In the first article of this series, we explored what Yoga therapy is or is not, along with the qualifications and requirements of who can provide Yoga therapy. We also discussed the benefits of Yoga. The next three articles will portray an individual, across the eating disorder spectrum. This particular article will illustrate a client diagnosed with bulimia nervosa and co-occurring substance use disorder in regards to what a Yoga therapist may observe on the mat in order to understand how this translates into behaviors and experiences and off the mat.
Kaitlyn (not her real name), age 26, was diagnosed with bulimia nervosa and borderline personality disorder. She had a history of drug and alcohol abuse, was bingeing and purging multiple times per day, three to four days per week and struggled with body image. Kaitlyn practiced Yoga for several years in a gym-like environment. Her perspective of Yoga was to “tone her abs and go for the burn,” in contrast with a Yoga studio that might focus on linking breath with movement, along with awareness.
The Yoga therapy, integrated with Kaitlyn’s multi-disciplinary treatment team’s plan, was a slow moving hatha sequence of postures, with the postures held for 15 mindful breaths each. This Yoga prescription was implemented to slow down Kaitlyn so that she could focus on mindfulness, being present, symptom reduction, and curbing impulsions vs. making the Yoga a “work-out,” focusing on shaping her body. The rationale behind the long holding poses was to keep the Yoga intensive enough to hold Kaitlyn’s interest, develop her awareness, while challenging her mentally, not just physically. By furthering her awareness of events leading up to her behaviors, the slow moving, yet long holding poses were instrumental in aiding Kaitlyn to tolerate uncomfortable states, aiding in her goal to decrease her impulsiveness to use behaviors when trying to avoid feeling her emotions along with her goal of body acceptance.
An article that I wrote for Gurze-Salucore, Eating Disorders Resource Catalogue, The Use of Yoga in The Treatment of Anorexia and Bulimia Nervosa, June of 2015, provides additional examples of how sequencing of Yoga postures by the Yoga Therapist, along with corresponding dialogue, can be used to move the client towards recovery. This was the model for Yoga therapy and Yoga-based treatment in the past, when we had Yoga therapists on staff, during the time I previously owned and operated my comprehensive eating disorder treatment center.
In recent studies, Yoga has been shown to increase the levels of Gama aminobutyric acid (GABA) in the brain by more than 20 percent. This is important because people dealing with substance abuse usually exhibit low levels of GABA. If Yoga can increase these levels, even for short periods of time, then individuals with a history of substance abuse with their bulimia nervosa, can more conscientiously focus on their recovery. In addition, mindful Yoga and meditation can affect the cerebral cortex, improving focus and awareness, while diminishing the impulsivity along with irrational thoughts and behaviors involved in eating disorders, substance abuse and related addictions.
As Dialectical Behavioral Therapy (DBT) is widely used in bulimia nervosa, borderline personality disorder and substance use disorders, the emotional regulation, behavior chain analysis, and distress tolerance skills are very congruent with skills and behaviors elicited in Yoga. In integrating Yoga therapy with the multi-disciplinary team’s treatment approach, Kaitlyn was able to integrate the Yoga therapy with her DBT skills learned in her comprehensive treatment.
Over the course of her treatment, Kaitlyn reported that her behaviors diminished as she learned to use Yoga to help delay her impulses. She learned to explore more deeply of what arose for her emotionally by learning to stay present in postures that were difficult or awkward. She was also able to notice when her borderline traits emerged and to observe this behavior before it became unmanageable. Kaitlyn began to appreciate her body for what it “could do” versus how she currently defined her body based on “what it is.”
Keep in mind that Yoga may not resonate with all clients struggling with eating disorders. I have witnessed athletic clients doing series of push-ups vs following the lead of the Yoga therapist, along with sleeping, picking lint off their mat the entire session and even cartwheels as a sign of disengagement, avoidance and defiance.
Nevertheless, Yoga can be instrumental in the treatment of individuals with bulimia nervosa, including those who have co-occurring disorders. Through a regular Yoga practice, individuals may find themselves in postures that are difficult or awkward “on the mat.” Learning to stay within the poses and work through them can help an individual take their Yoga “off the mat” when they feel the urge to binge or engage in unhealthy behaviors by curtailing the acting on this urge. In Yoga, individuals are encouraged to observe rather than react to their discomfort by breathing and listening carefully for what their body and mind are conveying. A qualified and properly certified Yoga therapist can be an adjunct to a comprehensive treatment team.
BEVERLY S PRICE is a certified eating disorder registered dietitian and iaedp supervisor, experienced registered yoga teacher and IAYT certified yoga therapist. Beverly is recognized for bringing mindfulness-based yoga to the eating disorder treatment community along with yoga therapy training programs in eating disorders for professionals. Beverlysprice.com
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders and not intended as endorsement by iaedp Foundation or its Board of Directors.