Yoga Therapy for Eating Disorders
There
is a growing interest in, and mounting evidence for, the use of yoga in
recovery from Eating Disorders. Many UK and US residential programs now offer yoga as part of their treatment package (Frisch, Herzog & Franko, 2006, found that two thirds of US programmes included yoga) and a growing number of clinical
commentaries are providing anecdotal support for its potential (e.g. Robin Boudette,
Laura Douglass). Eating
Disorder specific yoga programs are growing in number; for example, Chelsea
Roff, herself a survivor of severe AN, has founded Eat, Breathe, Thrive,
and Beverley Price has established the Reconnect with Food program.
So why might yoga be of help? The answer to this may well be different for each individual but here are some common elements that I have found to be helpful...
Relaxation.
Yoga can introduce people with eating problems to something which they often haven’t experienced in some time: relaxation. A large body of research suggests that most people who experience an eating disorder will also encounter a high level of anxiety at some point. In one study (Kaye et al., 2004) the authors found that approximately two-thirds of people with an eating disorder also suffer from an anxiety disorder at some point in their lives, the most common being OCD and Social Anxiety. Putting diagnoses to one side, it’s also fair to say that someone experiencing an eating problem is very likely to be stressed, both by the disorder itself and the experience of recovery. Yoga, through movement and breath, offers the experience of greater relaxation and the practical tools to be able to affect the nervous system, thereby influencing how we feel in life off the yoga mat.
A ‘way in’ to mindfulness.
“Mindfulness involves learning to direct our attention to our experience as it unfolds, moment by moment, with open-minded curiosity and acceptance. Rather than worrying about what has happened or might happen, it trains us to respond skilfully to whatever is happening right now, be that good or bad.” Mindfulness in Schools Project.
In recent years there has been increasing interest in incorporating mindfulness into treatment approaches, either as an intervention in its own right or as an adjunct to treatment. For example ACT (Acceptance and Commitment Therapy) has been applied to anorexia, DBT (Dialectical Behaviour Therapy) adapted for bulimia and binge eating, MBCT (Mindfulness Based Cognitive Therapy) adapted for binge eating, and MB-EAT (Mindfulness-Based Eating Awareness Training) developed for binge eating. Whilst there are important differences between the models, they are all based on the rationale that an avoidance or lack of awareness of inner experience contributes to eating problems, and that this can be addressed through mindfulness skills training.
Whilst it’s still early days, there is growing research evidence that these mindfulness-based approaches may be useful in the treatment of eating disorders. In a systematic review of the evidence Wanden-Berghe and colleagues (2011) concluded that mindfulness-based approaches are a promising development in the field. Whilst they were cautious in their conclusion (on the basis that the research base is small and studies are of varying quality) they noted that the studies which met their criteria for inclusion all had positive findings and therefore suggest they may be effective treatments.
However, mindfulness practices (like seated meditation) can be incredibly challenging when we are in the midst of huge challenges. Yoga, through movement and regulation practices offers an alternate way of building mindful awareness, and can be more accessible during an acute stage of illness.
Emotion awareness and regulation.
Bingeing, restricting and purging can all be thought of as ways of coping with difficult emotions. A mechanism through which both yoga and mindfulness may help is through improving emotion regulation. In both practices, the continual focus on on-going physical sensations builds interoceptive awareness (basically the awareness of body states e.g. thirst, hunger, pain, temperature, itch, tension) and acceptance, an important component of emotion awareness. A regular yoga practice also offers the opportunity to learn to stay in poses which are difficult or awkward. And herein lies another benefit from simply watching our body sensations… we learn not just to recognise but to tolerate our emotions, whatever they are. If we can really be with the stretch in our side in triangle pose without mentally switching off or coming out of the pose, we can also potentially learn to be with the butterflies in our tummy without using food (or something else) to shut down the experience. Simply watching gives us the space to respond to what we find rather than reacting habitually. This practice of staying with discomfort in a relaxed way provides training in staying present with difficult feelings, thoughts or sensations. This can translate into improved impulse control off the mat, helping us to tolerate uncomfortable emotional states and not to act on the urge to binge and/or purge for comfort or to numb ourselves by restricting.
Part of recovery is also learning to recognise and trust feelings of fullness and hunger. Through building interoceptive awareness yoga offers the opportunity to tune in to such messages from the body. With greater awareness the discomfort of over and under eating becomes more apparent and can help to guide us in our decisions. As Chelsea Roff explains:
“When someone develops greater mind/body awareness they tend to gravitate towards healthier behaviours. This is not because they’ve been told to or because they are following a rule, but because they actually experience the difference; they truly feel the bloating from bingeing, they become more aware that drinking red bull leaves them agitated. Yoga offers a bottom-up approach which gradually instils in people the desire for healthier habits. So rather than an internal battle with a decision to give something up (and the unhelpful craving cycles this sets up), unhealthy habits can drop away over time.”
Self-esteem and body image.
Too often in life we focus on how our bodies look; yoga helps us to focus on inner qualities, the felt experience of a pose and the mental quality of mind one brings to it. It offers us a way of befriending the body and listening deeply to its messages. In so doing it can helps us to foster a more accepting and compassionate relationship with the body, cultivating a sense of ‘home’ in your own skin.
Yoga, as a practice of union, invites us to recognise every part of ourselves and in so doing it offers a way of gradually disentangling the grip that negative body image can have on our lives. Of course, this takes time but through practicing over and over again we can create a new relationship to self, one that is kinder, gentler, and more forgiving.
The Yogic Path.
The practice of yoga can have hugely positive impacts on health and wellbeing, but it can also be just another way in which we act out a punishing relationship to our bodies. The asana ‘limb’ of yoga was never meant to be an isolated practice, and when we do so without any attention to the rest of the path it’s all too easy for our minds to get stuck on the physical body – and if we already have a troubled relationship to that body then it will most likely be a negative focus!
Yogic philosophy offers an alternative set of values which can counter eating disordered thoughts and behaviours. Yoga can also offer us a sense of belonging to a community which is focused on wellness and spiritual growth.
So why might yoga be of help? The answer to this may well be different for each individual but here are some common elements that I have found to be helpful...
Relaxation.
Yoga can introduce people with eating problems to something which they often haven’t experienced in some time: relaxation. A large body of research suggests that most people who experience an eating disorder will also encounter a high level of anxiety at some point. In one study (Kaye et al., 2004) the authors found that approximately two-thirds of people with an eating disorder also suffer from an anxiety disorder at some point in their lives, the most common being OCD and Social Anxiety. Putting diagnoses to one side, it’s also fair to say that someone experiencing an eating problem is very likely to be stressed, both by the disorder itself and the experience of recovery. Yoga, through movement and breath, offers the experience of greater relaxation and the practical tools to be able to affect the nervous system, thereby influencing how we feel in life off the yoga mat.
A ‘way in’ to mindfulness.
“Mindfulness involves learning to direct our attention to our experience as it unfolds, moment by moment, with open-minded curiosity and acceptance. Rather than worrying about what has happened or might happen, it trains us to respond skilfully to whatever is happening right now, be that good or bad.” Mindfulness in Schools Project.
In recent years there has been increasing interest in incorporating mindfulness into treatment approaches, either as an intervention in its own right or as an adjunct to treatment. For example ACT (Acceptance and Commitment Therapy) has been applied to anorexia, DBT (Dialectical Behaviour Therapy) adapted for bulimia and binge eating, MBCT (Mindfulness Based Cognitive Therapy) adapted for binge eating, and MB-EAT (Mindfulness-Based Eating Awareness Training) developed for binge eating. Whilst there are important differences between the models, they are all based on the rationale that an avoidance or lack of awareness of inner experience contributes to eating problems, and that this can be addressed through mindfulness skills training.
Whilst it’s still early days, there is growing research evidence that these mindfulness-based approaches may be useful in the treatment of eating disorders. In a systematic review of the evidence Wanden-Berghe and colleagues (2011) concluded that mindfulness-based approaches are a promising development in the field. Whilst they were cautious in their conclusion (on the basis that the research base is small and studies are of varying quality) they noted that the studies which met their criteria for inclusion all had positive findings and therefore suggest they may be effective treatments.
However, mindfulness practices (like seated meditation) can be incredibly challenging when we are in the midst of huge challenges. Yoga, through movement and regulation practices offers an alternate way of building mindful awareness, and can be more accessible during an acute stage of illness.
Emotion awareness and regulation.
Bingeing, restricting and purging can all be thought of as ways of coping with difficult emotions. A mechanism through which both yoga and mindfulness may help is through improving emotion regulation. In both practices, the continual focus on on-going physical sensations builds interoceptive awareness (basically the awareness of body states e.g. thirst, hunger, pain, temperature, itch, tension) and acceptance, an important component of emotion awareness. A regular yoga practice also offers the opportunity to learn to stay in poses which are difficult or awkward. And herein lies another benefit from simply watching our body sensations… we learn not just to recognise but to tolerate our emotions, whatever they are. If we can really be with the stretch in our side in triangle pose without mentally switching off or coming out of the pose, we can also potentially learn to be with the butterflies in our tummy without using food (or something else) to shut down the experience. Simply watching gives us the space to respond to what we find rather than reacting habitually. This practice of staying with discomfort in a relaxed way provides training in staying present with difficult feelings, thoughts or sensations. This can translate into improved impulse control off the mat, helping us to tolerate uncomfortable emotional states and not to act on the urge to binge and/or purge for comfort or to numb ourselves by restricting.
Part of recovery is also learning to recognise and trust feelings of fullness and hunger. Through building interoceptive awareness yoga offers the opportunity to tune in to such messages from the body. With greater awareness the discomfort of over and under eating becomes more apparent and can help to guide us in our decisions. As Chelsea Roff explains:
“When someone develops greater mind/body awareness they tend to gravitate towards healthier behaviours. This is not because they’ve been told to or because they are following a rule, but because they actually experience the difference; they truly feel the bloating from bingeing, they become more aware that drinking red bull leaves them agitated. Yoga offers a bottom-up approach which gradually instils in people the desire for healthier habits. So rather than an internal battle with a decision to give something up (and the unhelpful craving cycles this sets up), unhealthy habits can drop away over time.”
Self-esteem and body image.
Too often in life we focus on how our bodies look; yoga helps us to focus on inner qualities, the felt experience of a pose and the mental quality of mind one brings to it. It offers us a way of befriending the body and listening deeply to its messages. In so doing it can helps us to foster a more accepting and compassionate relationship with the body, cultivating a sense of ‘home’ in your own skin.
Yoga, as a practice of union, invites us to recognise every part of ourselves and in so doing it offers a way of gradually disentangling the grip that negative body image can have on our lives. Of course, this takes time but through practicing over and over again we can create a new relationship to self, one that is kinder, gentler, and more forgiving.
The Yogic Path.
The practice of yoga can have hugely positive impacts on health and wellbeing, but it can also be just another way in which we act out a punishing relationship to our bodies. The asana ‘limb’ of yoga was never meant to be an isolated practice, and when we do so without any attention to the rest of the path it’s all too easy for our minds to get stuck on the physical body – and if we already have a troubled relationship to that body then it will most likely be a negative focus!
Yogic philosophy offers an alternative set of values which can counter eating disordered thoughts and behaviours. Yoga can also offer us a sense of belonging to a community which is focused on wellness and spiritual growth.