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Yoga in the NHS: The role of yoga in Eating Disorders

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Every week we start class by opening up a selection of essential oils. We smell them, we notice what we’re drawn to, we discuss what they remind us of. We laugh over the fact that what one person loves, another person can’t stand. Sometimes we look up their emotional and physical properties in a book I bring in. Eventually we settle on one or two that we’re particularly drawn to. Right now, a festive blend of cinnamon, clove and wild orange is a group favorite. We take a few deep inhales of the oil or we place a few drops onto a cotton pad which the girls then keep by their side throughout their practice.

Some days there is a flurry of energy as the girls enter the space. If you were watching us through a window it could almost look like a familiar scene of a teenage sleepover. Some days the girls enter in silence, with a quieter, sometimes sad, more introspective mood. Our surroundings also echo this constant change…some days the corridor outside our practice room is busy and full of activity and noise and on other days it feels more peaceful, the light shines through the window in the most beautiful way and it’s possible to forget where we are.

Where we are is not in a beautiful modern yoga studio. We’re in an NHS hospital and the group I work with are adolescents that are in an intensive day treatment program for eating disorders. Here, I teach weekly yoga as part of a program designed to ‘tackle most known factors that contribute to ‘stuckness’ in recovery like a high level of anxiety, rigidity, inflexibility and perfectionism.’  The youngest child I work with is 11 years old, the oldest 18 and in the last 9 months I have had just one boy in my class.

This mirrors some of the statistics that we know about eating disorders. Beat, the UK’s eating disorder charity estimates that about 1.25 million people in the UK have an eating disorder. The National Institute of Health and Clinical Excellence estimates around 89% of sufferers are women and on average, anorexia first develops at around the age of 16 to 17. Anorexia has the highest mortality rate of any psychiatric disorder in adolescence.

The program offers a multidimensional approach including but not limited to, Cognitive Behavioural Therapy (CBT), family therapy and support, Art Psychotherapy and Mindfulness and Yoga. The latter may come as a surprise and yet yoga is valued as a central and respected part of the program offering.

As you can imagine, teaching and practicing yoga in a hospital comes with many challenges, however we are lucky enough to practice in the hospital chapel, a space that offers warm lighting, large windows and a reflective energy. Using the essential oils has become a wonderful tool to make the space feel like ours for the duration of our time together and it helps the girls settle and ‘arrive’.

There is a ton of information out there about yoga for eating disorders and there is even debate around whether or not yoga actually furthers or supports eating disorders in our western culture – my belief is that it absolutely has the potential to do so and I am continually refining the way that I teach to take this into account.

One of my intentions for the group is that I am trying to support their ability to self-regulate and develop self-awareness. An intention behind all of my work, not just for teens or those suffering with an eating disorder. So how do I do that? And how do we as teachers make yoga accessible and not another area in our student’s life which they strive to control.

When considering what would be most valuable to share with you, I have reflected on my approach and some of my learning’s having worked in this specialist clinical setting.

Of course language, room management, boundaries and a trauma sensitive approach are extremely important when working in a therapeutic setting but predominantly I am guided by one principle that I learnt whilst doing a years training in body psychotherapy. The principle is simply; to notice what the body wants to do and then to support the unfolding of this process. I experienced the power of working this way first-hand by working 1-2-1 weekly with my yoga teacher and body psychotherapist Kate Ellis. This approach revolutionised my own yoga practice, the way that I teach and it provides a framework for the way that I work in the NHS.

So what does this look like in reality? Firstly I am trying to facilitate a space whereby the girls enter into a “feeling state”. In other words they are beginning to gather their awareness and senses ‘in’ and notice how they feel. I have no attachment to what their practice looks like. Through the oils, a group check in and then a guided internal check in, very often the girls start to tune into what they need. By offering the invitation to explore being still or to move, by offering choice around what props they want to use, by stating that I don’t have any expectations around what their practice ‘looks like’, we start to create and develop a safe container to explore being in the body.

Out of 8 girls, I might have 2 that decide they want to fall asleep, 3 that are in different restorative positions and 3 that want to move and follow my gentle and intuitive guided practice. I encourage them to not stay anywhere they don’t want to be and remind them often that they can change their mind at any time. For most of their waking day, teenagers in general are being told what to do. Their own intuitive processing is often overridden by the demands of school, teachers and parents. An example of this is a teenager I worked with recently shared with me that she had severe period cramps at school and she was folded over her desk with her hand on her belly – an intuitive response to self-soothe and she was shouted at by a teacher to sit upright. This is happening all the time and sadly it often sets up a lot of conflict in the body and a pattern to override what we need. For me, given the many demands on the girls in their hospital life, our yoga practice is an opportunity for us to reconnect with their own body-wisdom. For me, this is advanced practice. Over a period of time, not only do the girls start to notice what feels good in their body, what feels helpful, what feels interesting, they also start develop the ability to get behind what they need and self-soothe in a healthy, compassionate way.

Through my language and my own embodiment I hope to put the body before the ‘pose’. Ultimately our work together is about deep listening and I think if we can experience this in the yoga classroom it has the possibility to travel with us into life off the mat.

Sadly, I think yoga practice can too often be rigid and another place to get things “right” or perform. I feel strongly that working with addition and mental health disorders means we need to rethink some of the classical approaches of ‘sequencing’ and instead be guided by our own embodied response and our students. Fundamentally we need to learn the skills to be guided by the individual and their physical and psychological needs.

Through working in this way with a small group size, it is possible for us as teachers to support an individual’s process within a group setting and my experience of practicing and teaching in this way is that is has profound therapeutic value. Through thank you letters and conversations with the girls, I am reminded often of the power of this practice and approach. I have witnessed girls that initially have wanted to use class as an opportunity to do ‘exercise’ and therefore lose weight, start to acknowledge their deep exhaustion and suddenly want to sleep. I have witnessed girls that could barely stay awake week-by-week, suddenly want to move. I have witnessed tears because something has been felt or acknowledged. I have witnessed girls that don’t want to speak suddenly have something to say. I have heard them articulate an experience of being in their bodies, if even for a moment, that feels safe and OK. It is in these moments that I truly believe (and know) yoga has the power to save lives.

My experience is that yoga within the NHS and in particular for those suffering with eating disorders has the capacity to support recovery and offer a line of support even when someone has finished their treatment program.

In light of my research and experience I realised that as a society and as yoga teachers, we have to do more in terms of preventative care. Last year I founded ‘the girlness project’ an initiative designed to support the mental and physical wellbeing of young girls and women. Through workshops, talks and classes we have served over 750 girls to date and our aim is to support girls develop a healthy relationship with body and self through reflective practice. To learn more about the project or to follow our journey, please visit our website and follow us on instagram @thegirlnessproject.

Etched into a plaque on the wall of the chapel are the words “towards the flowering of the lotus” – I look at them often and I think that this beautifully sums up yoga for me, a practice that can welcome and hold us in the muddiest of waters and yet has the potential to support our growth, our vulnerability and our blossoming.

The post Yoga in the NHS: The role of yoga in Eating Disorders appeared first on Yogamatters Blog.

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