Motivational Text Message Intervention for Eating Disorders: A Single-Case Alternating Treatment Design Using Ecological Momentary Assessment |
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| Institution: | 1. Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States;2. VA Connecticut Healthcare System – West Haven, Department of Psychology, 950 Campbell Avenue, West Haven, CT 06403, United States;1. Griffith University;1. Virginia Polytechnic Institute and State University;1. Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain;2. Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid.;3. Department of Psychiatry, Centre Hospitalier Universitaire De Brest, Brest, France;4. Department of Psychiatric Emergency and Post-Acute Care, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France;5. Department of Psychiatry, Centre Hospitalier Universitaire De Nîmes, Nîmes, France;6. Universidad Autónoma de Madrid;7. Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain;8. Departament of Personality, Assessment and Treatment, Universidad de Valencia, Valencia (Spain);9. Department of Signal Theory, Universidad Carlos III de Madrid, Leganés, Spain;10. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.;11. Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid.;12. Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Madrid.;13. Universidad Católica del Maule, Talca, Chile;14. CIBERSAM (Centro de Investigación Biomédica en Red Salud Mental), Carlos III Institute of Health, Madrid, Spain |
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| Abstract: | ObjectiveThis study tested a motivational text message treatment adjunct for individuals with eating disorders (EDs) who exhibited high dietary restraint/restriction. Method: A replicated single-case alternating treatment design was used to examine (a) the feasibility of combining a brief motivational interview with subsequent text messages and (b) the influence of the text messages on eating behaviors and motivation to change in individuals with EDs (N = 12). The protocol was 8 weeks and the text messages were adjunctive to cognitive-behavioral therapy. Results: The intervention was well accepted (mean rating = 7/10) and feasible within the context of monetary compensation (mean daily monitoring compliance = 91%). Text messages did not impact behavioral outcomes: dietary restraint and kilocalorie intake. They had mixed effects on motivation to change dietary restraint, measured by the Readiness and Motivation Questionnaire (RMQ). When receiving text messages, RMQ precontemplation scores (desire to restrict) significantly increased, indicating decreased motivation; however, action scores (effort toward reducing dietary restraint) significantly increased, indicating increased motivation. These effects were moderated by weight status. Underweight individuals (n = 4; body mass index BMI] < 19.0) reported increased ambivalence—that is, an increased desire to restrict and increased action toward reducing restriction—in response to the text messages. Normal weight participants (n = 8; BMI > 19.0) reported only increased action toward reducing restriction in response to the text messages. Discussion: These data demonstrate text messages are a potentially feasible and acceptable treatment adjunct and may be effective at increasing motivation to change for normal weight individuals, while their influence on underweight patients is more complex. These findings provide a foundation for future research in technology-based motivational interventions for EDs and offer preliminary evidence for using these methods among normal weight individuals. |
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