Yoga therapy for a client with Anorexia Nervosa

In my previous article, we looked at a case study that illustrated the implementation of Yoga therapy for a young woman with bulimia nervosa. In this article, we will explore Yoga therapy for a client diagnosed with anorexia nervosa.

When eating disorder practitioners hear, “Yoga” and “Anorexia Nervosa” in the same sentence, uneasiness is often felt – and rightfully so.  The concerns of using Yoga therapy in the treatment of a client with anorexia are heightened, as is in a client with bulimia or binge eating disorder, as across the spectrum, potential medical issues exist.

The Yoga therapist may work alone or work as part of a treatment team in a comprehensive setting. In the former setting, the Yoga therapist is encouraged to have a relationship and open communication with a multidisciplinary outpatient treatment team. In Yoga therapy, an initial assessment is completed with a client, similar to that of any other treatment team member’s preliminary assessment, in order to collect information and develop a client-centered, integrated treatment plan. In addition, a Yoga therapist might include an assessment of breath patterns, posture, and movement patterns. In the implementation of the Yoga therapy treatment plan, it is important for the client to know and understand why they are engaging in the recommended postures.

In a more comprehensive setting, the Yoga therapist has the benefit of a medical professional available to perform a medical exam, with lab work, prior to the client embarking on Yoga therapy. In addition, the Yoga therapist in a comprehensive setting has the benefit of a medical and/or nursing professional to perform concurrent vitals, along with a physical and behavioral assessment prior to each subsequent Yoga therapy session, in order to determine medical stability.

For the Yoga therapist who practices solo, a behavioral assessment is crucial before starting the day’s Yoga therapy session.  Is the client following their meal plan? Are they restricting? bingeing? purging? Are they hungover? Did they come into the Yoga therapy session drunk or high? How does the Yoga therapist assess the client physically? For the Yoga therapist that is also licensed medical or nursing professional, they are trained to perform physical assessments. For the Yoga therapist who is not trained medically and has concerns, having the client sit on their Yoga mat and breathe may be the extent of that day’s Yoga session, as meditation is in fact Yoga.

For a client with anorexia nervosa, a gentle hatha intervention is recommended. Even more powerful is a Yin Yoga flow, where the client experiences only seated, long holding postures using the lower half of their body. No muscle is used in Yin Yoga. This type of Yoga may bring up extreme agitation for the client as their work is to be still. Emotions tend to be elicited in these postures, where the client is unable to avoid feeling these emotions—another area of challenging work for the client with anorexia.

In my personal experience in working with a client struggling with anorexia nervosa, I have been able to elicit deep expressions of emotions in a Yin practice. In a number of cases, the client had expressed that it had been the first time they had cried and felt their feelings in quite some time. In a comprehensive treatment setting, the psychotherapist is available to process those emotions following the Yoga therapy session.

The Yoga therapist can observe whether or not the client sinks into the postures, as a metaphor for sinking into their life, or whether they hold back with tension and apprehension. Often, attachment is the root of the tension that your client may be experiencing physically and emotionally. Yoga therapy can help move your client forward with awareness. However, it is difficult for the client to let go of something, when they don’t know what they are holding onto. By observing and recording body language, including the resistance the client may be experiencing, the Yoga therapist can become in tune to what is going on in the moment. The Yoga therapist can then consult with the treatment team in order to hone the team’s support in helping the client uncover what may be holding them back from participating in their own life.

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.

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.

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