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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). 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. 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. 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.

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