1. Proposal to Study the Potential Benefits of Yoga in the Treatment of Eating Disorders by
Evaluating Yoga’s Effect on Stress Levels
Heather Aschenbrenner
North Carolina Agricultural and Technical State University
Abstract
Statement of Problem
Yoga: A Form of Mindfulness Methodology
Future Plans
References
Eating disorders (EDs) present an interesting
juxtaposition in the research realm; they are a
classification of mental disorders that focus on the
psyche, and yet they are also disorders that are
strongly related to food- a substance we all need to
survive. With such a complex, interrelated disorder,
where does one begin the treatment process? Do
medical professionals focus on the psyche, or focus on
food when with patients? Mindfulness based
approaches present an opportunity to assist in all of
the treatment angles of EDs.
EDs can be challenging to study individually because
of the “taboo” discussion surrounding the disease. As a
result, this proposal focuses on evaluating a frequent
co-occuring problem with EDs- stress. Yoga’s impact
on stress levels will be studied and I plan to use this
information to display the potential benefits of yoga
when used with patients who suffer from eating
disorders.
In order to evaluate the research conducted on mindful
yoga as a co-treatment for eating disorders (ED), it is
important to understand the social and cultural role in the
development of eating disorders (EDs). Frequently, the
development of EDs leads to a divide between the mind
and the body. Yoga provides a method to decrease the
gap in the divide through a philosophy that unifies mind,
body, and spirit, and is supported by scientific research.
While eating disorders vary in regards to their essential
features and characteristics, it is generally accepted that
eating disorders are, in part, provoked by concerns of body
shape and body weight (Keel & Forney, 2013). Body
dissatisfaction is perpetuated through media; a social
influence that reaches all age groups and genders.
The impact of EDs can be devastating for the individual
suffering from the disease; however, the ramifications of
EDs transcend much deeper, reaching family members
and friends as well (J. Ratner, personal communication,
November 13, 2013). EDs are among the top four leading
causes of other disease that lead to decreased length of
life through disabilities or death (Academy for Eating
Disorders [AED], 2014). In fact, among psychiatric
disorders, anorexia nervosa has the “highest overall
mortality rates and the highest suicide rate” (AED, 2014,
p.1).
To put the disease into perspective with other psychiatric
disorders, “the risk of death is three times higher than in
depression, schizophrenia or alcoholism and 12 times
higher than in the general population” (AED, 2014, p.1).
While diagnosed EDs statistical impact contains 0.3% to
3% of the population, the mortality rate is evidently
significant for this psychiatric disorder. Those who suffer
from ED’s frequently have comorbid diagnoses as well
(Swanson, Crow, le Grange, Swendsen, & Merikangas,
2011). The comorbid diagnoses consist of anxiety,
depression, obsessive compulsive disorder, and suicidal
ideation (Swanson et al., 2011).
With up to 20% of young women and, increasingly, more
defined percentages of young men experiencing
unhealthy eating patterns; there is an evident need to find
treatment methods, and potential preventative methods,
for EDs (AED, 2014). EDs take many different forms, thus
it is important to find a method that holds relevancy across
the diverse disorders. Mindfulness, with a focus on yoga,
presents a promising method, when in congruence with
other treatments, as benefiting patients who suffer from
EDs.
Yoga: A Proposed Method for the Co-treatment of EDs
The strong link between body dissatisfaction and eating
disorders underscores the need to find a form of treatment
that encourages self-love and identification with the body as
part of the whole person; yoga presents an opportunity to
fulfill this new treatment role. Explicitly, Dittmann and
Freedman (2009) propose that yoga provides a potential
pathway to join the mind, body, and spirit divide that is
developed as a result of self-objectification (i.e., the viewing
of the body as purely a materialistic, physical being). Yoga,
in its essence, is a form of mindfulness practice. Douglass
(2011) explains that the mindful practice of yoga “is primarily
interested in raising an individual’s awareness of the
patterns of his or her mind; it does this through postures,
breathing practices, deep relaxation and concentration
techniques” (p. 84). ED patients tend to have a disconnect
between the mind and body (Dale, Mattison, Greening,
Galen, Neace, & Matacin, 2009), and the simplistic definition
of mindful yoga above portrays a method that holds
potential to decrease the mind-body disconnect.
Research validating the use of yoga as a co-treatment for
EDs. Two small studies have been conducted incorporating
yoga into the treatment of EDs with positive results, or at
least showing no negative effect of including yoga in a ED
treatment plan (Dale et al., 2009; Carei et al., 2010). Carei
et al. (2010) compared a no yoga and a yoga group in order
to discover the effects of yoga on ED treatment outcome in
adolescents. A total of 54 participants received one-on-one
yoga, twice a week for an hour, over an eight week time
period by certified instructors. Ultimately, the study found
that food preoccupation and eating disorder symptoms
decreased over time and anxiety and depression improved
with treatment. Dale et al. (2009) completed a similar study
with five adult patients. The study involved a 6-day
intensive yoga workshop in which participants were exposed
to yoga and educational classes. This study showed
positive results by decreasing food preoccupation and
improving mood disturbance. The results of Dale et al.’s
(2009) study were maintained at a one month follow-up.
Important factors coming from Carei et al. (2010) and Dale
et al.’s (2009) research is that yoga is not detrimental in any
way to its participants. Both studies explicitly state that
there is room for improvement in their studies, however, the
results positively support further study of yoga as a co-
treatment for EDs. In fact, the researchers present
questions that help guide future areas of research: Is a
specific form of yoga better than others? Does previous
yoga knowledge impact treatment outcomes? Does yoga
truly here the mind-body disconnect that is present in a
patient with an ED? Is it yoga itself that is healing, or the
spiritual aspect incorporate in yoga?
Research in the field supports the potential positive effects
of yoga in the treatment of EDs. While the research is
positive, there is a need and a demand for more evidence-
based research. EDs, in essence, involve an individual
detaching from the body and losing the mind-body
connection. Yoga provides a format and a safe environment
Finding participants who are willing to discuss and
participate in research involving eating disorders and
body image can be challenging; thus making it hard to
find a large enough sample to research. As a result, this
study will evaluate yoga’s affects on the stress levels of
its participants.
Stress can be an indicator of anxiety; a disorder that is
frequently co-diagnosed with patients who suffer from
EDs (Swanson et al., 2011). Therefore, this study will
operate on the assumption that if yoga decreases stress
levels within its participants, than there is evidence to
believe that yoga may also benefit patients who suffer
from EDs. This study will be carried out using
quantitative research designs in order to obtain
information regarding the relationship between yoga and
stress. This study is done on the premise that it will also
be applicable to patients who suffer from EDs.
Participants will be recruited from local yoga studios
that are willing to participate in the study. There will be
no rule out factors.
I plan to analyze the data using one-group pre-/post
test, developing inferential statistics from paired t-tests
analysis. The Stress Assessment questionnaire (SAQ)
will be used for this study. The SAQ has been tested for
reliability an validity, with outcomes showing the test has
good internal consistency reliability with a median of
0.80 and significant criterion validity (median 0.25) when
compared to the Holmes -Rahe Scale
(MySkillsProfile.com, 2011).
The concept behind mindfulness is that the client can
explore the new, heightened sense of self in the present
moment and free from self and peer judgment (Godsey,
2013). Yoga is a form of mindfulness that allows clients to
explore the body free from judgment (Douglas, 2009).
Mindfulness has been used to reduce the severity of
anxiety and depression; two psychiatric conditions that are
strongly associated with EDs (Horowitz, 2009). This
suggests that mindfulness treatments may be beneficial to
patients who suffer from EDs.
In addition, Douglas (2009 & 2011) has researched the
benefits of yoga as a tool to help in the treatment of EDs.
While Douglas’s work supports the use of yoga as a
mindfulness treatment for clients with ED, she points out
that there is more research to be done in the field. There
still remains the question of what type of yoga is best, will
all clients with EDs benefit from yoga, and is there the
potential for yoga to cause more harm then benefit? These
questions that remain in the field of yoga as a co-treatment
for EDs, present the need for more research regarding
mindful-yoga practice as co-treatment for patients with
EDs. An article published as recently as 2013 exclaims
that there is a need for research in the field validating the
use of mindfulness approaches in the treatment of ED
patients (Godsey, 2013).
Yoga used as a mindfulness approach to EDs hold the
potential to offer an alternative form of treatment; a form of
treatment to be used in conjunction with other evidenced-
based treatments.
Academy for Eating Disorders. (2014). Fast facts on eating disorders. Retrieved from http://
www.aedweb.org/web/index.php/education/eating-disorder-information/eating-disorder-
information-14#6
Carei, T. R., Fyfe-Johnson, A. L., Breuner, C. C., & Brown, M. A. (2010). Randomized controlled
clinical trial of yoga in the treatment of eating disorders. Journal of Adolescent Health, 46, 346-
351. doi: 10.1016/j.jadohealth.2009.08.007
Dittmann, K. A., & Freedman M. R. (2009). Body awareness, eating attitudes, and spiritual beliefs
of women practicing yoga. Eating Disorders, 17, 273-292. doi: 10.1080/10640260902991111
Douglas, L. (2009). Yoga as an intervention in the treatment of eating disorders: Does it help?
Eating Disorders, 17, 126-139. doi: 10.1080/10640260802714555
Douglas, L. (2011). Thinking through the body: The conceptualization of yoga as therapy for
individuals with eating disorders. Eating Disorders, 19, 83-96.
doi:10.1080/10640266.2011.533607
Godsey, J. (2013). The role of mindfulness based interventions in the treatment of obesity and
eating disorders: An integrative review. Complementary Therapies in Medicine, 21, 430-439.
Horowitz, S. (2009). Treating eating disorders mindfully. Alternative and Complementary
Medicine,
15(1), 11-15. doi: 10.1089/act.2009.15101
Keel, P. K., & Forney, K. J. (2013). Psychosocial risk factors for eating disorders. International
Journal of Eating Disorders, 46(5), 433-439.
MySkillsProfile.com. (2011). Stress Assessment Questionnaire [User Manual]. Published
Instrument. Retrieved from
http://www.myskillsprofile.com/Guides/2009%20SAQ%20Professional%20Manual.pdf
Ocal. (2007). Stylized Yoga Person. Retrieved from http://www.clker.com/clipart-13333.html
Swanson, S.A., Crow, S.J., Le Grange, D., Swendsen, J., & Merikangas, K.R. 2011. Prevalence
and correlates of eating disorders in adolescents. Arch Gen Psychiatry, 68(7), 714-723. doi:
10.1001/archgenpsychiatry.2011.22
Literature Review
I plan to use this information to display the potential
benefits of yoga when used with patients who suffer from
eating disorders. I hope to submit the findings for
publication and intend to build on this research study in
the future. At the very least, I will submit my literature
review for publication as a thought piece.
(Ocal, 2007)