Working alliance in the treatment of anorexia nervosa: baseline predictors, motivation to change, and relationship to treatment outcome

Torres, Julian (2018) Working alliance in the treatment of anorexia nervosa: baseline predictors, motivation to change, and relationship to treatment outcome. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Background: Anorexia Nervosa (AN) is a severe and potentially deadly disorder that is often found to be resistant to treatment, especially in adult populations. Patients commonly present a strong ambivalence towards recovery and high rates of premature treatment termination. The working alliance has been found to be a strong predictor of treatment outcome across an array of psychological disorders and treatment approaches; however, little research has been conducted to understand its role in the treatment of AN and its relation to motivation for treatment or outcome in this population. The present pilot study sought to investigate primarily the associations between reports of working alliance, measurements of motivation for treatment, and AN treatment outcome. This is the first study to examine the relation between motivation and working alliance in AN patients. Method: The present study was a secondary analysis of data obtained from a sample of 53 adult AN patients who were admitted to a specialized inpatient/day-hospital eating disorder treatment program. The patients completed self-report questionnaires measuring autonomous and controlled motivation for treatment at baseline and at week four, self-report questionnaires regarding working alliance at week four, and clinical symptomatology and BMI were measured at baseline, week four, and discharge. Results: Changes in Autonomous motivation for treatment from baseline to week four were found to predict working alliance scores at week four. No association was found between measures of motivation for treatment or working alliance with treatment outcome or rates of premature treatment termination. In exploratory analyses, AN subtype (i.e., restricting vs. binge-purge) was significantly associated with working alliance scores, measures of treatment outcome, and rates of premature treatment termination. Conclusions: The results of this study point to the importance of early measurements of working alliance in this population and brings into question the validity of early self-reports of motivation in AN treatment. On balance, the present findings do not align with previous findings in the literature. Limitations of the current study related to high attrition and low statistical power are discussed. The differences observed between AN subtypes in their response to treatment add to a growing body of clinical knowledge that may suggest a need for researchers and clinicians to reformulate how these clinical subtypes are conceptualized.

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