A grounded theory analysis of early treatment motivation in Anorexia Nervosa

Abstract

Research to date, in the treatment for Anorexia Nervosa (AN), a chronic and severe condition (Steinhausen, 2002), has provided little insight into how motivation to recover can be improved. Moreover, current understanding of the psychotherapeutic processes that effect change are significantly limited (Rhodes, 2011). Aim: The aims of the study were to i) develop a grounded theory of the process of change in motivation in patients in the early stage of treatment; and (ii) isolate aspects of treatment, manualised and non-specific, which contributed to changes in motivation. Methods: Sixteen participants were recruited from an ongoing randomised controlled trial (Hay, 2010), comparing the Loughborough Eating disorders Activity therapy- Out-patient version (LEAPOut; Touyz et al., 2010) enhanced Cognitive Behavioural Therapy (CBT; Pike, Carter, & Olmsted, 2004) with CBT alone. Data collection was through semi-structured, qualitative interviews following the participants’ tenth session of therapy. Data was analysed using grounded theory principles (Charmaz, 2006; Glaser & Strauss, 1967). Results: The results yielded a model of the process of change in motivation occurring in three phases; illness, turning point and recovery. Participants’ whose experiences did not fit the dominant model are also discussed. Psychotherapeutic processes that impacted on motivation were therapist professionalism, non-judgemental approach, reliability, and ability to be collaborative and flexible. Trust, rapport, disconnect and perceptions of the treatment as a bandaid were identified as being significant factors of the relationship. The aspects of treatment that were isolated as impacting upon motivation to change were challenging fears, externalisation, food diaries, goal setting, information and weigh-ins. Conclusions: It was concluded that there may be merit in the application of the Self-Determination Theory (SDT; Ryan & Deci, 2000) and recovery model (Anthony, 1993) in AN treatment and research.