Eat Breathe Thrive: an interpretative phenomenological analysis of a yoga-based eating disorder intervention.

A growing body of evidence suggests that yoga-based interventions might aid in the prevention and treatment of eating disorders. The current qualitative study used Interpretative Phenomenological Analysis (IPA) to analyze the nature and degree of impact of a yoga and mindfulness-based eating disorder prevention intervention Eat Breath Thrive (EBT). Data was collected via semi-structured interviews with 16 participants over the age of 18 who took part in the EBT program between 2018 and 2022. Using IPA methodology, and after several rounds of coding, emergent themes were interpreted and organized to develop a theoretical model explaining the mechanism of change experienced and described by EBT participants. The resulting model outlines an experiential progression from psychoeducation and skill development/practice to increased mindful awareness, and empowered state experiences which led to the following outcomes: independent positive action, self-initiated positive state experiences, and increased embodied well-being. Participants reported increased self-compassion and self-acceptance, with decreased emphasis on disordered eating behaviors. Qualitative data is necessary for understanding why yoga works, from an experiential perspective. This study adds to the new, and rapidly expanding body of research supporting the positive effects of yoga and mindfulness on the prevention and treatment of eating disorders.

The Mindful Helping and Self-Care Model: Mindful Self-Care and Quality of Life Among a Racially Balanced Sample of Helping Professionals.

This study explored the Mindful Helping and Self-Care model and validated the Mindful Self-Care Scale (MSCS) among three racially balanced samples of helping professionals (n = 1,534). The study employed a cross-sectional, self-report design. The racial representation of participants was American Indian (n = 68), Asian (n = 351), African American (n = 384), Latino (n = 325), White (n = 301), and other (n = 114). The MSCS (33 items) showed good internal structure and measurement invariance to support generalizability across the three groups studied. With parsimony for application development, the Brief-MSCS (24 items) had a stronger internal structure across the three groups. Mindful self-care and secondary traumatic stress mediated the relationship between burnout and compassion satisfaction, as the total effects were greater than the direct effects. Mindful self-care practices were associated with reduced burnout risk. Mediation analysis results supported the Mindful Helping and Self-Care model. The empirical foundation for the 33-item MSCS and 24-item Brief-MSCS is further supported in this study. Both are excellent instruments for measuring mindful self-care factors in helping professionals using a behavioral frequency approach in a weekly time context. The Brief-MSCS is a more concise measure, making it particularly useful for application development. The reliability, construct, and concurrent validity of the MSCS and Brief-MSCS were confirmed. Mind-body practice is self-care; expressions vary by racial group and are associated with overall wellness. Future research should focus on professionals and cultures outside North America.

Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program.

Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.

Introduction to the special issue on yoga and positive embodiment: a note from the editors on how we got here.

Studying the practice of yoga and its relationship to body image, embodiment, and eating disorders brings together the professional and personal aspects of our lives as yoga practitioners, researchers, and women living in bodies within a society that can be tough on body appreciation. Developing this edition on "Yoga for positive embodiment in eating disorder prevention and treatment" has been a work of love for all of us. As yoga practitioners, we have personally experienced the benefits of yoga in our own bodies and felt that there may be benefits for others. As researchers, we are dedicated to the exploration and utilization of evidence-based practices to enhance well-being, promote a positive body image and sense of embodiment, and both prevent and treat eating disorders. Our experiences as yoga practitioners, in conjunction with our curiosity as researchers, led us to explore the extant evidence for yoga as a tool for leading to improvements in body image, disordered eating behaviors, and eating disorders, and to embark on our own research in this area to fill necessary gaps in our knowledge base. Our long-term dedication to the fields of body image and eating disorders, in conjunction with our emerging interest in yoga as a potential tool, led us to the compilation of this edition on yoga and positive embodiment.

Yoga and eating disorder prevention and treatment: A comprehensive review and meta-analysis.

Yoga is frequently used in conjunction with standard treatment approaches for eating disorders. However, yoga's efficacy and effectiveness in preventing and treating eating disorders has remained unclear. The aim of this comprehensive review and meta-analysis is to review the extant literature and assess the effects of yoga in the prevention and intervention of eating disorder symptoms and correlates in both clinical and non-clinical populations. Studies assessing yoga and its effect on eating disorder symptoms and/or body image as related to disordered eating, were eligible for inclusion. The comprehensive review details correlational, non-controlled, non-randomized controlled, and yoga comparison studies. For the meta-analysis, only randomized controlled trials comparing a yoga-based intervention to a non-yoga control group were included. In total, 43 studies are included in this review, with 11 trials involving 754 participants included in the meta-analysis. Results of the comprehensive review and meta-analyses results indicated yoga interventions demonstrated a small, significant effect on global eating disorder psychopathology, a moderate-to-large effect on binge eating and bulimia, and a small effect on body image concerns, as compared to the control conditions. There was no statistically significant effect on dietary restraint in either direction. Additionally, results indicated a small-to-moderate effect on a composite measure of eating disorder-related constructs. These findings suggest that yoga-based interventions may be an effective approach supporting the prevention and treatment of eating disorders.

Future directions for research on yoga and positive embodiment.

This article provides the concluding thoughts on the special issue, Yoga for Positive Embodiment in Eating Disorder Prevention and Treatment, which illustrate the progress being made on the relationship between yoga practice and the different indicators of positive embodiment that is relevant for the prevention and treatment of eating disorders. Based on the current body or work, we offer recommendations for the next steps for researchers for population-based, qualitative, and prevention and intervention research.

Eating disorders, embodiment, and yoga: a conceptual overview.

Yoga and its relation to embodiment and disordered eating has only recently received research attention. Nevertheless, early research indicates that yoga is an effective tool in the prevention and treatment of eating disorders. It is assumed that yoga ameliorates eating disorder symptoms and facilitates a shift from negative towards positive body image and well-being by cultivating positive embodiment (i.e., the ability to feel a sense of connection between mind and body). In order to provide the context of the constructs of disordered eating, embodiment, and yoga, this article presents a brief overview and conceptualization of these constructs. The three major eating disorders and current treatment methods are described. Further, the philosophical roots and theoretical models of embodiment are delineated and their communal core features are outlined. Lastly, the origin, basic principles, and modern interpretations of yoga are discussed.

Examining the effects of mindfulness-based yoga instruction on positive embodiment and affective responses.

Empirical evidence provides support for the inclusion of yoga as part of eating disorder prevention efforts through its positive impact on positive embodiment and experience of positive core affect. However, there is a need to identify the specific instructional strategies that will more consistently support positive embodiment and positive affect. We examined the effect of teaching a single yoga class using mindfulness-based instruction compared to appearance-based and neutral instruction alternatives on embodiment (i.e., state body surveillance, state body appreciation, pleasure during yoga) and changes in affect from before to after class. Female participants (N = 62; M age = 23.89, SD = 6.86) were randomly assigned to a yoga class that emphasized: being mindfully present in one's body, changing one's appearance, or just getting into yoga poses. ANOVAs revealed significantly higher body surveillance (ηp 2 =.10) and lower forecasted pleasure (ηp 2 =.21) in the appearance class compared to the other two classes. Participants in the mindfulness class experienced greater improvement in affect (ηp 2 =.08) from before to after class and higher remembered pleasure during the yoga class (ηp 2 =.19) compared to those in the appearance class. Emphasizing changes to appearance in yoga instruction may place participants at risk for less positive affect and less positive experiences of embodiment compared to mindfulness-based or even neutral yoga instruction.

Validation of the Mindful Self-Care Scale (MSCS) and development of the Brief-MSCS among hospice and healthcare professionals: a confirmatory factor analysis approach to validation.

OBJECTIVE: In the emotionally intense field of healthcare, the ability to peacefully inhabit one's body, maintain good boundaries, and be fully present during care is essential. This study aimed to validate the recently developed Mindful Self-Care Scale (MSCS) among hospice and healthcare professionals and develop a brief version of the 33-item MSCS. METHOD: A sample of hospice and healthcare professionals from all 50 states (n = 858) was used. A confirmatory factor analysis was run using a rigorous methodology for validation and item reduction to develop a brief version of the 33-item MSCS. The brief MSCS (B-MSCS) was developed by identifying items for exclusion through examination of conceptual overlap, descriptive statistics by detecting sources of improvement model fit using confirmatory factor analysis. Model modifications were done sequentially and with regard to theoretical considerations. RESULT: The existing model, 33-item MSCS with six subscales, had good fit to the data with all indicators in acceptable ranges (chi-square/df = 3.08, df (480), p < 0.01, root mean square error of approximation = 0.059, comparative fit index = 0.915, Tucker and Lewis's index of fit = 0.907). Nine items were excluded on the basis of very low loadings and conceptual and empirical overlap with other items. SIGNIFICANCE OF RESULTS: The final 24-item, B-MSCS model was consistent with the original conceptual model and had a closer fit to the data (chi-square/df = 1.85, df (215), p < 0.01, root mean square error of approximation = 0.041, comparative fit index = 0.961, Tucker and Lewis's index of fit = 0.955). In addition, the reliability, construct, and concurrent validity of the MSCS and B-MSCS were in the acceptable and good ranges, respectively. Mean and standard deviation of the MSCS and B-MSCS scores were similar; B-MSCS mean scores well approximated the MSCS scores. Informal mindful self-care, in the process of everyday life, was practiced more regularly and associated with increased wellness and reduced burnout risk than formal mind-body practices.

Secularity: Guiding Questions for Inclusive Yoga in Schools.

This commentary explores the legal and ethical obligations of yoga programs and teachers to uphold both the principles and the spirit of secularism when teaching yoga in schools. Arguing that secularity is essential both to comply with legal mandates and to maximize inclusivity and access, each facet of a secular approach to yoga in schools is explored through an inquiry-based model meant to help the reader gain clarity and make informed choices when developing school-based yoga programming. This article does not address the use of nonsecular yoga for children outside the school setting. It instead speaks to the complexities of topics such as spirituality, personal transformation, secular ethics, and the use of cultural and historical artifacts within school programs. While inviting continued reflection on the nuances of the topic, the article concludes that given both the legal imperatives and potential risk of exclusion, failure to offer school-based yoga using a secular approach threatens to undermine the success of the field and hinder access to practices that have positive effects on young people.

Trauma-informed yoga training in Kenya: A qualitative pilot study on feasibility and acceptability.

The current study presents a pilot qualitative exploration of the collaboration of two yoga service agencies in implementing a trauma-informed mindfulness-based teaching curriculum in Kenya, Africa. Yoga and mindfulness practices have been demonstrated as successful complementary and alternative approaches to managing the impacts of stress trauma. This study explores the feasibility and acceptability of mindfulness programming for yoga teachers in the Nairobi region of Kenya. Grounded theory is used to explore survey results. Outcomes demonstrate promise for both acceptability and feasibility. Curriculum tools were viewed as effective, and participants indicated intention to both utilize and share tools. Reflections on program effectiveness and impacts are addressed, as are potential considerations for improved program translation. Findings suggest the potential benefit for future collaborations, and also suggest best practices considerations for global implementation of embodied mindfulness programming.

The Africa Yoga Project and Well-Being: A Concept Map of Students' Perceptions.

BACKGROUND: Concept mapping methodology was used to explore the perceived impact of practicing yoga with the Africa Yoga Project (AYP)-an organisation created to increase health and well-being by providing community-based yoga classes throughout Kenya. AYP's mission fit with theoretical models of well-being is discussed. Anecdotal evidence and initial qualitative research suggested the AYP meaningfully impacted adult students. METHODS: Of the hundreds of AYP's adult students, 56 and 82 students participated in Phases I and II, respectively. Phase I brainstorming resulted in 94 student-generated statements about their perceived change. Phase II participants sorted and rated statements in terms of importance. Multidimensional scaling and hierarchical cluster analysis of sort data was utilised to map and group statements into clusters. RESULTS: Based on statistical and interpretive criteria, a five-cluster solution with the following concepts was identified as the best model of students' change: Personal Growth; Interpersonal Effectiveness (lowest importance); Physical and Social Benefits; Emotional Resiliency; and Improved Self-Concept (highest importance). CONCLUSIONS: Overall, students reported positive perceptions of the AYP. Additional research is needed to quantify students' change, and to compare the AYP outcomes to those of other programs aimed at poverty-related stress reduction and well-being.

Yoga Communities and Eating Disorders: Creating Safe Space for Positive Embodiment.

With adequate education and guidance, yoga communities, as part of the therapeutic landscape in the 21st century, can play a significant role promoting positive embodiment for those with, and at-risk for, eating disorders (EDs). To do this, yoga teachers need to know how to create a body-positive community and be able to recognize and respond to those at risk and struggling with EDs in their communities. In order to address yoga teaching methods associated with EDs and ED risk, broader conceptual approaches and specific practices associated with positive embodiment are offered. These include the broader conceptual approaches of: intentional inclusion and acceptance, experiential emphasis, supporting positive embodiment and inquiry. Studio pragmatics are also detailed as related to the body, breath, emotions, and community. Assessment, referral, and community engagement are also addressed.

Interpretive phenomenological analysis of a lawsuit contending that school-based yoga is religion: A study of school personnel.

This study focused on the perspectives of school personnel affiliated with the Encinitas Union School District in California following a lawsuit arguing that their yoga-based program included religion and therefore was unsuitable for implementation in public schools and was unconstitutional. Participants (N = 32) were interviewed using a semistructured interview, and data were analyzed according to Interpretative Phenomenological Analysis. Five super-ordinate themes (including sub-themes) were identified in an iterative process, including: participants' perspectives on the roots of yoga and the type of yoga taught in their district; the process of introducing a yoga-in-the-schools program in light of this contention (including challenges and obstacles, and how these were met); perspectives on the lawsuit and how the process unfolded; effects of the lawsuit on school climate and beyond; and perspectives on yoga as, and as not, religious. The study attempts to shed light on the impact of an ongoing lawsuit on a school district at the time of implementation of a program for students' well being.

A controlled trial of a yoga-based prevention program targeting eating disorder risk factors among middle school females.

This study investigates outcomes of a revised version of a yoga-based, eating disorder prevention program, targeting eating disorder risk factors, among fifth grade girls (i.e., Girls Growing in Wellness and Balance: Yoga and Life Skills to Empower [GGWB]). The program is designed to decrease eating disorder risk factors and bolster self-care and includes revisions not yet studied that extend the program to 14 weeks and enhance content addressing self-care. Efficacy was assessed using a controlled, repeated measures design. Results indicate that participation in the GGWB program significantly decreases drive for thinness and body dissatisfaction while significantly increasing self-care when compared to a control group. As expected, the program did not have significant effects on eating disordered behaviour likely due to low baseline rates among participants. Implications of findings as well as directions for future research on prevention are discussed.

The Africa Yoga Project: A Participant-Driven Concept Map of Kenyan Teachers' Reported Experiences.

OBJECTIVE: The Africa Yoga Project (AYP) trains and funds Kenyans to teach community yoga classes. Preliminary research with a small sample of AYP teachers suggested the program had a positive impact. This study used concept mapping to explore the experiences of a larger sample. METHODS: Participants brainstormed statements about how practicing and/or teaching yoga changed them. They sorted statements into self-defined piles and rated them in terms of perceived importance. Multidimensional scaling (MDS) of sort data calculated statement coordinates wherein each statement is placed in proximity to other statements as a function of how frequently statements are sorted together by participants. These results are then and mapped in a two-dimensional space. Hierarchical cluster analysis (HCA) of these data identified clusters (i.e., concepts) among statements. Cluster average importance ratings gave the concept map depth and indicated concept importance. Bridging analysis and researchers' conceptual understanding of yoga literature facilitated HCA interpretive decisions. RESULTS: Of 72 AYP teachers, 52 and 48 teachers participated in brainstorming and sorting/rating activities, respectively. Teachers brainstormed 93 statements about how they had changed. The resultant MDS statement map had adequate validity (stress value = .29). HCA created a 12-cluster solution with the following concepts of perceived change: Identity as a Yoga Teacher; Prosocial Development; Existential Possibility; Genuine Positive Regard; Value and Respect for Others (highest importance); Presence, Acceptance, and Competence; Service and Trust; Non-judgment and Emotion Regulation (lowest importance); Engagement and Connection; Interpersonal Effectiveness; Psychosocial Functioning; and Physical Competence and Security. CONCLUSIONS: Teachers perceived the AYP as facilitating change across physical, mental, and spiritual domains. Additional research is needed to quantify and compare this change to other health promotion program outcomes.

Incorporating positive body image into the treatment of eating disorders: A model for attunement and mindful self-care.

This article provides a model for understanding the role positive body image can play in the treatment of eating disorders and methods for guiding patients away from symptoms and toward flourishing. The Attuned Representational Model of Self (Cook-Cottone, 2006) and a conceptual model detailing flourishing in the context of body image and eating behavior (Cook-Cottone et al., 2013) are discussed. The flourishing inherent in positive body image comes hand-in-hand with two critical ways of being: (a) having healthy, embodied awareness of the internal and external aspects of self (i.e., attunement) and (b) engaging in mindful self-care. Attunement and mindful self-care thus are considered as potential targets of actionable therapeutic work in the cultivation of positive body image among those with disordered eating. For context, best-practices in eating disorder treatment are also reviewed. Limitations in current research are detailed and directions for future research are explicated.

The effects of yoga on eating disorder symptoms and correlates: a review.

BACKGROUND: Yoga is a popular adjunct therapy for eating disorders (EDs). A systematic review and synthesis of the yoga literature is needed to guide treatment recommendations and future research. This article provides a review of studies that used yoga for preventing and treating EDs. METHOD: Databases were searched for peer-reviewed articles about yoga practice and ED symptoms and correlates. RESULTS: Of the 14 articles reviewed, 40% used cross-sectional designs to examine risk and protective factors for EDs among yoga practitioners, and 60% used longitudinal designs to assess the effectiveness of yoga interventions for preventing and treating EDs. Yoga practitioners were reported to be at decreased risk for EDs, and ED risk and symptoms were reduced or unchanged after yoga interventions. CONCLUSIONS: Well-controlled studies are needed to understand whether the positive effects of yoga on ED symptoms and correlates are related to the type of yoga practiced, the amount/frequency of practice, and/or other variables.