – the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED) [in German]. Psychotherapie, Psychosomatik, Medizinische Psychologie 62, 450–455.Google Scholar
von Brachel, R, Hötzel, K, Dörries, A, Striegler, K, Braks, K, Huber, T, Vocks, S (2011). Adaptation and validation of the Pros and Cons of Eating Disorders Scale (P-CED) in German women with eating disorders. Poster presentation at the 41st Annual Congress of the European Association of Cognitive and Behavioral Therapies (EABCT), Reykjavik, Iceland, September 2011.Google Scholar
von Collani, G, Herzberg, PY (2003). A revised version of the German adaptation of Rosenberg's Self-Esteem Scale [in German]. Zeitschrift für Differentielle und Diagnostische Psychologie 24, 3–7.Google Scholar
Wade, TD, Frayne, A, Edwards, S-A, Robertson, T, Gilchrist, P (2009). Motivational change in an inpatient anorexia nervosa population and implications for treatment. Australian and New Zealand Journal of Psychiatry 43, 235–243.Google Scholar
Waller, G (2012). The myths of motivation: time for a fresh look at some received wisdom in the eating disorders? International Journal of Eating Disorders 45, 1–16.CrossRefGoogle Scholar
Wesemann, D, Grunwald, M (2008). Online counselling for persons with eating disorders and their relatives. Results of a survey on the effects and benefits of the consulting service on the ab-server [in German]. Psychotherapeut 53, 284–289.CrossRefGoogle Scholar