1. Improvements in Readiness for Change as a Function of Binge Eating Status Stephanie E. Cassin, Krista E. Brown, Megan I. Jones, Erin C. Dunn, Suja Srikameswaran, & Josie Geller St. Paul’s Hospital & The University of British Columbia Introduction Discussion Participants Objective Results References Examination of shifts in outcome variables over time Regardless of binge status, improvements were demonstrated in: - Drive for thinness (p <.002) - Psychological distress (p <.005) - Hopelessness (p <.04) - Self-esteem (p <.04) - Self-concept: - Increased importance of friends (p <.001) - Decreased importance of appearance (p <.01) Fifty-five participants (44.3% of the sample) showed improvements in readiness for change (20% reduction in RMI restriction precontemplation scores) over the 5-month study period. The current analyses are limited to these participants. Participants met DSM-IV diagnostic criteria for an eating disorder, and the breakdown was as follows: - AN-B/P:5.5% - AN-R:7.3% - BN:41.8% - EDNOS:45.5% Breakdown of participants into groups: - Non-bingers composed 29.1% of the sample (n = 16) - Bingers composed 70.9% of the sample (n = 39) Previous research has shown that readiness for change predicts clinical outcome in the eating disorders. Specifically, using the Readiness and Motivation Interview (RMI; Geller & Drab, 1999), restriction precontemplation, or the extent to which individuals want to restrict dietary intake, has been shown to predict enrollment in intensive treatment, symptom change, dropout, and relapse (Geller, Cockell, & Drab, 2001; Geller, Drab-Hudson, Wisenhunt, & Srikameswaran, 2004). The identification of factors associated with improvements in readiness will contribute to our understanding of how to assist individuals prepare for change and to the development of preparatory interventions for symptom reduction treatment. To date, no studies have examined whether the factors that are associated with improvements in readiness differ between individuals who binge eat and those who do not. Previous research indicates that binge eating is an ego dystonic symptom, whereas dietary restriction is more ego syntonic. As such, individuals who binge eat may differ from those who do not in the extent to which they are distressed by their eating disorder and psychiatric symptoms. To determine factors that are associated with improvements in readiness for change, and to examine whether these factors differ among individuals who binge eat and those who do not. Procedure Participants (N = 124) were recruited from a metropolitan Canadian eating disorders clinic at the time of their initial referral and completed measures of readiness and motivation for change, eating disorder symptoms, psychiatric symptoms, self-esteem, and quality of life at baseline and again five months later. No participants accessed intensive treatment during the five month study period. Participants had a range of treatment experiences including medical visits, participation in patient education groups, individual therapy, and dietary consults. Measures Readiness and Motivation Interview (RMI; Geller & Drab, 1999; Geller, Cockell, & Drab, 2001). A symptom specific interview measure of readiness and motivation for change in the eating disorders. Eating Disorders Inventory – 2 (EDI-2; Garner, 1991). A questionnaire measure of eating disorder symptom severity. Brief Symptom Inventory (BSI; Derogatis, 1993). A questionnaire measure of psychiatric symptom severity. Beck Hopelessness Scale (BHS; Beck, 1974). A questionnaire measure of hopelessness. Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965). A questionnaire measure of self-esteem. Shape and Weight Based Self-Esteem Inventory (SAWBS; Geller, Johnston, & Madsen, 1997). A questionnaire measure that assesses the relative importance of personal attributes (including shape and weight), to feelings of self-worth. Summary of Findings: Independent of binge status, improvements in readiness for change were associated with improvements in psychiatric and eating disorder symptomatology (drive for thinness, psychological distress, hopelessness, and self-esteem), as well as changes in self- concept (increased importance of relationships and decreased importance of appearance). Greater body dissatisfaction among binge eaters may be attributed to higher body mass index; however, improvements in body dissatisfaction among binge eaters occurred in the absence of change in body mass index. Conclusions: Overall, there were more similarities than differences between bingers and non-bingers, and findings suggest that improvements in readiness were associated with decreased distress, decreased ED symptomatology, and increased importance placed on relationships. Given the similarities between bingers and non-bingers, mixing these individuals in preparatory treatment programs is not contraindicated. Beck, A.T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861-865. Frisch, M. B. (1994). Quality of life inventory (QOLI): Manual and treatment guide. Minneapolis, MN: National Computer Systems. Derogatis, L. R. & Spencer, P. M. (1982). The brief symptom inventory (BSI): Administration, scoring, and procedures manual. Towson, MD: Clinical Psychometric Research. Garner, D. (1991). Eating disorder inventory-2: Professional manual. Odessa, FL: Psychological Assessment Resources. Geller, J., Cockell, S.J., & Drab, D.L. (2001). Assessing readiness for change in the eating disorders: The psychometric properties of the Readiness and Motivation Interview. Psychological Assessment, 13, 189-198. Geller, J. & Drab, D.L. (1999). The Readiness and Motivation Interview: A symptom specific measure of readiness for change in the eating disorders. European Eating Disorders Review, 7, 259-278. Geller, J., Drab-Hudson, D., Whisenhunt, B., & Srikameswaran, S. (2004). Readiness to change dietary restriction predicts outcomes in the eating disorders. Eating Disorders: The Journal of Treatment and Prevention,12, 209-224. Geller, J., Johnston, C., & Madsen, K. (1997). The role of Shape and Weight in Self-Concept: The Shape and Weight Based Self-Esteem Inventory. Cognitive Therapy and Research, 21, 5-24. Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press. Changes in drive for thinness (EDI-2) Changes in body dissatisfaction (EDI-2) as a function of binge status Results Please address correspondence to: Stephanie Cassin E-mail: Stephanie_Cassin@camh.net Shifts in outcome variables as a function of binge status For the binge group only, improvements in readiness for change were associated with improvements in: - Body dissatisfaction (p <.001) - Bulimic behaviours (p <.001) Changes in importance of friends (SAWBS) Changes in importance of appearance (SAWBS) Note. ** p <.01 Non-Binger M (SD) Binger M (SD)p Age24.6 (5.8)29.8 (7.7)<.05 Body Mass Index18.6 (3.9)21.8 (3.7)<.01 ED Duration (years)5.2 (5.2)11.5 (7.4)<.05