Assessment of stage of change and intervention strategies

One of the difficulties in the treatment of eating disorders is the high level of resistance to treatment and high percentages of treatment dropout. One of the causes of treatment dropout on the part of patient is the problem of motivation. When introducing treatment, it is necessary to evaluate the patient's motivation for treatment and to consider how to motivate the patient for treatment. There are stages of attempting to change one's behavior in order to engage in treatment, and these are described in the Transtheoretical Model of the Stage of Change as a series of stages in which people make typical progress in thinking about, initiating, and continuing new behaviors as theorized by Prochaska and Diclement. The stages of change are structured as a cyclical model consisting of five stages: pre-contemplation, contemplation, preparation, action, and maintenance. Prochaska et al. showed that there is a relationship between the stages of change and the patient's self-change behavior, dropout, and treatment efficacy in addictive behaviors, and it has also been shown to be useful in patients with eating disorders. Depending on which cycle the patient is in, the therapist needs to vary the way to motivate the patient to change her eating behavior. Motivation for change has evolved from the field of substance use disorders (e.g., alcohol, illegal drugs, smoking). Motivation is considered to be multifaceted, dynamic, modifiable, and influenced by social reactions and clinician attitudes and techniques. Miller and colleagues summarized the techniques as Motivational Interviewing, which has been shown to be useful in the field of alcohol and substance use disorders and has since been applied in the field of eating disorders. The 2017 NICE guideline in the UK lists Maudsly Anorexia Nervosa Treatment for Adults (MANTRA) as one of the recommended treatments for adult anorexia nervosa. The five stages of change and Motivational Interviewing are important techniques incorporated in MANTRA. As for interventions tailored to the stage of change, explanation of disease and psychological education are important in the pre-contemplation stage because of the lack of disease awareness. In the contemplation and preparation stages, techniques from Motivational Interviewing are used, and especially in the preparation stage, the patient is asked to think about the future self. In the action phase, specific behavioral goals and praise for efforts are necessary, and in the maintena