Yoga and Eating Disorders – What works?
Can yoga help people recovering from an eating disorder? A number of studies have investigated yoga for eating disorders, so what do they tell us about how and why yoga can help?
Anybody who’s taken a few yoga classes knows that there are many different styles of this ancient practice. A steamy, fast paced Bikram class and a super slow Restorative practice don’t seem to have much in common and yet they are both described as 'yoga'.
Different yoga styles use different techniques and, as a result, have different outcomes (you’re unlikely to develop killer abs during a yoga nidra and a lunchtime express vinyasa class rarely includes a long, deep relaxation).
It is becoming increasingly common to find yoga being offered at facilities that treat eating disorders, and yet there are few guidelines on what approach teachers should take, and what training they need in order to deliver the most appropriate practices.
One of the reasons for this is that there haven’t been enough high-quality studies on what actually works. While the literature on yoga for eating disorders is encouraging, studies so far have measured different types of students (ie. Type of eating disorder, age, circumstances etc), doing different types of yoga (Iyengar, individualised yoga therapy, hatha etc). It's not surprising that these studies often show different outcomes.
What type of yoga is best for people with eating disorders?
When it comes to supporting people recovering from eating disorders, does it matter what kind of yoga is taught? Yes, it does.
If you're familiar with Patanjali's Yoga Sutras, the ancient text that underpins the modern practice of yoga, you'll know that the first principle of yoga is Ahimsa - non-harming. Yoga teachers working in the eating disorders space are supporting a vulnerable population and Ahimsa should always be the primary goal.
To ensure that Ahimsa is being practiced during a yoga class for students recovering from an eating disorder, it's important to begin with an understanding what eating disorders are, how they develop and what symptoms people experience.
Eating disorders are complex and have many different risk factors, including:
- Genetic factors
- Psychological factors (ie. perfectionism, low self-esteem, body dissatisfaction)
- Socio-cultural factors (ie. Social/cultural ideas of beauty and body image)
- A history of trauma
It's also important for yoga teachers to understand that up to 97% of people with eating disorders also experience other mental health issues, such as:
- Obsessive Compulsive Disorder
- Chronic Fatigue
- Cardiovascular disease
While not everybody who develops an eating disorder has experienced trauma, it is recognised as a significant factor. Traumatised people find it difficult to attune to their bodies and tolerate the intense physical, sensory and emotional experiences that they feel. These experiences are also common in people with eating disorders. Fortunately, there is lots of evidence to show that some very specific yoga techniques can help to manage these symptoms.
Trauma Sensitive Yoga for eating disorders
Based on the work of psychiatrist Bessel van der Kolk and yoga teacher David Emerson, trauma sensitive yoga techniques have been developed to help traumatised students increase their emotional awareness and develop trust in their own bodies.
This approach has many benefits for working with people with eating disorders, not least the fact that trauma sensitive yoga has been well researched and shown to reduce unhealthy coping behaviours and increase feelings of ownership over one’s own body.
It’s also a gentle and non-directive type of yoga that empowers students to make positive decisions about what they do with their bodies, rather than trying to live up to external ideals (a strong pattern for people with eating disorders). The gentle, non-aerobic approach makes it safe for those with anorexia or bulimia who have a history of over-exercising. In contrast, yoga classes that emphasis external appearances (such as getting the shape of a yoga posture 'right') or require strong, active movements could potentially encourage unhealthy behaviours in people with eating disorders.
What’s more, trauma sensitive yoga has distinct guidelines around the language used by the teachers, how they interact with students and the environment in which classes are taught. These guidelines make it easier for teachers to keep their students safe, help them make progress and monitor results.
At the moment, there are few studies specifically on trauma sensitive yoga for eating disorders, although there is plenty of evidence that this approach reduces many of the symptoms experienced by people with eating disorders, including anxiety, depression and problems with emotional processing.
Trauma sensitive yoga is the foundational approach that I used while teaching young people recovering from anorexia and bulimia at Westmead Children's Hospital. Evaluations conducted at the Adolescent Medicine Unit at the hospital showed that both clinicians and patients found trauma-sensitive yoga to be helpful in reducing anxiety and, in turn, helping students to manage their symptoms.
Yoga can and does help people with eating disorders and others affected by trauma and teachers who are trained in trauma sensitive yoga techniques can make a big difference to the lives of their students.
Want to learn more about yoga therapy?You'll find plenty of free yoga therapy resources here.
Beets, MW; Mitchell, E. (2010) Effects of yoga on stress, depression, and health-related quality of life in a nonclinical, bi-ethnic sample of adolescents: A pilot study. Hispanic health care international, 8(1) 47-53(7). DOI: 10.1891/1540-4126.96.36.199
Brewerton TD (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders 15:285–304
Carei, T.R; Fyfe-Johnson, A; Breuner, C.C; Brown, M.A. (2010). Randomized controlled clinical trial of yoga in the treatment of eating disorders. Jl Adolescent Health 46(4).346–351. DOI: 10.1016/j.jadohealth.2009.08.007
Daubenmier, J.J. (2005) The relationship of yoga, body awareness and body responsiveness to self objectification and disordered eating. Psychology of Women Quarterly 2, 207-219. DOI: 29:10.1111/pwqu.2005.29
Emerson, D; Sharma, R; Chaudhry, S; Turner, J. (2009) Trauma-sensitive yoga: principles, practice, and research. International Journal of Yoga Therapy 19
Frisch M. J., Herzog D. B., Franko D. L. Residential treatment for eating disorders. International Journal of Eating Disorders. 2006;39(5):434–442.
Mitchell, K.S; Dick A.M; DiMartino D.M; Smith B.N; Niles B; Koenen K.C; Street A (2014) A pilot study of a randomized controlled trial of yoga as an intervention for PTSD symptoms in women. Jl. Traumatic Stress, 27 (2)121-8. doi: 10.1002/jts.21903
Mitchell, KS, Dick, AM; Niles, BL; Street, AE; DiMartino, DM; (2014). Examining mechanisms of change in a yoga intervention for women: The influence of mindfulness, psychological flexibility, and emotion regulation on PTSD symptoms. Journal of clinical psychology,70, (12) 1170–1182 DOI: 10.1002/jclp.22104
National Eating Disorders Collaboration (2010). Eating disorders: The way forward: An Australian national framework. Sydney: NEDC. http://www.nedc.com.au/files/pdfs/NEDC_National%20Framework_Final.pdf
Tagay, S; Schlottbohm, E; Reyes-Rodriguez, M; Repic, N; Senf, W. (2014). Eating Disorders, Trauma, PTSD and Psychosocial Resources Eat Disord. 22(1): 33–49.doi: 10.1080/10640266.2014.857517
Spinazzola, J; Rhodes, A; Emerson, D; Earle, E; Monroe, K. (2011) Application of yoga in residential treatment of traumatized youth. Jl of the American Psychiatric Nurses Association, 17(6): 431-44 / DOI: 10.1177/1078390311418359
Van der Kolk, B; Stone, L; West, J; Rhodes, A, Emerson, D; Suvak, M; Spinazzola, J.(2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. Jl. Clin Psychiatry 75. DOI: 10.4088/JCP.13m08561.