The acceptability, feasibility and possible benefits of a group-based intervention targeting intolerance of uncertainty in adolescent inpatients with anorexia nervosa

Figures & data

Table 1. Group content and protocol

Session number	Session content
Session 1	Introducing IU—psychoeducation around IU; exploring the pros and cons of certainty and uncertainty. Completion of outcome measures
	Homework: Identify a situation when you experienced uncertainty and note down your response (thoughts, feelings, behaviours)
Session 2	Linking IU to EDs—brainstorm around the role of IU in causing and maintaining EDs
	Homework: Identify a situation in the week when you found yourself using ED behaviours to manage uncertainty
Session 3	Awareness training—experiment designed to increase awareness that worry is used to manage uncertainty. The group was told that an unknown visitor might join the group at some point. They then engaged in worry to manage their worries around this. Group discussion around how useful this strategy was given patients had little control over the event. Brainstorm around other strategies to manage worry when events are outside of your control
	Homework: Note down three events that caused worry that may or may not be within your control
Session 4	Awareness training—review of ideas generated through homework. Situations were written down and divided into two categories—situations that could be solved through problem-solving and those beyond our control. Brainstorm around problem solving strategies for events that can be problem solved
	Homework: Look out for one uncertain situation in the week and use one strategy for managing it outside of ED behaviours and worry
Session 5	Re-evaluation of beliefs about worry—thought challenging around worry being a useful coping strategy, generation of alternative coping strategies when faced with uncertain situations. Development of a coping card of strategies to use in situations that could be managed using problem-solving and situations beyond our control
	Homework: Try out the coping card during the week
Session 6	Focusing on the bigger picture—using cognitive styles to step back from situations and improve problem-solving
	Homework: Practice switching to the bigger picture during one difficult situation this week
Session 7	Exposure—focus on a worrying situation that occurred this week and use the strategy of “fast forwarding the DVD”, involving going beyond the situation and reflecting on what you might think and feel about it in several years’ time
	Homework: Practice this technique in a key work session
Session 8	Review of strategies—brainstorming barriers, discussing experiences. Generating new ideas
	Homework: Feedback one way your support network could help you in your family therapy session this week
Session 9	Coping with change during recovery—visit from a past service user with questions and answered focused on how to cope with change
Session 10	Awareness training revisited—the group were told that the group might be held in a different room next week. Discussion around how to manage the uncertainty experienced around this change
Session 11	Relapse prevention—developing a written plan of how to manage uncertainty; discussion of how tolerating uncertainty might assist in recovering from an ED
Session 12	Summing up—development of individual mind map depicting new learning achieved from the group. Completion of outcome measures and feedback

Note: IU = Intolerance of uncertainty.

Table 2. Group member demographics and clinical and intolerance of uncertainty outcome measures

Gender	Female n = 10 (100%)
Age	14.6 (SD = 1.43; minimum = 13; maximum = 17)
Diagnosis	n = 8 (80%) restricting AN; n = 2 (20%) binge purge AN
Number of sessions attended (maximum = 12)	11.3 (SD = 1.06), 60% attended all 12 sessions
	Drop out n = 0 (0%)
Weight for height percentage	79.4 (SD = 4.24)
EDE-Q Global	3.12 (SD = 0.48)
Depression (BDI)	20.5 (SD = 3.78)
State anxiety (percentile)	85.5 (SD = 8.45)
Trait anxiety (percentile)	82 (SD = 11.25)
	Pre-treatment	After treatment	3 months FU
IUS	94.8 (SD = 4.18)	76.6 (SD = 5.7)a	71.4 (SD = 11.76)b, c

Notes: BDI = Beck Depression Inventory; EDE-Q = Eating Disorders Examination Questionnaire; IUS = Intolerance of Uncertainty Scale (all patients completed the IUS at all time-points).

Paired t-test outcomes: a = post treatment score is significantly different to pre-treatment score; p = ≤0.01; b = 3-month follow-up score does not differ from post-treatment score; p > 0.01; c = 3-month follow-up score is significantly different to pre-treatment score; p = ≤0.01.