Dancing with change: a qualitative exploration of in-session motivation to change in the treatment of anorexia nervosa

ABSTRACT Objective Motivation is considered essential in the treatment of anorexia nervosa (AN). However, the in-session nature of, and variables associated with, changes in motivation are only partially understood in this population. The aim of this study was to conduct an exploratory investigation of the in-session nature of motivation to change in people during cognitive behavioural therapy for anorexia nervosa (CBT-AN). Method Thirty-eight therapy-session transcripts from nine participants, collected as part of a larger multi-site randomised control trial, were analysed using inductive thematic analysis. Results Two superordinate themes were generated: (i) betwixt and between; and (ii) rhythms of motivation. Two concurrent yet distinct rhythms of motivation were observed within and across participant sessions, with shifts in motivation occurring alongside identity (re)negotiations. Conclusions Findings highlight the complex and multifaceted nature of the in-session processes of motivational change in persons with AN, and support previous literature suggesting factors independent of treatment may facilitate tipping points of change. Furthermore, this study proposes that an integrated or dual-wave model of motivation may assist clinicians in understanding how they can better facilitate and support motivation for change in clients with AN during treatment. KEY POINTS What is already known about this topic: Enhancing motivation is considered essential for improving treatment outcomes. Motivation is conceptualised as a dynamic process; however, it is typically assessed through quantitative self-report measures at set points during treatment. The in-session dynamics of motivation to change are poorly understood. What this topic adds: In-session motivation to change is a complex, multifaceted process closely associated with individual identity (re)negotiations. There may be dual processes of motivation occurring during treatment that are influenced by factors independent of treatment. A proposal for an integrated model of motivation for anorexia nervosa.