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UBC Theses and Dissertations

A decisional balance measure of readiness for change in Anorexia nervosa Cockell, Sarah Jane


Women with anorexia nervosa tend to be ambivalent about change and resistant to treatment. A growing number of researchers suggest that this ambivalence must be targeted early on, before attempting to engage clients in action-oriented treatment that focuses on immediate symptom reduction. However, in order to appropriately address client ambivalence, it must be accurately evaluated with empirically validated instruments. The purpose of this thesis was to develop and validate a Decisional Balance (DB) measure of readiness for change in anorexia nervosa. In Study 1, 246 women with anorexia nervosa completed the DB, and a subset completed the DB again one week later. Unlike traditional decisional balance measures that have two factor (pro-con) solutions, factor analytic techniques indicated that a three factor solution provided the best fit for the DB data in this study. These factors included general negative consequences of the disorder (Burdens), valued achievements such as self-control, being very thin, and striving for perfection (Benefits), and using anorexia nervosa as a means for avoiding aversive emotions, challenges, and responsibilities (Avoidance Coping). The DB demonstrated good internal consistency and test-retest stability. In study 2, 80 women with anorexia nervosa completed the DB, along with other measures of readiness for change, as well as measures unrelated to readiness. Support was found for both convergent and divergent validity. Finally, in study 3, 80 women with anorexia nervosa completed the DB, and a measure of anticipated difficulty completing symptom-challenging recovery activities. In addition, participants attempted to complete three recovery activities in the week following initial assessment. Criterion validity was not well supported, most likely because the concurrent and predictive validity measures focused on behavior change, when non-behavioral measures may have been more appropriate. Overall, the results suggest that the DB for anorexia nervosa is a measure of awareness or insight about the functions of this disorder. The theoretical and clinical implications of this research are reviewed and directions for future investigations are proposed.

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