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

Participants in this study will take part in a six-week Narrative Medicine (NM) curriculum designed to enhance self-expression, reflection, and resilience in individuals with anorexia nervosa. Workshops will be conducted weekly on Zoom and will include:

• 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
• Group discussions and sharing to foster community, connection, and self-expression

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

Feasibility will be measured by participant retention in intervention.

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).

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

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).

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).

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).

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).