BRIEF REPORT

A Randomized Controlled Trial of Motivational

Interviewing 1 Self-Help Versus Psychoeducation 1
Self-Help for Binge Eating

Rachel A. Vella-Zarb, MA1* ABSTRACT

Objective: Motivational Interviewing
Jennifer S. Mills, PhD1 (MI) is a collaborative therapy that focuses
Henny A. Westra, PhD1 on strengthening a person’s internal
Jacqueline C. Carter, PhD2 motivation to change. Research suggests
that MI may be helpful for treating binge
Leah Keating, MA1 eating; however, findings are limited and
little is known about how MI for binge
eating compares to active therapy con-
trols. The present study aimed to build
on current research by comparing MI as
a prelude to self-help treatment for binge
eating with psychoeducation as a prelude
to self-help treatment for binge eating.
Method: Participants with full or sub-
threshold DSM-IV Binge Eating Disorder
or nonpurging Bulimia Nervosa were ran-
domly assigned to receive either 60
minutes of MI followed by a self-help
manual (n 5 24) or 60 minutes of psy-
choeducation followed by a self-help
manual (n 5 21). Questionnaires were
completed pre- and postsession, and at 1
and 4 months postsession.
Results: MI significantly increased
readiness to change and confidence in
ability to control binge eating, whereas
psychoeducation did not. No group
differences were found when changes
in eating disorder attitudes and behav-
iors were examined.
Discussion: MI offers benefits for
increasing motivation and self-efficacy.
However, it may not be a uniquely
effective treatment approach for reduc-
ing binge eating. V
C 2014 Wiley Periodi-
cals, Inc.
Keywords: binge eating disorder;
motivation; randomized controlled trial;
binge eating; self-help; psychoeducation
(Int J Eat Disord 2015;48:328–332)

Introduction study,7 90 adults with full or subthreshold Bulimia

Motivational Interviewing (MI) is a client-centered
psychotherapy that aims to enhance motivation to
change through the use of empathy and directive
techniques.1,2 There has been interest in using MI
for treating eating disorders (EDs) because of high
rates of ambivalence about treatment in this popu-
lation3; however, findings are limited.4,5 Support to
date is strongest for using MI as treatment for
binge eating.4
Two studies have examined the efficacy of MI
for Binge Eating Disorder (BED).6,7 In the first
Accepted 22 December 2013
Partial support for this research was provided by the Social Sci-
ences and Humanities Research Council of Canada (SSHRC) Joseph
Armand-Bombardier Canada Graduate Scholarship, awarded to
Rachel Vella-Zarb. There are no known conflicts of interest.
*Correspondence to: Rachel Vella-Zarb; York University, Faculty
of Health, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
E-mail: rachelvz@yorku.ca
1
York University, Toronto, Ontario, Canada
2
Memorial University, St. John’s, Newfoundland, Canada
Published online 13 January 2014 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/eat.22242
VC 2014 Wiley Periodicals, Inc.
Nervosa (BN) or BED were randomly assigned to
receive either one session of an adaptation of MI,
called Motivational Enhancement Therapy
(MET), followed by a self-help manual or self-
help alone. MET resulted in increased readiness
to change binge eating and a significantly greater
proportion of participants were abstinent from
binge eating in the MET (24.4%) versus self-help
only condition (8.9%). In the second study,6 108
women with BED were randomly assigned to
receive either one session of MI followed by a
self-help manual or self-help alone. MI partici-
pants reported significantly greater self-efficacy
and greater improvements in binge eating, mood,
self-esteem, and quality of life. Although findings
are promising, implications are limited given that
both studies compared MI 1 self-help to self-help
alone. It is unclear whether there is something
specific about MI that makes it an effective prel-
ude to treatment or whether there are other non-
specific factors that lead to benefits (e.g.,
therapist contact). Therefore, it is important to
examine how MI for BED compares to an active
therapy control.

328 International Journal of Eating Disorders 48:3 328–332 2015


FIGURE 1 Summary of participant flow. MI, motivational interviewing. *Excluded as an outlier due to session length.
The present study built on previous research
by comparing one session of MI followed by a
self-help manual to one session of psychoeduca-
tion followed by a self-help manual for individu-
als with clinically significant binge eating
problems. Psychoeducation was chosen for com-
parison because it has been shown to be an
effective psychotherapeutic approach for treating
binge eating and is often used as the first step in
stepped care treatment.8 The primary aim was to
test the hypothesis that MI 1 self-help would
lead to greater improvements in ED behaviors,
attitudes, and abstinence from binge eating. The
secondary aim was to examine whether MI
would lead to greater improvements in readiness
to change and self-efficacy than would
psychoeducation.
International Journal of Eating Disorders 48:3 328–332 2015
A RANDOMIZED CONTROLLED TRIAL FOR BINGE EATING
Method
Participants and Procedure
The York University Psychology Research Ethics Board
approved this study. Data collection occurred between
September 2011 and August 2012. Participation involved
informed consent. Participants were recruited from York
University and the community. A priori power calcula-
tions indicated a minimum overall sample of 38 partici-
pants was necessary for an 80% chance of detecting
significant effects on primary outcomes (p 5 .05).
Participants were required to meet full or subthreshold
DSM-IV criteria for BED or Bulimia Nervosa, Non-
Purging Subtype (BN-NP)a. “Subthreshold” was defined
a
It should be noted that DSM-5 no longer requires the identification
of Bulimia Nervosa subtypes.
329
VELLA-ZARB ET AL.
as one binge eating episode per week for 3 months. Par-
ticipants were excluded if they were under 18, met crite-
ria for substance abuse, had diabetes, were pregnant,
were not proficient in English, expressed active suicidal
ideation, had been using psychiatric medication for
under 3 months or dosage had varied over the previous 3
months. Eligibility was determined by an online ques-
tionnaire and Structured Clinical Interview for DSM-IV
Disorders (SCID) ED section completed via telephone,
with binge eating frequency modified to study criteria.
Forty-seven participants were eligible to participate
and were randomly assigned to condition, stratifying for
current involvement in psychotherapy. Randomization
was performed by an arms-length researcher using SPSS.
Enrollment and assignment were performed by the first
author. Allocation was 1:1 in a parallel groups design.
Participants were blind to treatment assignment until
after completing baseline measures. Following study
completion, one participant from each group was
removed as an outlier based on session length (psycho-
education 5 27.03 minutes, MI 5 83.07 minutes), leaving
a total of 45 participants (psychoeducation n 5 21; MI
n 5 24) (see Fig. 1).
Following assignment, participants completed ques-
tionnaires assessing ED symptoms (Eating Disorder
Examination Questionnaire – EDE-Q), readiness to
change (University of Rhode Island Stages of Change
Assessment – URICA), and eating self-efficacy (Weight
Efficacy Lifestyle Questionnaire – WEL). They then par-
ticipated in the intervention session to which they were
assignedb. The first author conducted all therapy ses-
sions to control for potential discrepancies as a redult of
therapist characteristicsc. Mean MI session length was
55.76 minutes (SD 5 7.03) and mean psychoeducation
session length was 49.73 minutes (SD 5 7.03); they were
not statistically significantly different.
Following session completion, participants were given
the self-help manual, Overcoming Binge Eating9 and
completed measures examining readiness to change
(URICA) and self-efficacy (WEL). One and 4 months
later, participants were contacted via email to complete
online follow-up questionnaires assessing ED symptoms
(EDE-Q).
The majority of participants were Caucasian (77.8%)
and female (95.6%), mean age was 24.88 years (SD 5 6.91
b
Complete protocol for both interventions is available by request from
the first author. There was no overlap in material between the two inter-
vention sessions.
c
In preparation, the first author (a senior-level PhD Clinical Psychol-
ogy student) participated in a multiday MI training led by William Miller
and attended additional MI workshops. To ensure treatment protocols
were followed in both conditions, two registered clinical psychologists
(Drs. Jennifer Mills and Henny Westra) reviewed a random selection of
audiotaped sessions and provided clinical supervision.
330
years), and mean BMI was 27.06 (SD 5 6.54). Four partic-
ipants (8.9%) were participating in psychotherapy for
mood-related problems at prescreening (MI: n 5 3, psy-
choeducation: n 5 1). Approximately 73% of participants
(n 5 33) met full (n 5 16) or subthreshold (n 5 17) criteria
for BED; 27% (n 5 12) met full (n 5 8) or subthreshold
(n 5 4) criteria for BN-NP.
Results
Missing Data and Attrition
The majority of missing data were because of
inability to reach participants at follow-up.
Attrition rate was 22.22% (n 5 10). There were no
significant group differences in attrition. Compari-
son of completers and noncompleters on all meas-
ured variables revealed no significant differences.
Multiple imputation was used to estimate missing
datad.
Primary Outcomes. Eating disorder behaviors and atti-
tudese. A repeated measures ANOVA showed a sig-
nificant main effect of time on EDE-Q global
scores, F(1.95, 83.67) 5 13.47, p < .001, gp2 5 0.24,
indicating an overall decrease in ED symptoms
across groups. Significant changes occurred
between baseline and 1 month, F(1, 32) 5 19.87,
p < .001, gp2 5 0.31, and baseline and 4 months,
F(1, 43) 5 18.87, p < .001, gp2 5 0.30 only. No signifi-
cant Group 3 Time interaction was found (see
Table 1).
Binge Eating Abstinence. Abstinence from binge
eating did not differ between groups at 1 month
(Fisher’s Exact Test: p 5 .71; 14% of psychoeduca-
tion participants reported no binges in the previous
month versus 21% of MI participants). At 4 months,
group differences were still not statistically signifi-
cant, v2 (N545) 5 2.55, p 5 .15; 19% psychoeduca-
tion versus 46% MI).
Secondary Outcomes. Readiness to Change. A
repeated measures ANOVA revealed a main effect
of time on the URICA readiness composite,
F(1, 43) 5 16.31, p < .001, gp2 5 0.28. This finding
d
Multiple imputation is highly recommended for dealing with missing
data because it eliminates problems associated with case-wise deletion,
such as reductions in power and loss of potentially predictive informa-
tion, and is not subject to many of the same biases as other imputation
methods. Although research indicates that multiple imputation is an
acceptable approach for minimizing bias because of missing data in lon-
gitudinal studies, all hypotheses were additionally tested using complete
case analysis and results were compared. Findings indicated that results
were comparable.
e
Sphericity was violated for repeated measures ANOVAs examining
changes on the EDE-Q total. To account for this, Greenhouse-Geisser cor-
rections were used.
International Journal of Eating Disorders 48:3 328–332 2015
 A RANDOMIZED CONTROLLED TRIAL FOR BINGE EATING

TABLE 1. Means and standard deviation by treatment group at all time points
PED baseline MI baseline PED post-session MI post-session PED 1-month MI 1-month PED 4-months MI 4-months
(N 5 21) (N 5 24) (N 5 21) (N 5 24) (N 5 21) (N 5 24) (N 5 21) (i5 24)

Variables M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)

URICA Readiness 10.27 9.25 10.52 10.24 ___ ___ ___ ___
Compositea,b
(1.69) (1.85) (1.28) (1.35)
WEL Totala,b 71.62 72.83 73.04 92.39 ___ ___ ___ ___
(28.18) (25.80) (27.12) (26.07)
b
EDE-Q Global 3.48 3.46 ___ ___ 2.70 2.81 2.59 2.70
(0.90) (1.35) (1.00) (1.12) (1.19) (1.21)
a
p < .05 significant group 3 time interaction.
b
p < .01 significant main effect of time.
PED 5 Psychoeducation, MI 5 Motivational Interviewing, URICA 5 University of Rhode Island Stages of Change Assessment Scale, WEL 5 Weight Efficacy
Lifestyle Questionnaire, EDE-Q 5 Eating Disorder Examination Questionnaire.

was qualified by a significant Group 3 Time improved efficacy, although MI is intended to be

interaction, F(1, 43) 5 5.59, p 5 .02, gp2 5 0.12. MI
participants showed a significant increase in readi-
ness from pre- to postsession, t(23) 5 24.11,
p < .001, d 5 0.61, whereas psychoeducation partic-
ipants did not, t(20) 5 21.41, p 5 .17, d 5 0.17 (see
Table 1).
Eating Self-Efficacy. A repeated measures ANOVA
showed a main effect of time on self-efficacy meas-
ured by the WEL, F(1, 43) 5 9.19, p 5 .004,
gp2 5 0.18. A significant Group 3 Time interaction
was also found, F(1, 43) 5 6.87, p 5 .01, gp2 5 0.14.
MI participants displayed a significant increase
in self-efficacy from pre- to postsession, t(20) 5
24.03, p 5 .001, d 5 0.75, whereas psychoeducation
participants did not, t(20) 5 20.29, p 5 .78, d 5 0.05
(see Table 1).
Discussion
The purpose of this study was to compare MI as a
prelude to self-help for binge eating to psycho-
education as a prelude to self-help for binge
eating. Participants in both groups showed signifi-
cant and equivalent improvements in ED symp-
toms. MI led to significant increases in readiness
to change and self-efficacy, whereas psychoeduca-
tion did not.
This study has numerous strengths: an RCT
design was employed, an active therapy compari-
son group was used, and the interventions utilized
were brief, inexpensive, and could be easily put
into practice. This study also has its limitations.
First, sample size was small, but comparable to
other studies examining MI for EDs.10–12 Second,
treatment involved only one 60-minute interven-
tion session. Adding multiple sessions may have
brief, typically one or two sessions.1 Third, out-
comes were measured by self-report question-
naires, which can be subject to bias; using a
clinical interview to assess changes may have
been preferable. However, self-report measures
reduce participant burden, which is important
when measurements are frequent as in this study.
Fourth, all therapy sessions were conducted by a
single therapist who was not blind to study
hypotheses. Although she worked to ensure equiv-
alent treatment across conditions, allegiance
effects remain a possibility. Fifth, this study did
not include a “no treatment” control; findings
cannot rule out the possibility of regression to the
mean.
Findings indicate that MI is more effective than
psychoeducation at increasing readiness to
change and self-efficacy in individuals who binge
eat. However, MI 1 self-help does not appear to
offer any unique benefit for reducing binge
eating.
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