From Mat to Meal to Healed: Using Yoga Therapy in the Treatment of Binge Eating Disorder
by Marissa Sappho, LCSW, BCD, CEDS
Every body tells a story, and when we are in the throes of an eating disorder, that story goes unheard. The process of Yoga Therapy helps a client determine what is going on in their body and in their life through postures, breath work, and guided meditation; in short, this form of yoga is a therapy session for your body and allows the individual the chance to tell their own recovery story.
During a session of the Body Image & Shame Resilience group I run, I asked the group members this question: What comes to mind when I say the word “exercise”? Every member of the group groaned and sighed with pained expressions, a reaction that I fully anticipated. As an eating disorder specialist and binge eating disorder expert, I know firsthand that for many people with eating disorders, exercise is a dirty word. For my clients with Binge Eating Disorder, the concept of “exercise” conjures feelings of ambivalence, passion, obsession, fear, shame, punishment, guilt, reward, pleasure/displeasure, obedience and rebellion. Many of my clients have storied histories to physical activity. Some have been overweight since childhood, (sometimes related to early on-set Binge Eating Disorder, and other times not), with well-meaning but misinformed parents who offered up sports teams, personal trainers, and gym memberships in order to help “get the weight under control.” Others enjoyed physical movement in balanced activities before the development of the eating disorder, at which point the relationship to their body and movement shifted. Others still, have complicated relationships to their body, which have inhibited engagement in movement in ways that are pleasurable. I consider physical movement to be a critical element in the process of recovering from Binge Eating Disorder – but probably not in the ways that you might assume.
At Aurora Behavioral Health Eating Disorder Treatment Center in New York City, our program is mindfulness and yoga-therapy based. Our clinical approach is rooted in yogic principles (the Yama’s and Niyama’s) that offer a template for ethical living. These principles include concepts of things to do and things not to do. The yama Ahimsa, means non-violence, which can be interpreted as being gentle and kind (and non-violent) to others in words and actions, as well as being non-violent with yourself. Clients with Binge Eating Disorder often commit acts of violence to themselves on a regular basis, through negative self-talk (“You’re disgusting, how could you eat that?” “You have no self-control!”), through isolation and separateness (avoiding social events and social connectedness), and behaviors (binge-eating, acts of self-punishment or self-harm). Learning the principles of the yamas and niyamas can provide an emotional structure to lean on during the recovery process when one is determining how to find their own balance. The next part of our yoga therapy program includes an asana practice (yoga postures), though probably not in the way that you are familiar with. There is a difference between gentle or restorative yoga that some call "therapeutic yoga" and the practice of yoga therapy. Our clinical staff is trained in the Phoenix Rising Yoga Therapy method which is distinctive in the following ways:
- Yoga Therapy is typically performed with eyes closed, though for certain clients it may be done with eyes open (this determination is made after a clinical assessment is performed in order to evaluate what will ensure emotional safety and growth for the client); this allows for concentration on an inner experience and helps reduce self-judgment about "doing it right" or negative forms of body-awareness
- Yoga Therapy is performed with posture assistance and touch (the decision to perform yoga therapy with touch is also made during the clinical assessment and always discussed with the client before any touch is applied)
- Yoga Therapy does not follow a particular series of asana postures, but rather postures may be introduced individually as a way to begin a dialogue with the body around emotional experiences
- Yoga Therapy may have moments of relaxation, but sometimes, just like in talk psychotherapy sessions, clients may leave the session feeling emotionally activated
During a binge-eating episode, you become disconnected from your physiological and emotional experience. These episodes often have a disassociated quality, perhaps an intense energy behind them, and serve as a way to numb out, disconnect and avoid painful emotional content. Essentially, binge-eating is the opposite of Yoga Therapy. In a binge episode we are tuned out instead of tuned in. We are disembodied instead of engaged in an embodied experience. Clients with Binge Eating Disorder experience intense emotion dysregulation. A flooding of feelings occurs, creating a state of overwhelm. Sadness, panic, anxiety, anger, loneliness, guilt, shame, course through you, feeding into destructive thought patterns and behaviors. Yoga Therapy is the opposite practice. It requires one to be both in and with an experience, rather than a distant or passive watcher. In Yoga Therapy, through attentive mindful engagement of your mind and body, you will change the script so that you are having your feelings, instead of your feelings having you. In ancient sanskrit we would say, Yoga chitta vritti nirodhah, which means, Yoga is the quieting of the fluctuations of the mind. For many of my clients when I ask them the question "What were you feeling before or during a binge eating episode?" it is hard to find the words. Being in touch with feelings and naming them is an important step in understanding binge-eating episodes and preventing them. Yoga Therapy provides the opportunity to put language to sensations, locating the feelings within the experience and in the body.
In Binge Eating Disorder, people tend to disconnect from and ignore important bodily cues. Hunger, fullness and satiety all become dysregulated and are attended to in an imbalanced way. Hunger can be misinterpreted or may be ignored until a sensation of starvation occurs. Feelings of fullness are overridden in an attempt to chase something that won't be found. The body's natural satiety cues are often missed or never felt at all. Other physical needs may also go ignored, including bladder and bowel signals, experiences of pain or injury, sexual desires, and for biological women, menstruation. The practice of Yoga Therapy requires one to connect with their body and begin to listen to what it wants and needs to communicate to us. Yoga Therapy can be the first step toward trusting your body. This level of internal attunement is important to help restore balance in ones’ relationship to food. Mindful, intuitive, integrated eating practices, are the path and structure toward wellness with food. In order to develop a mindful eating practice, one needs to be able to connect to emotional and physiological signals within oneself; Yoga Therapy helps lay the foundation for this.
In Yoga Therapy, between the poles of what is comfortable, safe, familiar and easy and the opposite space of violating the body by requiring too much of it, pushing too hard, or not listening to cues, exists a middle space we refer to as "edge." In Yoga Therapy a person is supported to find their edge. This is the space of "just right". A place that is neither too little, nor too much. Here in this space, clients become connected to limits and boundaries. The Yoga Therapist helps a client push past the safe, familiar, easy space to take a few steps just beyond where someone thinks they can go or wants to go, while maintaining emotional and physical safety; the stretch just before your limit is the place where edge lives. In the recovery process, we are constantly required to stretch ourselves a little further than we think we are capable of doing, and we experience the most success in this kind of growth when we are given the right supports, both on and off the mat. Awareness and exploration of limits and boundaries around your own edges that are explored in a Yoga Therapy session extend beyond the yoga room and facilitate growth at the dining table, and in ones relationships.
People with Binge Eating Disorder are often plagued by a harsh critical voice that attacks the essence of the self. In Yoga Therapy, we practice sitting with what is, without sitting in judgement. We practice being in an experience without protesting it, trying to fix it, or change it. In these moments, you are building "emotional muscle" to help tolerate painful experiences and feelings, and challenge destructive thought patterns. Acceptance of what is, represents a non-judgmental mindful experience. This can be applied to our experience of our body as we work from feelings of body-shame, to feelings of body-acceptance, to feelings of body love & gratitude. Acceptance of what is, may also be practiced in other ways off the mat, including when one experiences a "bad food moment" such as guilt or shame over a food choice, or after a binge-eating episode. Practicing a stance of acceptance of what is, can allow us to move on from these moments rather than staying with them and berating ourselves.
Yoga Therapy offers clients a chance to engage with their body from a place of love and care, allowing for movement of the body that is centered on respect and understanding of bodily needs, strengths, and limitations. When my group members heard the word exercise, they linked it to their eating disorder, and to a society that tells us exercise is a means to become thin. In their minds, exercise is something that is required in order to be viewed as good, and healthy, and valued. It was experienced as something one can fail at. It was often thought of as something to be done in order to prevent weight gain, or to support weight loss (i.e. as a "calorie burner"). It brought up feelings of shame and humiliation: for not wanting to do it, for not being able to do it, for not being "good enough" at it, for not physically "looking" the "right" way while doing it, and for not doing it often enough. When we introduce the recommendation for Yoga Therapy, some clients balk, as their experience with traditional yoga has been one of intimidation -- "No way! I hate yoga! I do not want to put on yoga pants, I look disgusting!," "I went to yoga once at my gym and it was a bunch of skinny people and my body couldn't do the same things and I felt embarrassed and like a failure."
At Aurora, we work to re-frame a client’s ideas about exercise, preferring to use the term movement, or mindful movement. Yoga Therapy offers an opportunity to engage in physical movement of the body that is focused on having a conversation with your body, participating in movement out of an act of self-love, rather than an act of self-hate. Yoga Therapy extends the work of traditional talk therapy, helping to develop a mind-body connection, allowing for the creation of space to think about one’s own self. It is here that we can continue the important work of unraveling and understanding the clients experience and their true, deep-rooted feelings in order to resolve them. Painful feelings, thoughts and memories which may be too difficult for the conscious mind to access and process, become accessible and digestible when a mind-body connection is made.