Table 3.

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

Author	Interventions	Study aim	Participants	Study design	Measures	Outcome	Limitations	Quality	Theoretical framework
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