Incorporating Narrative Into the Treatment of Youth With Anorexia Nervosa (Virtual)

• Narrative Medicine (NM) Workshop Series (Behavioral): The Narrative Medicine (NM) Workshop Series is a structured six-week behavioral intervention designed to enhance self-expression, reflection, and resilience in adolescents and young adults recovering from eating disorders. This intervention differs from traditional psychotherapeutic or psychoeducational approaches by integrating literary analysis, creative writing, and guided discussion as therapeutic tools. Each one-hour weekly workshop includes: * Close reading of visual or written texts related to themes such as self-definition, resilience, kindness, and possibility * Creative writing exercises in response to structured prompts that encourage self-reflection and personal storytelling * Facilitated group discussions to foster connection, self-expression, and emotional processing in a supportive environment

Primary outcomes

• Number of participants in each session [Immediately post-intervention (Week 6)]: Feasibility will be measured by participant retention in intervention.
• Satisfaction with intervention components using 5-point Likert scales and semi-structured individual interviews [Immediately post-intervention (Week 6)]: Acceptability will be measured by questionnaire including 5-point Likert scales and semi-structured individual interviews assessing content relevance, writing prompts, group discussions, and facilitation. Scale title: Intervention Satisfaction Questionnaire (ISQ) Minimum value: 1 (Strongly Disagree) Maximum value: 5 (Strongly Agree) Interpretation: Higher scores indicate greater satisfaction with the intervention (better outcome).

Secondary outcomes

• Illness-Identity Centrality [Pre- (Week 0) and immediately post-intervention (Week 6)]: Assessed using the Illness Identity Questionnaire, which evaluates self-concept clarity and personal identity coherence. Scale title: Illness Identity Questionnaire (IIQ) Minimum value: 1 (Strongly Disagree) Maximum value: 5 (Strongly Agree) Interpretation: Subscale scores reflect distinct illness identity states; higher scores indicate greater endorsement of that identity orientation
• Social Connectedness [Pre- (Week 0) and immediately post-intervention (Week 6)]: Measured using the Social Connectedness Scale (SCS), which assesses perceived closeness to others and sense of belonging. Scale title: Social Connectedness Scale (SCS) Minimum value: 1 (Strongly Disagree) Maximum value: 6 (Strongly Agree) Interpretation: Higher scores indicate greater feelings of social connectedness and belonging (better outcome).
• Depression Symptoms [Pre- (Week 0) and immediately post-intervention (Week 6)]: Measured using the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms. Scale title: Patient Health Questionnaire-9 (PHQ-9) Minimum value: 0 (Not at all) Maximum value: 3 (Nearly every day) Interpretation: Higher scores indicate greater severity of depressive symptoms (worse outcome).
• Anxiety Symptoms [Pre- (Week 0) and immediately post-intervention (Week 6)]: Measured using the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Scale title: Generalized Anxiety Disorder 7-item (GAD-7) Scale Minimum value: 0 (Not at all) Maximum value: 3 (Nearly every day) Interpretation: Higher scores indicate greater severity of anxiety symptoms (worse outcome).
• Eating Disorder Severity [Pre- (Week 0) and immediately post-intervention (Week 6)]: Measured using the Eating Disorder Examination Questionnaire (EDE-Q), which captures cognitive and behavioral symptoms of AN, and percent of expected body weight (EBW) at follow-up. Scale title: Eating Disorder Examination Questionnaire (EDE-Q) Minimum value: 0 (No days / Not at all) Maximum value: 6 (Every day / Extremely) Interpretation: Higher scores indicate greater severity of eating disorder psychopathology (worse outcome).

Sex: All, ages: 16 Years to 25 Years

Inclusion Criteria:

* 16-25 years old
* have a DSM-5 diagnosis of AN (confirmed by the UCSF Eating Disorders Program clinical team),
* currently engaged in outpatient eating disorder treatment, ensuring medical stability and capacity for a group-based intervention
* English fluency to engage in reflective writing and discussions
* Cognitive ability to meaningfully participate in narrative-based exercises

Exclusion Criteria:

* Currently medically unstable or require inpatient hospitalization
* History of psychosis, schizophrenia spectrum disorder, bipolar disorder, or personality disorder
* Severe neurocognitive impairment that would prevent engagement with the intervention
* Active suicidal ideation or non-suicidal self-injury within the past two months
* Insufficient English proficiency to participate in group discussions and writing exercises

• Knio L, Sridhar H. Phenomenology of Identity: Narrative Medicine Curricula in the Care of Eating Disorders. J Med Humanit. 2025 Dec;46(4):673-696. doi: 10.1007/s10912-025-09929-6. Epub 2025 Jan 27. PMID 39869237

• Anoushka Sinha, MD, MS, Principal investigator, University of California, San Francisco