The structure of motivation: Assessing readiness to change dimensions and their predictive value with the network validation of the Italian version of the Anorexia Nervosa Stages of Change Questionnarie

ObjectiveMotivation to change is an important predictor for treatment outcomes in individuals with anorexia nervosa (AN), however, the existence and clinical relevance of distinct motivational dimensions are understudied. This study aimed to structurally validate the AN Stage of Change Questionnaire (ANSOCQ) in the Italian adult AN population to identify separate motivational dimensions and their association with clinical variables and outcomes.MethodInpatients and outpatients with AN (N = 300) completed the ANSOCQ and measures assessing eating and depressive psychopathology. Unique Variable Analysis and Exploratory Graph Analysis were employed to identify dimensions in the network structure of ANSOCQ. Cross-sectional associations with clinical variables were assessed in the whole sample. Predictive value on weight and psychopathology was assessed in inpatients.ResultsTwo dimensions were identified, one comprising items relative to weight gain, and the second items regarding attitudes towards eating, body, and emotional problems. Feelings associated with eating resulted as most central in the network. Higher scores in the first dimension and ANSOCQ total predicted weight gain during hospitalisation. No significant predictors emerged for changes in eating psychopathology.DiscussionThese findings confirm the robust psychometric properties of ANSOCQ and provide support for the use of its subdimensions in clinical practice.Motivation to change is an important predictor of clinical improvement in individuals with anorexia nervosa (AN). The AN Stages of Change is a reliable tool for assessing motivation, and valuable clinical information can be obtained from its structure. In this study, we utilise an innovative method based on network analysis to assess motivational dimensions and their associations with weight gain and psychopathology in the Italian population. Two main dimensions emerged, one pertaining to weight gain and significantly associated to inpatient weight increase, and the second regarding attitudes towards eating, body, and emotional problems. The application of network analysis to motivation to change introduces a novel and potentially valuable model for future investigations.