Ready or Not: Examining Self-Reported Readiness for Behavior Change at Intake Assessment for Adults With an Eating Disorder.

Adults with eating disorders filled out a one-question Readiness Ruler when they asked for help.

Staff then tracked who showed up to CBT group, how many sessions each person sat through, and who dropped out.

The team wanted to see if the single readiness score could forecast attendance or quitting.

The ruler scores did not predict any part of group engagement.

People who said they were very ready did not attend more often or stay longer.

Surprisingly, higher readiness was tied to worse eating-disorder symptoms at the start.

Staddon et al. (2002) looked at CBT groups for mixed anxiety and mood problems. They found that self-esteem and symptom severity did forecast who stayed. The eating-disorder sample in Green et al. (2020) breaks that pattern, showing the same kind of intake data can act differently across diagnoses.

Parent et al. (2011) studied parent training groups and found parent depression and coparent conflict predicted attendance. Their method was similar—check baseline surveys then count sessions—but the useful predictors were concrete life factors, not a vague readiness line.

Howard et al. (2023) warn that many ABA intake tools lack solid psychometric backing. The Readiness Ruler joins that list; it feels quick and client-friendly yet fails to do its job.

If you run or refer clients to CBT groups for eating disorders, skip the Readiness Ruler. Spend the intake time on measurable factors like symptom severity, transport barriers, or past no-shows. Track those instead of hoping a single self-rating will tell you who stays.