Table 3 The scope of the evidence base for integrated yoga and psychological approaches for the treatment of eating disorders

Cook-Cottone et al. [8]

USA

Eight weekly two-hour group sessions of the attunement in mind, body, and relationship (AMBR) program

Psychological Intervention: Incorporates CBT and DBT with dissonance-induction content

Yoga Intervention:50-min of body-focused yoga and 15-min of meditation/ relaxation practices were incorporated into the weekly group sessions of AMBR. Participants were instructed on breathing and self-talk during postures, which increased incrementally in difficulty over the eight weeks

To describe the theoretical foundations and examine preliminary outcomes for treating eating disorders with the AMBR program

29 women diagnosed with anorexia or bulimia nervosa engaged in an eating disorder treatment clinic (ages 14–30 years; mean age = 20 years) across one six-session group and four 8-session groups

N = 24 completing

Aged between 20 and 25 years (Mean 20 years)

Attrition: 44 participants signed up for the program with 29 (66%) completing it

Single group pilot study with pre- post data

Three subscales from the Eating Disorder Inventory-2 (EDI-2; Garner, 1991): Drive for Thinness (DT), Body Dissatisfaction (BD); Bulimia (BU)

Significant reductions were observed in participants’ DT and BD scores after the program

No significant differences were observed in BU scores

Preliminary support for an integrative mind body treatment encompassing aspects of CBT, DBT and relational theory in the treatment of eating disorders

Further research is warranted for empirical validation of positive findings using RCT design and more robust outcomes measures, as well as qualitative data collection to assess participant experiences and feedback

Level 3

Non-randomized controlled cohort/follow-up study

Integration of yoga and psychological therapy based on ‘Theoretical Attunement Framework’. Weekly themes were taken from the Theoretical Attunement Framework

Diers et al. [18]

USA

Eight weekly 90 min group sessions of the Yoga Body Image (YBI) program

Psychological Intervention: 45-min group discussion after yoga practice to allow discussion about class theme aimed to aid in the participant’s verbal processing of their experience in sensation, emotion and overall experience. Goal setting also used

Yoga intervention: 45 min of therapeutic yoga that incorporated aspects of hatha, vinyasa, and viniyoga. Each session focused on a different theme related to body image such as body awareness and appreciation, free movement, non-judgement, emotional connection, breathing, body-mind capabilities, resiliency and neutrality. Yoga postures (asanas) breath technique (pranayama) and guided imagery selected to support theme

To examine the programs acceptability and perceived impact on body image as reported by participants before and after the program

91 participants expressed interest in the study and took first class of YBI

67 participants completed both pre and post questionnaires

N = 67

66 = female

1 = male

No age range given. No specific ED diagnosis given

Pilot Feasibility study

Survey data was used to quantitatively examine changes in body image concern scores before and after program

Open ended survey questions used to understand observed changes in body image scores and as a phenomenological exploration of the mechanisms through which yoga might influence body image concerns

Statistically significant improvements in body image concerns

Qualitative data showed improvement in body image concerns, emotional benefits, improved relationship with others and improved self-acceptance and awareness

Limited information about sources of potential bias related to participants’ personal characteristics, specific treatment and referral method

Level 3

Non-randomized controlled cohort

Program called YBI program. Based on theory that yoga is a multidimensional tool that can promote embodiment and therefore improve body image which is particular issue with ED

Group discussion aimed to enhance experience of embodiment through verbal processing and allowed peer-based discussion/support. Goal setting was used to encourage change

Goal setting used

Weekly themes based on improving body image (body awareness and appreciation, free movement, non-judgement, emotional connection, breathing, body-mind capabilities, resiliency and neutrality)

Fetterman [20]

USA (dissertation only)

HIVE, stands for Healing, Integration, Vitality, and Experiential. 6 group sessions focussed on a theme

Psychological Intervention: Aspects of psychoeducation, CBT, DBT and Disonnance interventions included in group discussion after yoga practice

Homework prescribed each week focusing on journaling, daily meditation practice, and an at home 20 min yoga sequence. Journal assignments are related to theme for week

Yoga Intervention: Yoga practice followed by a guided meditation

To describe HIVE program

No description regarding targeted participant group other than for people with an eating disorder

No specific ED diagnosis or age range given

Program description only

Dissertation only

Weekly themes address core contributing theories of eating disorder symptomatology such as thin-ideal internalization, body appreciation and acceptance (body dissatisfaction), tolerance of negative affect, perfectionism, objectified body consciousness, poor interoceptive awareness, and low self-esteem

Homework considered significant as a mechanism for change

Group used to promote interpersonal learning and group cohesion

Clarke [15]

USA (dissertation only)

Finding OM yoga program

10 week program including

Yoga intervention: 1 h group yoga class in the Baptiste Power Vinyasa style using poses recommended to alleviate depression, anxiety and obesity. Class began and ended with guided meditation specific to BED-related issues such as distress tolerance, self image and binge/food related behaviour

Psychological Intervention: 30 min psychoeducational discussion group

To assess whether the Finding Om yoga program, either with or without a CBT-style discussion component, would reduce bingeing behavior in people with BED

Females 18 year + with BED diagnosis

13 participants started study

3 participants dropped out

6 participants assigned to no discussion group (3 dropped out)

7 participants assigned to discussion group

Randomly assigned experimental design study with pre- post data

EDE-Q-I

A yoga log (recording time and duration of yoga practice)

Yoga Feelings Checklist

Five factor mindfulness questionnaire (FFMQ)

Body Responsiveness Questionnaire (BRQ)

Report of Binge eating episodes dropped significantly from 4.75 to 1.95 per week

Significant reduction in scores on the EDE-Q-I. Significant increases in body awareness, body responsiveness and various facets of mindfulness were seen on the BRQ and FFMQ. There were no significant differences in results between the discussion group versus no-discussion group conditions, but anecdotal response indicated a perceived benefit of participation in the discussion group

Small sample size, imbalance of conditions and lack of a control group

Dissertation only

Yoga log was developed to replicate a food log used in BED treatment

Yoga raises body awareness and responsiveness to bodily sensations [16], it was hypothesized that yoga practice would additionally help reduce bingeing behaviors

The intention of the discussion was to consolidate and advance members’ treatment gains by capitalizing on the factors inherent in group, such as feelings of universality and the sharing of information (Yalom 1995)

Weekly themes were specifically related to BED- issues such as distress tolerance, self-image and binge/food related behaviour