Yoga as adjunctive therapy in the treatment of people with anorexia nervosa: a Delphi study

Abstract

Background There is preliminary evidence to suggest that yoga can be beneficial in reducing anxiety, depression and general eating disorder symptoms in people with Anorexia Nervosa (AN). It is unclear whether the therapeutic benefits of yoga are supported or utilised in the treatment of AN amongst clinical experts. The present study aimed to explore and synthesise expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with AN. Methods A Delphi methodology was employed, with clinicians considered experts in the treatment of AN recruited internationally to form the panel (n = 18). The first iteration of questionnaires comprised of four open-ended questions concerning the experts’ understanding of the term yoga and opinions on its’ use in therapy generally and more specifically in the treatment of AN. Using content analysis, statements were derived from this data and included as Likert-based items in two subsequent rounds where panellists rated their level of agreement on each item. Seventeen out of 18 respondents completed all three iterations. Results Consensus (level of agreement defined at ≥ 85%) was achieved for 36.47% of the items included in the second and third rounds. The panel reached consensus on items defining yoga and pertaining to its’ general benefits. The panel agreed that yoga is a adjunct therapy for various problems, consensus was not achieved on the specific use of yoga as an adjunct therapy in the treatment of comorbid anxiety, depression or trauma in patients with AN. Although the expert panel acknowledged a number of benefits for use of yoga in AN, they strongly endorsed that future research should evaluate the potential risks of using yoga as an embodied practice. Conclusions It is possible that yoga could be considered for inclusion in future guidelines if supported by empirical research. We conclude that there seems to be enough consensus that such further scientific investigation is warranted. Plain English summary This study aimed to explore expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with Anorexia Nervosa (AN). Clinicians considered experts in the treatment of AN recruited internationally to form the panel (n = 18). Experts were asked about their understanding of the term yoga and their opinions on its’ use in therapy. The panel reached consensus on items defining yoga and pertaining to its’ general benefits. Although the panel agreed that yoga is a nice additional therapy for various problems, consensus was not achieved on the use of yoga as an additional therapy in the treatment of specific problems like anxiety, depression or trauma in people with AN. The expert panel acknowledged a number of benefits for use of yoga in AN. However the panel strongly considered that future research should evaluate the potential risks of using yoga as an embodied practice. The areas of collective agreement gained in the study can serve as preliminary guidelines for the use of yoga in AN whilst guiding future research directions.

How to address physical activity and exercise during treatment from eating disorders: a scoping review

“…Two studies explored the opinions of therapists on PAE during treatment of EDs [ 57 , 58 ▪ ]. One Delphi study on therapists’ opinion on the effect of yoga as an adjunctive therapy on comorbid disorders in ED did not reach consensus, as there is limited documentation and controlled studies on this aspect [ 57 ].…”

“…Two studies explored the opinions of therapists on PAE during treatment of EDs [ 57 , 58 ▪ ]. One Delphi study on therapists’ opinion on the effect of yoga as an adjunctive therapy on comorbid disorders in ED did not reach consensus, as there is limited documentation and controlled studies on this aspect [ 57 ]. However, interviews with accredited exercise physiologists (AEP) on their experiences working in clinics with EDs, showed that AEPs had similar perspectives to that of patients [ 58 ▪ ].…”

Anorexia nervosa through the lens of a severe and enduring experience: ‘lost in a big world’

“…Likewise, the somatic and dissociative aspects described in this study may lend to adaptations to clinical practice which include ‘body process’ or bottom-up therapeutic approaches [ 125 , 139 – 141 ]. The acceptability and efficacy of this is unknown for SE-AN and care would need to be taken to respecting difficulties people with SE-AN may have in connecting to their bodies, felt sense of self (interoception) and emotions [ 125 ].…”

Testing the causal relationships of physical activity and sedentary behaviour with mental health and substance use disorders: a Mendelian randomisation study

“…Furthermore, more research is needed to clearly disentangle the effects of specific types and intensity levels of physical activity on different mental health and substance use disorders. For instance, a rapidly growing body of research indicates that body-mind activities (e.g., yoga) and low intensity activities (e.g., walking) have positive effects on various mental health disorders [ 58 – 60 ]. Correspondingly, the results presented here suggest that sedentary and light physical activities could be particularly beneficial for certain disorders, such as anorexia and schizophrenia.…”