The Use of Yoga in the Treatment of Anorexia and Bulimia Nervosa

The Use of Yoga in The Treatment of Anorexia and Bulimia Nervosa

By Beverly Price, MA, E-RYTbeverly_price_0313_sm

For an individual struggling with Anorexia or Bulimia Nervosa, Yoga therapy can be a powerful treatment tool. The role of a Yoga therapist in a treatment setting is much different than what a Yoga instructor can provide. The role of a Yoga instructor is to take what one knows about the practice of yoga and lead a group of students through a class. Typically Yoga instructors teach group classes at studios and gyms, although some do teach individuals privately. A Yoga therapist is trained to work with individuals not only physically, but on an emotional and spiritual level as well. They are also trained in an area of specialty, such as eating disorders, in order to focus on facilitating healing and transformation of an individual.

This article will take you through a Yoga Therapy session with an individual patient or group of patients diagnosed with the eating disorders described above:

The Yoga therapist sets the tone of the treatment room by dimming the lights and warming the room to a cozy and comfortable temperature (not too hot, not too cold). There is no “front” or “back” of the room. It is the Yoga therapist’s job to circulate within the space and observe the patients, in terms of their body language and response to the flow of postures given. This is not the place for the Yoga therapist to model postures or perform his/her own practice. There may be soft background music or absence of music, as the Yoga therapist sets a theme at the onset and follows through with dialogue to support the theme.

For example, a theme about judgment may open with the following story by the Yoga therapist, as patients are in seated meditation:

“There was a woman who placed her laundry on drying racks in her front window. A neighbor walked by daily and wondered with disgust why the woman placed her dirty laundry in the front window for all of the neighbors to view. After at least a week went by, the neighbor walked by to find that the woman’s clothes hanging in the front window were now clean. When the neighbor finally confronted the woman, the neighbor exclaimed with sarcasm, “I am glad to see that your clothes hanging in the window are now clean!” The woman responded, “My clothes have always been clean. I just washed the windows.”

As the Yoga experience shifts to a moving meditation, the Yoga therapist allows the individual or group to move in any way that feels right — from “cat-cow,” to “cobra,” to “down dog,” — the Yoga therapist invites the patient to work with their eyes closed as to not judge themselves or other patients that may also be in the room. “Feel what it is like to be inside of your own body at this very moment,” states the Yoga therapist, “Yoga is not a competition or a race. There is no scorecard… Just you on your mat in your own personal practice.”

The Yoga therapist then moves the patient to a dynamic sequence, such as reverse table to boat pose with at least 15 breaths held per pose, along with a sequence of three of each alternating poses. As the Yoga therapist moves the patient towards their “edge,” that place which is not too much but not too little, the intensity of the sequence is geared to the strongest patient offering modifications to the least strong and/or more compromised. The Yoga therapist describes the edge as follows, “You find yourself in a heated discussion. Embrace this discussion as a learning exchange in speaking each other’s truths. When it becomes a heated argument, you may be beyond your edge and need to know when to walk away. Your edge at this moment may be seated meditation or child’s pose.” It is important for the Yoga therapist to give permission to the patient to take child’s pose at any time, but yet empower the patient to understand when he/she is using child’s pose to avoid confrontation with issues that need to be worked out, without judgment, on their Yoga mat. For many patients, child’s pose may be their edge. Softening around the edge is also encouraged with the message from the Yoga therapist that the patient “should not be so hard on himself or herself.”

A series of long holding postures, moving side to side, that strengthen the mind may be brought in next by the Yoga therapist, as the therapist encourages the patient to make a strong determination to stay in the posture as uncomfortable as it may feel…equating this discomfort to uncomfortable emotions that may surface at anytime. “Breakdown often happens before breakthrough. As we release physical pain, we release emotional pain,” the Yoga therapist directs. The Yoga therapist may offer adjustments stating, “If I come around to adjust you, please know that I am making a connection, not a correction. The Yoga therapist is trained to intuitively know when the patient does not want to be touched. In this case, an “adjustment” may consist of simply sitting next to the patient, while he/she is in their personal practice, and listening to their breathing while energetically encouraging him/her to work through obstacles on their mat. “Our obstacles are our greatest teachers, this is how we grow and transform,” offers the Yoga therapist.

The Yoga therapist then brings in static, dynamic postures such as a long holding chair posture or Buddha squat, encouraging the patient to stay present and in the moment. “Light always comes after a dark storm,” may be an appropriate metaphor here.

As the Yoga therapeutic session winds down, long holding Yin postures, that require no muscle work, may be brought in at this time such as pigeon pose or a long holding forward folds. “There is nothing to do now but just be – without self-judgment,” notes the Yoga therapist, “For some of you, your work is to be still…which may be the hardest thing you will do all day.”

Following the Yin postures comes Sivasana, an ending resting pose lying on one’s back. Sivasana with eyes open or seated meditation should be offered as an alternative for those patients working through trauma issues. An appropriate song relating to the theme may be played here or simply silence. Seated gratitude may be a way to close the experience, followed by journaling of the experience by the patient and discussion, along with medical record documentation and communication to the entire treatment team. Keep in mind that the techniques outlined in this article may be used for individuals with Binge Eating Disorder, and my colleague and trained Reconnect with Food® Yoga Therapist, Shirley Kessel, will elaborate more in her article within this issue.

Trained Yoga therapists in an eating disorder setting are an integral part of the treatment team. At the Inner Door Center®, the Yoga therapists don’t just walk into our clinic, facilitate a therapeutic movement sequence then leave. They facilitate group process and therapy to assess what has come up for the patient during the therapeutic movement hour, they chart in the medical record, they attend case consultation and they have a significant report with program patients. Keep in mind that conversation can be a barrier to intimacy and therefore, patients can talk their way out of feeling. Studies indicate that approximately 55% of communication is body language, 38% is the tone of voice, and 7% is the actual words spoken. The Yoga mat can be a great tool for self-expression.

About the author:

Beverly Price, MA, E-RYT is the CEO and Founder of the Inner Door Center,® the world’s first and only Mindfulness Yoga-Based Treatment Eating Disorder Treatment Program offering Partial Hospitalization, Intensive Outpatient and Outpatient levels of care along with co-occurring substance abuse treatment. Inner Door Center®’s Reconnect with Food® Yoga Therapy is a Charter Member School of the International Association of Yoga Therapists (IAYT.org). The training program focuses on using Yoga to help individuals with eating disorders and other co-occurring psychological conditions (anxiety, depression, trauma, substance abuse and related addictions). The requirement to enroll in this Yoga therapy training is that you have at least a 200 RYT certification and are a licensed professional working in the field of eating disorders. Peer/Recovery Coaches may be admitted to the program with at least three years of clean recovery along with a significant amount of community service, including professional recommendation letters.

 

 

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