Novel motivational text message intervention for eating disorders: a single case experimental study
Shingleton, Rebecca M.
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New strategies to increase motivation to change and reduce problematic behaviors in eating disorders (EDs) are needed. Text messages may offer a novel way to enhance motivation and change behavior by providing real-time support outside of psychotherapy sessions. The primary aim of this study was to test a text-message treatment adjunct for individuals with EDs. The secondary aim was to investigate the effects of message frame (gain-frame highlighting rewards of changing behavior; loss-frame highlighting consequences of maintaining behavior) and its congruency with individual orientation (i.e., when approach-oriented individuals receive gain-frame messages and avoidant-oriented individuals receive loss-frame messages). Individuals with EDs (N=12; 10 female; mean age=21.5) were recruited to participate in a treatment study. A single-case alternating treatment design was used to test the influence of combining a brief motivational interview with subsequent text messages on feasibility and eating-related outcomes. Visual and graphical inspection and Generalized Estimating Equations [GEE] were used to test hypotheses. I hypothesized that the intervention would be feasible and well-accepted; receiving text messages (vs. no messages) would result in higher kilocalorie intake, lower dietary restraint, and higher motivation to change (measured by the Readiness and Motivation Questionnaire [RMQ]); and loss-frame (vs. gain-frame) messages would produce more change, moderated by motivation orientation. The intervention was well accepted (mean rating=7/10) and feasible (mean daily-monitoring compliance=91%). Text messages did not impact behavioral outcomes, nor did message frame or orientation congruency, and had mixed effects on motivation. RMQ precontemplation (desire to engage in dietary restraint) increased, indicating decreased motivation, and RMQ action scores (effort towards reducing dietary restraint) increased, indicating increased motivation when receiving text messages, across the sample. Normal-weight participants (n=8) reported only positive effects of text messages. Individual case data indicated that the text messages were associated with positive effects on the outcomes for 3 participants, mixed/no effects for 7, and negative effects for 2. This is the first study to investigate text messages as a motivational treatment adjunct in EDs. The data demonstrate text messages are a feasible and acceptable treatment adjunct and may be most effective at increasing motivation to change for normal- vs. underweight individuals. Continued research is needed to enhance the impact of motivational interventions on behavioral outcomes.