Psychological Assessment © 2013 American Psychological Association

2013, Vol. 25, No. 3, 759 –768 1040-3590/13/$12.00 DOI: 10.1037/a0032539

The Psychometric Properties of the Readiness and Motivation

Questionnaire: A Symptom-Specific Measure of Readiness for Change in
the Eating Disorders

Josie Geller Krista E. Brown

St. Paul’s Hospital and University of British Columbia University of Hawai‘i at Ma៮ noa

Suja Srikameswaran William Piper and Erin C. Dunn

St. Paul’s Hospital and University of British Columbia University of British Columbia
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Readiness for change, as assessed by the Readiness and Motivation Interview (RMI), predicts a number
of clinical outcome variables in eating disorders including enrollment in intensive treatment, symptom
change, dropout, and relapse. Although clinically useful, the training and administration of the RMI is
time consuming. The purpose of this research was to (a) develop a self-report, symptom-specific version
of the RMI, the Readiness and Motivation Questionnaire (RMQ), that can be used to assess readiness for
change across all eating disorder diagnoses and (b) establish its psychometric properties. The RMQ
provides stage of change, internality, and confidence scores for each of 4 eating disorder symptom
domains (restriction, bingeing, and cognitive and compensatory behaviors). Individuals (N ⫽ 244) with
current eating disorder diagnoses completed the RMQ and measures of convergent, discriminant, and
criterion validity. Similar to the RMI scores, readiness scores on the RMQ differed according to symptom
domain. Regarding criterion validity, RMQ scores were significantly associated with ratings of antici-
pated difficulty of recovery activities and completion of recovery activities. The RMQ contributed
significant unique variance to anticipated difficulty of recovery activities, beyond those accounted for by
the RMI and a questionnaire measure of global readiness. The RMQ is thus an acceptable alternative to
the RMI, providing global and domain-specific readiness information when time or cost prohibits use of
an interview.

Keywords: eating disorders, readiness, motivation, measurement, psychometric validation

Supplemental materials: http://dx.doi.org/10.1037/a0032539.supp

Treatment nonadherence, dropout, and relapse are common
occurrences in the eating disorders and are associated with a
mismatch between the behavioral expectations of treatment and
patient readiness for change (e.g., Geller, Cockell, & Drab,
2001; Gowers & Smyth, 2004). Across treatment modalities,
This article was published Online First May 6, 2013.
Josie Geller, Eating Disorders Program, St. Paul’s Hospital and Depart-
ment of Psychiatry, University of British Columbia, Vancouver, British
Columbia, Canada; Krista E. Brown, Department of Psychology, Univer-
sity of Hawai’i at Ma៮ noa; Suja Srikameswaran, Eating Disorders Program,
St. Paul’s Hospital and Department of Psychiatry, University of British
Columbia; William Piper and Erin C. Dunn, Department of Psychiatry,
University of British Columbia.
This research was supported by an operating grant from the Canadian
Institute of Health Research. We thank the staff at St. Paul’s Hospital for
their help with recruitment. We also gratefully acknowledge study partic-
ipants for contributing their time to this project.
Correspondence concerning this article should be addressed to Josie
Geller, Eating Disorders Program, St. Paul’s Hospital, 1081 Burrard
Street, Vancouver, British Columbia V6Z 1Y6, Canada. E-mail:
jgeller@providencehealth.bc.ca
patients and clinicians view treatment that is collaborative and
responsive to patient readiness as more acceptable and likely to
result in long-term change than treatment that does not consider
this patient characteristic (Geller, Brown, Zaitsoff, Goodrich, &
Hastings, 2003). Thus, patient readiness is important to assess
to ensure treatments match patient needs. Unfortunately, esti-
mating readiness for change in the eating disorders is challeng-
ing; clinicians who make readiness ratings following an intake
assessment are extremely poor at predicting subsequent change
in patient behavior (Geller, 2002). The difficulty of accurately
assessing readiness may be due to socially desirable responding
or patients’ global statements of intent misinterpreted as moti-
vation to change their eating habits (Waller, 2012). Standard-
ized tools with objective behavioral criteria are needed to
deliver treatments that match patient needs.
The Readiness and Motivation Interview (RMI; Geller &
Drab, 1999) is a semistructured interview that assesses readi-
ness to change disordered eating symptoms. Because the RMI
considers each symptom separately (e.g., dietary restraint, vom-
iting), it can be administered to individuals with all eating
disorder diagnoses. The RMI provides global and symptom-
specific subscale scores, which have been shown to vary by

759
 760 GELLER, BROWN, SRIKAMESWARAN, PIPER, AND DUNN
symptom domain that predict enrollment in and dropout from
treatment, symptom change, and relapse in adult samples
(Geller et al., 2001, Geller, Drab-Hudson, Whisenhunt, &
Srikameswaran, 2004) and short-term behavioral outcomes in
adolescents (Geller et al., 2008). RMI interviewers use a curi-
ous, nonjudgmental stance to convey acceptance of ambiva-
lence, thus reducing the likelihood of socially desirable re-
sponding. These strengths may account for the demonstrated
clinical utility of this interview.
Although the RMI is clinically useful, training interviewers
to conduct and administering an interview is time consuming
and expensive. Self-report measures have the advantage of
requiring little or no formal training of interviewers and are less
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
time consuming and easy to administer. Three questionnaire
This document is copyrighted by the American Psychological Association or one of its allied publishers.
measures have been developed to assess readiness for change in
the eating disorders: the Stages of Change Questionnaire (SCQ;
McConnaughy, Prochaska, & Velicer, 1983; modified for eat-
ing disorders in Treasure et al., 1999), the Motivational Stages
of Change for Adolescents Recovering from an Eating Disorder
(MSCARED; Gusella, Butler, Nichols, & Bird, 2003), and the
Anorexia Nervosa Stages of Change Questionnaire and its
bulimia nervosa counterpart (ANSOCQ; Rieger et al., 2000;
BNSOCQ; Martinez et al., 2007).
The SCQ provides stage of change scores (e.g., precontem-
plation, action) for their eating disorder, and the MSCARED
assigns individuals to a single stage of change. Both require
individuals to conceptualize their eating behaviors as a group
(e.g., SCQ items ask about readiness to give up “problematic
eating behaviors”). As eating-disordered individuals engage in
a variety of behaviors, it is likely that they may be willing to
change some symptoms (e.g., bingeing) but not others (e.g.,
restricting). Thus, scores on these measures are difficult to
interpret. The ANSOCQ and BNSOCQ have an advantage over
the aforementioned measures because they assess readiness to
change specific eating disorder symptoms, as well as related
interpersonal and affective symptoms. However, although items
on these measures assess multiple dimensions of readiness,
separate scores are not provided for each dimension, yielding
only a composite score. Also, neither measure can be used
across the eating disorder spectrum.
In developing a questionnaire measure of readiness, two
other dimensions may be useful to consider. The first is inter-
nality (the extent to which an individual is changing for oneself
vs. for others), which has been shown to predict long-term
relapse and outcome (Geller et al., 2004; Vansteenkiste,
Soenens, & Vandereycken, 2005). The second is confidence,
also known as self-efficacy (Bandura, 1990), which consistently
predicts reductions in alcohol consumption (e.g., Bertholet,
Cheng, Palfai, Samet, & Saitz, 2009) but has received little
investigation in the eating disorders.
The purpose of this study was to develop a questionnaire
measure that describes readiness, confidence, and internality
ratings across all symptom domains and can be used for all
eating disorder diagnoses. Thus, this research was conducted to
evaluate the psychometric properties of the Readiness and Mo-
tivation Questionnaire (RMQ) in adult women with anorexia
nervosa (AN), bulimia nervosa (BN), or eating disorder not
otherwise specified (EDNOS) and to investigate the relation
between RMQ scores and two analog measures of clinical
outcome.
Method
Participants
Two hundred and forty-four women who were seeking care at
a specialized Canadian eating disorder program participated in
this research. Psychology graduate student research assistants
made diagnoses, under the supervision of three registered clin-
ical psychologists, using the diagnostic questions from the
Eating Disorders Examination (EDE; Cooper & Fairburn,
1987). A diagnosis of anorexia nervosa–restricting subtype
(AN–R), anorexia nervosa– binge-purge subtype (AN–BP), bu-
limia nervosa–purging subtype (BN–P), bulimia nervosa–
nonpurging subtype (BN–NP), or EDNOS was made when all
criteria of the Diagnostic and Statistical Manual of Mental
Disorders (4th ed.; American Psychiatric Association, 1994)
were satisfied for a period of 3 months prior to the research
assessment. Body weight and/or height were unavailable (i.e.,
unknown by the participant or not taken at the time of the
research assessment) for 37 participants; thus, a conclusive
diagnosis could not be made for this subset of the sample.
Procedure
The majority of study participants were recruited at the time
of their initial referral for treatment. Participants provided
written consent and completed a research assessment that in-
cluded the Readiness and Motivation Questionnaire (RMQ) and
measures of reliability and validity. A subset of prospective
study participants received a letter explaining the study, a
consent form, and a copy of the RMQ prior to their initial
intake assessment. They completed the RMQ and written con-
sent 1 week before their in-person research assessment (which
included a second RMQ and measures of reliability and valid-
ity). This procedure was followed until the desired test–retest
sample size (n ⫽ 20) was achieved. All participants received a
phone call 1 week after the research assessment to assess the
completion of activities related to recovery, a means of esti-
mating the predictive validity of RMQ scores. Approval to
conduct this research was granted by the University of British
Columbia–Providence Health Care (PHC) Research Ethics
Board, which oversees research involving human subjects con-
ducted at PHC.
The Readiness and Motivation Questionnaire (RMQ)
The RMQ is based upon the Readiness and Motivation Inter-
view (RMI). Like the RMI, the RMQ is used in conjunction with
each of the 12 diagnostic questions from the EDE (Cooper &
Fairburn, 1987), so that both diagnostic and motivational informa-
tion is obtained for each symptom. As in the RMI, the RMQ
assesses readiness status and internality—the extent to which
change, when occurring, is for internal versus external reasons (see
Table 1 for sample items). The RMQ provides two motivational
 READINESS AND MOTIVATION QUESTIONNAIRE
Table 1
Sample Diagnoses
Sample
Diagnosis n %
Anorexia nervosa (BP) 29 14
Anorexia nervosa (R) 22 11
Bulimia nervosa (P) 49 24
Bulimia nervosa (NP) 2 1
EDNOS 105 51
Note. BP ⫽ binge/purge; R ⫽ restricting; P ⫽ purge; NP ⫽ nonpurge; EDNOS ⫽ eating disorder not
otherwise specified.
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stage scores (precontemplation and action/maintenance)1 for each
of four symptom domains (restriction, cognitive, bingeing, and
compensatory strategies). In the RMI and the RMQ, individuals
are not categorized into a discrete stage but rather are assigned a
score based upon the extent to which they identify with the stage
being assessed (e.g., an individual may be assigned a score of 20%
for precontemplation and 80% for action). In order to assess
self-efficacy, which has theoretically been linked to health behav-
ior change (Miller & Rollnick, 2002), a “confidence” scale was
included in the RMQ evaluating the extent to which individuals
feel confident in their ability to change each symptom.
Like the RMI, the RMQ yields total (averaged across all 12
symptoms) and symptom-specific (restriction, cognitive, bingeing,
and compensatory strategies) scores for the following categories:
precontemplation, action, internality, and confidence. RMQ scores
are continuous and range from 0 to 100. The presence of each
eating disorder symptom is assessed using the diagnostic items of
the EDE Questionnaire (Fairburn & Beglin, 1994), the “gold
standard” questionnaire measure of eating disorder pathology. If a
symptom is not relevant for a respondent, she or he is instructed
to skip the follow-up questions; thus, both total and symptom
domain scores are based only on the symptoms that are relevant to
the individual respondent. As with the RMI, higher RMQ precon-
templation and lower RMQ action scores indicate lower readiness
to change. Higher RMQ internality scores indicate changing for
internal reasons (i.e., for self), and higher RMQ confidence scores
indicate a greater degree of confidence in the ability to change
behavior. Several rounds of pilot testing were conducted, and
based upon participant feedback, minor changes were made to the
measure to increase the clarity of RMQ items.
Convergent and Discriminant Validity Measures
Demographic information. Participants provided their age,
height, weight, age of onset of their eating disorder, and the
occupation of their parents (or themselves, depending upon their
living arrangement). Socioeconomic status (SES) was calculated
using the 1981 Socioeconomic Index for Occupations in Canada
(Blishen, Carroll, & Moore, 1987). Demographic information was
used to estimate the discriminant validity of RMQ scores.
Readiness and Motivation Interview (RMI; Geller et al.,
2001; Geller & Drab, 1999). The RMI is a semistructured
interview that is used in conjunction with each of the diagnostic
questions from the EDE (Cooper & Fairburn, 1987), so that
diagnostic and motivational information is obtained for each
761
Age (in years) Body mass index
M SD M SD
27.0 6.7 16.1 1.2
24.2 9.4 15.7 1.3
27.0 8.2 21.6 5.3
26.0 N/A 23.6 2.1
28.8 9.4 20.3 3.9
symptom. The RMI provides three motivational stage scores (pre-
contemplation, contemplation, and action) for each of four symp-
tom domains (restriction, cognitive, bingeing, and compensatory
strategies), as well as global precontemplation, contemplation,
action, and internality scores. The RMI has demonstrated excellent
interrater reliability, ranging from 95.6% to 97.4% for each stage
of change, and good internal consistency in adults, ranging from
.63 to .84 (Geller et al., 2001). In the current study, internal
consistency estimates ranged from .59 to .81. RMI Precontempla-
tion, Action, and Internality subscale scores were used in this
research to estimate the convergent validity of RMQ scores.1
Stages of Change Questionnaire (SCQ; McConnaughy et al.,
1983). The SCQ is a 32-item general measure of stage of change
that provides global precontemplation, contemplation, action, and
maintenance scores. In adult eating disordered samples, coefficient
alpha estimates ranged from .73 to .90 (Geller et al., 2001; Treasure
et al., 1999; Ward, Troop, Todd, & Treasure, 1996). In the current
study, internal consistency estimates ranged from .77 to .87. The SCQ
was also used to estimate the convergent validity of RMQ scores.
Eating Disorders Inventory–2 (EDI–2; Garner, 1991). The
EDI–2 is reliable and valid self-report questionnaire of attitudes,
personality features, and eating disorder symptoms. The sum of the
Drive for Thinness, Body Dissatisfaction, and Bulimia subscales
reflects general concern with shape, weight, and eating (Welch, Hall,
& Walkey, 1988) and was used as a measure of global symptom
severity. Previous research in an adult sample indicated good internal
consistency for this composite score (Welch et al., 1988). In this
study, internal consistency for this score was .87. Previous research
has shown that readiness for change (i.e., higher RMI action scores)
was associated with lower levels of eating pathology (Geller et al.,
2001, 2008). As such, the EDI–2 was used to estimate the convergent
validity of RMQ scores.
Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982).
The BSI is a well-established inventory of psychiatric symp-
toms, yielding nine symptom scores and three global indices of
distress. In this study, the Global Severity Index (GSI), the
average distress experienced across all nine symptom dimen-
sions, was used; internal consistency for the GSI was .96.
1
In both the RMI and RMQ, the maintenance stage is considered
indistinguishable from the action stage, as ongoing work is typically
necessary in the eating disorders to maintain change. In addition, because
previous research (Geller et al., 2001, 2004, 2008) has shown that RMI
contemplation scores are not associated with clinical outcomes, this stage
was not assessed in the RMQ.
 762 GELLER, BROWN, SRIKAMESWARAN, PIPER, AND DUNN
Previous research using the RMI has demonstrated that higher
readiness for change (i.e., higher action scores) was associated
with lower levels of psychiatric distress (Geller et al., 2001). As
such, the BSI was used to estimate the convergent validity of
RMQ scores.
Balanced Inventory of Desirable Responding (BIDR; Paul-
hus, 1994). The BIDR is a psychometrically sound measure of
the tendency to respond in a socially desirable way. The BIDR is
composed of two subscales: (a) Self-Deceptive Enhancement
(SDE), which reflects cognitive overconfidence, and (b) Impres-
sion Management (IM), which reflects exaggerated social conven-
tionality. Only IM items of the BIDR were administered to esti-
mate the discriminant validity of RMQ scores; internal consistency
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for the IM subscale was .68. BIDR information was collected on a
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subset of the sample (n ⫽ 50) who did not differ from the
remainder of the sample on demographic information (e.g., age,
illness duration, body mass index [BMI], diagnosis); on RMI,
RMQ, EDI, or BSI scores; or on either measure of criterion
validity (all ps ⬎ .05).
Criterion Validity Measures
Anticipated Difficulty of Recovery Activities (ADRA; Geller
et al., 2001, 2008). The ADRA is a 26-item interview measure
assessing the anticipated difficulty of completing tasks related to
eating disorder recovery. This measure was used in both the adult
and adolescent RMI psychometric validation studies. ADRA items
describe recovery-oriented tasks such as delaying vomiting by 30
min or increasing food intake by one meal. Participants are asked
to rate the difficulty of each relevant item on a 10-point scale. The
total score is the mean of applicable difficulty ratings and ranges
from 0 to 10. Internal consistency estimates for the ADRA in
previous studies were good (.87 for adults and .78 for adolescents).
In the current study, internal consistency was .80, and ADRA
scores were not correlated with the IM subscale of the BIDR. The
ADRA was used to estimate the concurrent validity of RMQ
scores.
Completion of Recovery Activities (CRA; Geller et al., 2001,
2008). Participants were asked to select three recovery-
oriented tasks from the ADRA (one activity that they rated as
somewhat difficult, a second rated as moderately difficult, and
a third rated as extremely difficult) and to attempt these activ-
ities during the week after the assessment. In a follow-up phone
call, participants were assigned a score of 0 if the activity was
not attempted, 1 if the activity was partially completed, and 2 if
the task was fully completed, yielding a total behavioral task
completion score ranging from 0 to 6. CRA scores were not
significantly correlated with the IM subscale of the BIDR. As in
the RMI psychometric validation studies (Geller et al., 2001,
2008), the CRA was used to estimate the predictive validity of
RMQ scores.
Planned Statistical Analyses
To determine whether RMQ readiness scores differ according to
symptom domain, we conducted a series of analyses of variance
(ANOVAs) comparing mean domain scores (i.e., restriction, cog-
nitive, compensatory, and bingeing) for each of the four RMQ
dimensions (i.e., precontemplation, action, internality, and confi-
dence). Internal consistency estimates were calculated for each of
the four RMQ readiness dimensions (i.e., precontemplation, ac-
tion, internality, and confidence scores). RMQ scores were ex-
pected to differ significantly according to symptom domain.
Therefore, it was anticipated that internal consistency alphas
would be low to moderate. To assess the test–retest reliability of
RMQ scores, we calculated correlations between RMQ total pre-
contemplation, action, internality, and confidence scores in the
subset of the sample who completed the RMQ on two occasions.
Convergent validity was determined by correlating RMQ total
precontemplation, action, internality, and confidence scores with
the RMI, SCQ, BSI GSI, and EDI composite score. Since the
RMQ is a questionnaire version of the RMI, correlations between
the corresponding subscale scores on these two measures were
expected to be moderate. Given that the SCQ is a global measure
of stage of change, it was hypothesized that correlations between
RMQ and SCQ scores would be weak to moderate. Finally, based
upon previous research using the RMI (Geller et al., 2001, 2008),
it was hypothesized that correlations between RMQ scores and
EDI composite and BSI GSI scores would also be weak to mod-
erate, with higher readiness (i.e., higher action scores) associated
with fewer psychiatric and eating disorder symptoms. To estimate
the discriminant validity of RMQ scores, we calculated correla-
tions between RMQ total precontemplation, action, internality, and
confidence scores and age, BMI, SES, and BIDR scores. It was
hypothesized that RMQ scores would be unrelated to scores on all
measures of discriminant validity.
To establish the criterion validity of RMQ scores, we calculated
correlations between RMQ total precontemplation, action, inter-
nality, and confidence scores and the two analog measures of
clinical outcome (ADRA and CRA). In order to examine the
predictive validity of the RMQ, we conducted multiple regressions
examining the relative contribution of the RMQ to the prediction
of ADRA and CRA, after controlling for the RMI and again after
controlling for the SCQ. In each regression, only subscale scores
that were significantly correlated with the respective measure of
criterion validity were entered. Given the exploratory nature of
these analyses, no hypotheses regarding the predictive utility of the
RMQ relative to the RMI were made. These regressions were done
a second time controlling for BIDR IM scores. In order to correct
for Type I error, we set alpha at .01 in interpreting statistical
significance in all aforementioned analyses.
Results
Demographics
The mean age of the total sample (n ⫽ 244) was 27.7 years
(SD ⫽ 8.8), BMI was 19.5 (SD ⫽ 4.4), age of eating disorder onset
was 16.2 (SD ⫽ 4.5), duration of eating disorder was 11.4 years
(SD ⫽ 10.1), and SES was 51.0 (SD ⫽ 15.5), indicating upper
middle class. Table 2 provides diagnostic information for the
sample.
Precontemplation, Action, Internality and Confidence
Scores Using the RMQ
A series of four within-subject ANOVAs were conducted
comparing mean symptom domain scores for each of the four
 READINESS AND MOTIVATION QUESTIONNAIRE 763

Table 2
Convergent Validity of the Readiness and Motivation Questionnaire

Readiness and Motivation Questionnaire Total Score

Measure Precontemplation Action Internality Confidence

Readiness and Motivation Interview total scores

Precontemplation .56ⴱⴱ ⫺.47ⴱⴱ ⫺.39ⴱⴱ ⫺.44ⴱⴱ
Contemplation ⫺.22ⴱ ⫺.09 .17ⴱ .02
Action ⫺.41ⴱⴱ .60ⴱⴱ .27ⴱⴱ .47ⴱⴱ
Internality ⫺.21ⴱ .17 .53ⴱⴱ .14
Stages of Change Questionnaire total scores
Precontemplation .16 ⫺.14 ⫺.22ⴱ ⫺.18
Contemplation ⫺.07 .14 .19 .08
Action ⫺.24ⴱ .49ⴱⴱ .26ⴱ .34ⴱⴱ
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Maintenance ⫺.05 .41ⴱⴱ .14 .21

.47ⴱⴱ ⫺.14 ⫺.22 ⫺.35ⴱⴱ
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Brief Symptom Inventory Global Severity Index

total score
Eating Disorders Inventory total score .57ⴱⴱ ⫺.37ⴱⴱ ⫺.15 ⫺.47ⴱⴱ
ⴱ ⴱⴱ
p ⬍ .01. p ⬍ .001.

RMQ dimensions (see Table 3). All four ANOVAs were sig-
nificant. Similar to research using the RMI, precontemplation
scores were highest for restriction and compensatory domains,
and action scores were highest for the bingeing domain (see
supplemental figure online). Post hoc contrasts revealed all four
symptom domains differed significantly from each other for
precontemplation, internality, and confidence dimensions. For the
action dimension, bingeing scores were significantly higher than
cognitive and compensatory strategies, which were significantly
higher than restriction.
Internal Consistency Reliability
Mean precontemplation, action, internality, and confidence
ratings for each of the four symptom domains, based on the
items endorsed for each individual, were used to calculate
internal consistency. Coefficient alphas were as follows (n ⫽
178): precontemplation ⫽ .55, action ⫽ .66, internality ⫽ .80,
and confidence ⫽ .77. Coefficient alphas were recalculated
removing the bingeing domain and were as follows (n ⫽ 223):
precontemplation ⫽ .47, action ⫽ .71, internality ⫽ .80, and
confidence ⫽ .71. These low to moderate internal consistencies
were expected, given that readiness differs according to symp-
tom domain (as illustrated in Table 3).
Table 3
Criterion Validity of the Readiness and Motivation
Questionnaire—Correlations With the ADRA and CRA
Readiness and Motivation Recovery Activities
Questionnaire measures
total score ADRA
Precontemplation .48ⴱⴱ
⫺.15
Action ⫺.40ⴱⴱ
Internality ⫺.35ⴱⴱ
Confidence ⫺.47ⴱⴱ
Note. ADRA ⫽ Anticipated Difficulty of Recovery Activities; CRA ⫽
Completion of Recovery Activities.
ⴱⴱ
p ⬍ .001.
Test–Retest Reliability
Correlations were conducted between RMQ total scores at Time
1 and Time 2 to assess the stability of RMQ scores in the test–
retest sample (n ⫽ 19 participants had valid data at both study time
points). These correlations were as follows: precontemplation r ⫽
.62 (p ⬍ .01), action r ⫽ .73 (p ⬍ .001), internality r ⫽ .81 (p ⬍
.001), and confidence r ⫽ .80 (p ⬍ .001). Inspection of test–retest
scores by domain revealed that the bingeing domain accounted for
the lowest precontemplation test–retest results. When this item was
removed, overall test–retest for precontemplation was r ⫽ .73.
Convergent Validity
Correlations between RMQ total precontemplation, action, in-
ternality, and confidence scores and the RMI, SCQ, BSI GSI, and
EDI composite score are reported in Table 4. All correlations were
in the expected directions. Correlations between the RMQ and the
BSI subscales were conducted and are provided.2,3
2
In order to determine which BSI subscales accounted for the significant
correlations with RMQ precontemplation and confidence scores, we con-
ducted follow-up analyses that revealed that RMQ precontemplation scores
were significantly correlated with all BSI subscales and RMQ confidence
scores were correlated with most (six of nine) of the subscales (Somatiza-
tion, Obsessive–Compulsive, Depression, Anxiety, Phobic Anxiety, Para-
noid Ideation, and Psychoticism). Together, these analyses suggest that
precontemplation and confidence were associated with global, as opposed
to a specific form of distress.
3
The convergent and criterion validity analyses were also performed
CRA
using RMQ subscale scores. The overall pattern of results was similar to
the global score analyses, with RMQ restriction and cognitive subscales
.24ⴱⴱ showing the strongest associations. As shown in previous research using
.13 the RMI, the restriction precontemplation score was especially robust (i.e.,
.12 correlation with ADRA r ⫽ .49, p ⬍ .001, and correlation with CRA r ⫽
–.21, p ⬍ .05). This convergence of results with the RMI is encouraging
and further justifies acceptance of the moderate internal consistency esti-
mates for the RMQ, supporting the inclusion of the precontemplation
domain in the final measure.
 764 GELLER, BROWN, SRIKAMESWARAN, PIPER, AND DUNN

Table 4
Criterion Validity of the Readiness and Motivation Questionnaire: Hierarchical Multiple
Regression Analyses With Stages of Change Questionnaire

Variable R2 F change ␤

Anticipated Difficulty of Recovery Activities

Stages of Change Questionnaire .04 5.35ⴱ
Action ⫺.19
Readiness and Motivation Questionnaire .29 11.95ⴱⴱⴱ
Precontemplation .23ⴱ
Action ⫺.16
Internality ⫺.18ⴱ
Confidence ⫺.17
Completion of Recovery Activities
Stages of Change Questionnaire .11 11.72ⴱⴱⴱ
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Action .32ⴱⴱⴱ
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Readiness and Motivation Questionnaire .13 3.21†

Action .19†
Note. ADRA ⫽ Anticipated Difficulty of Recovery Activities; CRA ⫽ Completion of Recovery Activities.
†p ⫽ .08. ⴱp ⬍ .05. ⴱⴱⴱp ⬍ .001.

Discriminant Validity
Correlations between RMQ total precontemplation, action,
internality, and confidence scores were performed with social
desirability (using the BIDR IM score), age, BMI, and SES.3 As
expected, RMQ scores were unrelated to socially desirable
responding and to the majority of the other discriminant validity
measures (all ps ⬎ .01). However, RMQ total confidence scores
were negatively correlated with age (r ⫽ –.23, p ⬍ .01).
Criterion Validity
Criterion validity was assessed by conducting correlations
between RMQ total scores and the ADRA and CRA.3 As
indicated in Table 5, all four RMQ total scores (i.e., precon-
templation, action, internality, and confidence) were signifi-
cantly correlated with the ADRA in the expected directions (all
ps ⬍ .001), and RMQ action was significantly correlated with
CRA scores (p ⬍ .01). In comparison, RMI precontemplation,
action, and internality scores were significantly associated with
ADRA scores (all ps ⬍ .01), and RMI precontemplation and
action scores were associated with CRA scores (ps ⬍ .01). In
order to compare the RMQ with another questionnaire measure
of readiness, the SCQ, we also calculated the correlations
between SCQ precontemplation, contemplation, action, and
maintenance scores and the two measures of criterion validity.
Only two of the eight correlations reached statistical signifi-
cance (SCQ action scores were negatively associated with
ADRA scores, p ⬍ .05, and positively associated with CRA
scores, p ⬍ .01).
Finally, in order to examine the relative contribution of the
RMQ to the prediction of the two measures of criterion validity,
we conducted multiple regressions: two examining the relative

Table 5
Criterion Validity of the Readiness and Motivation Questionnaire: Hierarchical Multiple
Regression Analyses With the Readiness and Motivation Interview

F
Variable R2 change ␤

Anticipated Difficulty of Recovery Activities

Readiness and Motivation Interview .17 13.33ⴱⴱⴱ
Precontemplation .19ⴱ
Action ⫺.22ⴱⴱ
Internality ⫺.11
Readiness and Motivation Questionnaire .32 10.68ⴱⴱⴱ
Precontemplation .27ⴱⴱⴱ
Action ⫺.07
Internality ⫺.13
Confidence ⫺.19ⴱ
Completion of Recovery Activities
Readiness and Motivation Interview .09 7.93ⴱⴱⴱ
Precontemplation ⫺.21ⴱ
Action .13
Readiness and Motivation Questionnaire .10 1.53
Action .12
Note. ADRA ⫽ Anticipated Difficulty of Recovery Activities; CRA ⫽ Completion of Recovery Activities.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.
 READINESS AND MOTIVATION QUESTIONNAIRE 765

contribution of the RMQ to the prediction of ADRA and CRA
after controlling for the RMI, and two examining the contribu-
tion of the RMQ to ADRA and CRA after controlling for the
SCQ. In each regression, only those subscale scores that were
significantly correlated with the respective measure of criterion
validity were entered.
In the RMI regressions, the RMQ explained additional unique
variance in ADRA scores after controlling for RMI precontem-
plation, action, and internality. The RMQ accounted for an
additional 15% of the variance, with RMQ precontemplation
and confidence scores reaching statistical significance (see Ta-
ble 6). The RMQ did not account for additional variance in
CRA scores after controlling for the RMI. Regarding the pre-
dictive utility of the RMQ relative to the SCQ, the RMQ
explained additional unique variance in ADRA scores after
controlling for SCQ action. As shown in Table 7, the RMQ
accounted for an additional 27% of the variance, with RMQ
precontemplation and internality scores reaching statistical sig-

Table 6
Readiness and Motivation Questionnaire—Sample Items
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Readiness and Motivation Questionnaire

It’s common for people to have mixed feelings about making changes to their eating and eating-related thoughts and behaviors. We’re
interested in learning about your current and past experiences.

1. DIETARY RESTRICTION

On how many days out of None 1–5 Days 6–12 Days 13–15 Days 16–22 Days 23–27 Days Daily
the past 28 days have
you consciously tried to
restrict the amount of
food you eat to
influence shape or
weight? (please circle
one of the following)

If you have never tried to restrict, please go to the next section.

If you have ever restricted, please answer the following questions:
A small part of me About half of me Most of me

In the past two weeks, 0% 10 20 30 40 50 60 70 80 90 100%

how much of you has
wanted to restrict your
eating? (please circle
one of the following
percentages)
A small part of me About half of me Most of me

In the past two weeks, 0% 10 20 30 40 50 60 70 80 90 100%

how much of you has
been actively working
to eat more? (please
circle one of the
following percentages)
Not very much for me About half for me Mostly for me

If you were to reduce 0% 10 20 30 40 50 60 70 80 90 100%

your restriction (i.e. eat
more), how much of
this would be for you
(versus for others)?
(please circle one of the
following percentages)
Not at all confident Extremely confident

If you decided to reduce 0% 10 20 30 40 50 60 70 80 90 100%

your restriction (i.e.,
eat more), how
confident are you in
your ability to do so?
(please circle one of the
following percentages)
 766 GELLER, BROWN, SRIKAMESWARAN, PIPER, AND DUNN
Table 7
Mean Precontemplation, Action, Internality, and Confidence Scores for the Readiness and Motivation Questionnaire
Symptom domains
Restriction Cognitive
Readiness and Motivation
Questionnaire subscales M SD M SD
Precontemplation 81.85d 19.30 46.72a 27.01
Action 29.50a 26.48 40.46b 26.09
Internality 52.03a 29.78 70.37c 27.72
Confidence 37.16c 22.74 26.95a 23.08
Note. Subscripts denote statistically significant differences at p ⬍ .05.
ⴱ
p ⬍ .001.
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
nificance. These regressions were conducted a second time,
controlling for BIDR, and the results did not change.
Discussion
In this research, we examined the psychometric properties of the
RMQ, a new symptom-specific self-report measure of readiness to
change for all eating disorder diagnoses. The RMQ demonstrated
fair test–retest reliability and good convergent and discriminant
validity. Similar to the RMI, RMQ scores differed across symptom
domains, with readiness scores lowest for dietary restriction and
highest for binge eating. These differences across symptom do-
mains account for the fair internal consistency scores within each
RMQ stage of readiness. RMQ confidence scores, not previously
examined in this population, also differed according to symptom
domain. Finally, RMQ scores correlated significantly with two
measures of criterion validity and accounted for unique variance in
ratings of anticipated difficulty of recovery activities, after con-
trolling for social desirability and existing measures of readiness.
Thus, the RMQ provides symptom-specific readiness information
across the eating disorder spectrum and is a good alternative to the
RMI when time or cost makes using an interview measure prohibitive.
The RMQ has a number of advantages over previous measures
of readiness. First, it provides both global and symptom-specific
scores. As the RMQ is based upon the diagnostic questions of the
EDE, it can also be used for all symptom configurations and
diagnoses. Other symptom-specific measures cannot be used in a
mixed sample, which is problematic as the most common eating
disorder diagnosis is EDNOS. In addition to readiness scores, the
RMQ also provides internality and confidence scores. These are
underresearched domains in the eating disorders and would benefit
from further investigation. Finally, a symptom-specific question-
naire of readiness allows for easy administration to large samples
(e.g., through Web-based platforms).
Similar to previous research (e.g., Geller et al., 2001), readiness
as assessed by the RMQ differed according to symptom domain,
suggesting that when assessing readiness it is important to be
explicit about which eating disorder behaviors or cognitions are
being considered. Lack of clarity about this point may explain
inconsistent findings from previous research and account for un-
derestimation of the importance of readiness in predicting clinical
outcomes (e.g., Waller, 2012). RMQ confidence scores also dif-
fered according to symptom domain. Confidence to change cog-
nitions regarding shape, weight and eating were lowest of the four
symptom domains. Exploring barriers to cognitive change and
Compensatory Bingeing
M SD M SD F ␩2
70.87c 20.65 57.98b 31.58 94.87ⴱ .62
42.53b 25.44 60.11c 31.46 35.57ⴱ .38
64.91b 26.75 81.91d 25.86 56.32ⴱ .49
41.12d 22.70 35.17b 29.15 21.88ⴱ .27
helping patients develop skills that target cognitive aspects of the
eating disorder may help build self-efficacy and enhance overall
readiness. Finally, as in previous research, internality ratings were
lowest for dietary restriction, suggesting that normalizing eating
and gaining weight are consistently the most challenging issues to
address and are the least aligned with patients’ internal goals.
Convergent validity findings were consistent with those of pre-
vious research using the RMI: higher precontemplation and lower
action scores were associated with more severe eating disorder and
psychiatric symptoms. Given the implicit differences between
participating in an interview and completing a questionnaire, the
moderate correlations between RMI and RMQ scores were not
unexpected. Possibly, this stems from an inability to develop a
shared definition of both the behaviors assessed and level of
readiness, as occurs in the RMI. The RMI is a preferred measure
because it allows patients to clarify these definitions.
Further research is needed to replicate the criterion validity
of the RMQ in other samples. Like the RMI scores, RMQ scores
were not associated with most measures of discriminant validity
(SES, BMI, impression management). The lack of association
with impression management is particularly noteworthy and
suggests that the RMQ may provide a more objective measure
of readiness than would be obtained from a typical clinical
assessment. In this study, age was negatively associated with
RMQ confidence scores. This result may have been influenced
by the nature of our sample; participants were drawn from a
tertiary center and had an average duration of illness of 11
years. Lower confidence reported by older patients may be the
result of more previous unsuccessful recovery attempts.
Correlations between RMQ scores and scores on two analog
measures of outcome suggested that the RMQ holds promise for
predicting other clinical outcomes. However, whereas RMI
precontemplation and action scores have predicted outcome
(Geller et al., 2001, 2008), in this study only RMQ action scores
were associated with both the ADRA and CRA. It is possible
that the RMI interviewer stance is important for obtaining
accurate precontemplation estimates. RMI interviewers model
curiosity and nonjudgment and encourage discussion about
ambivalence. This approach may promote honesty and openness
when considering feelings about change and rating readiness.
Despite possible differences in the strength of RMI and RMQ
precontemplation scores, it is noteworthy that the RMQ ac-
counted for unique variance in ADRA scores after controlling
for both the SCQ and the RMI. This additional predictive utility
 READINESS AND MOTIVATION QUESTIONNAIRE
of the RMQ beyond that of the RMI may be partially due to the
addition of confidence ratings in the RMQ and suggests that the
RMQ shows overall promise as a measure with clinical utility.
This study sets the stage for future research projects. First,
given that the stability of readiness to change binge behaviors
was low, further investigation is warranted to determine how to
improve the assessment of the binge domain in questionnaire
format. As noted elsewhere (e.g., Fairburn & Wilson, 1993),
binge eating is an ambiguous behavior requiring contextual
analysis and therefore is more difficult to assess. It may be
helpful to determine whether providing more information about
a binge in the RMQ (e.g., a specific example) increases stability
of this score. This would be a particularly important topic to
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
explore, as readiness to change binge eating may be critical to
This document is copyrighted by the American Psychological Association or one of its allied publishers.
consider in treating patients with night eating disorder, or those
undergoing bariatric surgery. Future research examining the
psychometric properties of the RMQ by eating disorder diag-
nostic subgroup may also be a useful contribution to this
literature. As noted earlier, these findings may have been in-
fluenced by our use of a female tertiary care sample, and it is
unknown whether our results are generalizable to males and to
patients who are less chronically ill. Finally, although the RMQ
shows promise in predicting clinical outcomes, more research is
needed with longer follow-up to determine the relation between
RMQ scores and measures such as engagement, dropout, and
relapse. It should be noted, however, that readiness information
will be more useful in predicting engagement and adherence to
action-oriented treatment (i.e., program that requires weight
gain or cessation of eating disorder behaviors) versus treatment
with few nonnegotiable contingencies. As treatment options
continue to be developed and evaluated, readiness information will be
critical, together with information about symptom severity and life inter-
ference, in ensuring that patients are matched to the appropriate level and
type of care.
In sum, the RMQ demonstrated relatively sound psychomet-
ric properties and is an easily administered tool, which may be
useful for matching patient readiness to treatment offered, thus
ensuring maximum responsiveness to patient needs and effi-
cient use of limited treatment resources. The RMQ has strengths
that other questionnaire measures of readiness in the eating
disorders do not possess and, much like the EDE Questionnaire
(which is considered to be the best approximation of the “gold-
standard” diagnostic EDE interview), is currently the best ap-
proximation of the RMI, the current “gold standard” interview
measure of readiness in the eating disorders.
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Received February 1, 2012
Revision received February 4, 2013
Accepted February 6, 2013 䡲