Wednesday 12/06/2024
PHOTO: Lina Trochez
Text: Laura Torrens y Lina Camacho
If you are someone that struggles with an Eating Disorder and you are thinking of starting treatment, or you are already in the midst of your treatment and you are having a hard time maintaining motivation for the process, it would be important to ask yourself what motivates you to recover. Research has shown that lack of motivation can prevent someone from seeking help when they need it and also contributes critically to ED treatment dropout rates; patients that lack motivation typically report a significant delay between the onset of ED symptoms and their engagement with treatment services. The duration of untreated ED, meaning the time between onset of the ED and first contact with treatment, ranges from 2.5 years for Anorexia Nervosa to 6 years for Binge-Eating- Disorder.
Motivation in the recovery process from an Eating Disorder
Motivation is often defined as readiness, willingness, and ability to change, however is not as simple as that, it is important to acknowledge that motivation includes multiple facets and is a complex phenomenon. The Transtheoretical Model of Health Behavior Change (TTM) by Prochaska and DiClemente can be used to understand a person’s motivation (or lack thereof) to recover from their ED. The TTM proposes that when changing a health behavior, an individual will gradually progress through six stages of willingness to change. The movement between these levels of motivation occurs through the idea of a spiral, because the stages do not follow an idea of linearity, but of a flexible and volatile change that depends on numerous factors. That is why the authors adopted the idea of spiral, because the person can move freely between stages, without a fixed or rigid sequence.
Stages of change by Prochaska and DiClemente:
- Precontemplation: At this stage the person may have little or no awareness of a problem and no intention to change. The goals of the Precontemplation stage include raising the person’s awareness of the problem and inviting change of the problematic behavior. To leave the Precontemplation stage, the person must develop an interest or concern for change.
- Contemplation: The person begins to think about making a change and about to modify a behavior that he or she evaluates as problematic. To progress in the process of change, it is important to understand that ambivalence is normal at this stage. In other words, what the person may experience is “I want to change AND I want things to stay the same”. Ambivalence about change is normal and to be expected. When we try to let go of a behavior there is understandably hesitation and doubt. At this stage an analysis is needed of the costs and benefits of making, or not making, a change.
- Preparation: Here the decision-making process takes place. In this stage, it is important to ensure commitment towards change and rely on your support system for the development of an Action Plan. Asking yourself “What do I need (from myself and others) to succeed in my goals?” can facilitate the preparation for a real change and consequently put a plan into practice.
- Action: at this stage changes effectively begin to occur. It is very important to reinforce each success or achievement, so that an increase in self-efficacy can occur, which will be essential in the face of the challenges that can arise in behavior change.
- Maintenance: At this stage, the person shows commitment to their change and conscious actions to avoid temptation. They are prepared for potential pitfalls, with well-developed coping skills and support systems.
- Relapse: The model includes Relapses as part of the process. Even after years in the maintenance stage, lapses and relapses may be common, the goal here is to understand a lapse or relapse does not mean a failure in the change process, and that it is only important to have an evaluation of the strategies that did not work for a specific situation, and upon reflection and with greater insight resume the process.
How to help a person with en Eating Disorder? Support and its influence on motivation
It’s important to highlight as well that motivation doesn’t happen in a vacuum, recovery is often possible because of the presence of supportive and understanding relationships. Whether it’s family, friends, or medical professionals, the empathy and non-judgmental support they provide can significantly impact motivation. Patients that have been interviewed about their recovery, placed high value on being asked how they were feeling, or on being offered empathy for their emotional state that accompanied their ED. They appreciated this approach much more than when others ignored their ED or simply pointed to changes in their bodies without acknowledging emotions.
How to help someone with an ED based on testimonials of what is helpful and what is not:
“Sometimes it can be so hard to start that conversation about an eating disorder because you don’t want to accuse someone. But I think it’s even asking someone if they’re okay. It was so helpful and laid out a supportive space for me to just be like, this is what’s going on, and I really appreciate you asking and noticing.” -Helpful.
“She called me out on my behaviors… said, ‘I see when … the only thing you order is salad without dressing… you look so skinny. You really look like you’re sick,’… It sounds kind of punitive. It sounds not compassionate. It didn’t feel warm…[It] felt like, ‘You’re doing this, and it’s wrong.” – Harmful.
“I think that was really hard for me because there wasn’t anyone that I felt like was saying, hey, you should probably get treatment, a lot of times through- out my life.” Patients often felt people didn’t intervene enough in their disorder, and instead people often ignored the disorder or passively perpetuated behaviors (e.g., by purchasing “safe” foods). This lack of intervention was described as harmful.
“I trust my therapist and I know she wants the best for me.” – A strong therapeutic alliance, or having a strong personal connection with their therapist, has been described as helpful.
“I do remember one mom, she talked about how she wasn’t able to be a mom and still have her eating disor- der … You can’t have true relationships with other peo- ple with your eating disorder. I think that stuck with me, because it’s always gonna take over your life.” The awareness of how EDs can get in the way of relationships, especially relationships with one’s own children is often a helpful motivator towards recovery.
“My motivation was always there, it just depended on how frustrated or miserable I was… I felt… more capa- ble of recovery each time. I learned lessons…and I think it took a certain amount of…falling down so many times that I was like I need to step it up more…” Understanding and accepting that change is not a linear process is often helpful in recovery.
Applying these insights to help someone with an eating disorder
Understanding these factors can significantly enhance the approaches we take in supporting those with eating disorders. Interventions that focus on enhancing supportive relationships and building strong therapeutic alliances could be more effective in motivating individuals towards recovery.
For those in recovery, identifying your personal motivators can be a powerful step towards healing. For friends and family, understanding the impact of your support can transform the recovery landscape for your loved ones.
References
- Daugelat, MC., Kimmerle, J., Hagmann, D. et al. Improving motivation and treatment uptake behaviors of patients with eating disorders using patient narrative videos: study protocol of a pilot randomized controlled trial. J Eat Disord 12, 1 (2024). https://doi.org/10.1186/s40337-023-00960-3
- Del Rio Szupszynski, K.P., de Ávila, A.C. (2021). The Transtheoretical Model of Behavior Change: Prochaska and DiClemente’s Model. In: Andrade, A.L.M., De Micheli, D., Silva, E.A.d., Lopes, F.M., Pinheiro, B.d.O., Reichert, R.A. (eds) Psychology of Substance Abuse. Springer, Cham. https://doi.org/10.1007/978-3-030-62106-3_14
- Venturo-Conerly KE, Wasil AR, Dreier MJ, Lipson SM, Shingleton RM, Weisz JR. Why I recovered: A qualitative investigation of factors promoting motivation for eating disorder recovery. Int J Eat Disord. 2020; 53:1244–1251. https://doi.org/10.1002/eat.23331