The incorporation of the stage of change model in the day hospital treatment of patients with anorexia nervosa

The development of day hospital programmes for patients with anorexia nervosa has received much interest of late. However, there has often been little attention paid to the unique nature of this disorder. For this reason, we set out to design day hospital treatment programmes to reflect and incorporate an understanding of the ambivalence towards change demonstrated by the majority of such patients. We recognise that, from the sufferers' perspective, anorexia is a functional and ego syntonic illness. It is an illness that on some levels has "adaptive" advantages which the patient does not wish to relinquish. Patients are at different levels of readiness to change aspects of their behaviour. Therefore day hospital treatment programmes must aim to match the type of therapy delivered to the readiness to change of the patient. If there is a 'mismatch' between the stage of change and the goals of treatment, resistance will occur. Using the transtheoretical model of change as a paradigm, we have designed a series of day programmes that aim to meet the needs of patients at different stages of change.