Scientific research is central to our mission. Over the past decade, we’ve collaborated with researchers to conduct several large trials on the benefits of yoga in eating disorder prevention and treatment.
A multi-study research initiative is currently underway on the Eat Breathe Thrive intervention. Led by Dr. Catherine Cook Cottone — a leading researcher in the field of yoga and eating disorders — there have been five studies on the Eat Breathe Thrive program to date. The results of the first three studies have now been published, with more underway.
Research on Eat Breathe Thrive
We have worked with researchers to conduct five studies on three major populations:
adults with clinical eating disorders; adults with subclinical disordered eating and mental health challenges; young people at risk of eating disorders.
The results of the first three studies were published this year with outstanding results. Among other findings, researchers have found Eat Breathe Thrive reduces eating disorder symptoms, boosts protective factors, and helps to prevent relapse. Many results were sustained at six month follow-up.
Prevention
Studies have shown Eat Breathe Thrive can help prevent eating disorders in those at risk.
community
Studies have shown Eat Breathe Thrive can help those struggling with subclinical eating disorders.
treatment
Winter 2020 to Fall 2025
Studies are currently underway to assess Eat Breathe Thrive as a complementary treatment.
Study Overviews
Study One: Does Eat Breathe Thrive help people with subclinical eating disorder challenges?
published
This randomized controlled trial explored whether the Eat Breathe Thrive Seven-Week intervention reduces the risk of eating disorders in a community sample of adults experiencing subclinical disordered eating and body image challenges. Data was collected in eight cities throughout the United States and United Kingdom. Two hundred individuals were enrolled in the study. Each participant was randomly assigned to one of two groups: six-week course or waitlist control.
The study found that “compared to controls, Eat Breathe Thrive 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.”13
Study Two: Does Eat Breathe Thrive help prevent relapse from eating disorders?
data collection complete
This randomized controlled trial is currently underway. It explores whether the Eat Breathe Thrive Yoga for Eating Disorder Recovery intervention reduces eating disorder symptoms, improves mental health, and prevents relapse in a group of two-hundred women in recovery from eating disorders. Data was collected on a rolling basis for twelve months. Upon admission, clients were randomized into either the four-week course or waitlist control group. This study will assess how the program impacts eating disorder symptoms, depression, anxiety, and a host of protective factors (e.g. interoceptive awareness, emotion regulation, social connection). We are seeking evidence to demonstrate Eat Breathe Thrive can reduce the risk of relapse among those in active eating disorder recovery.
Study Three: Does eat breathe thrive prevent eating disorders among college athletes?
Published
This controlled trial explored whether the Eat Breathe Thrive Seven Week-Series can prevent eating disorders and boost protective factors among university athletes. Data was collected over two semesters at the University at Buffalo. To ensure adequate recruitment for the study, the Eat Breathe Thrive program was offered as an undergraduate course to Division I athletes at the university. The control group consisted of college athletes not enrolled in the program. This study found the Eat Breathe Thrive program improves body trust and interoceptive awareness in college athletes, a population in which eating disorders are especially common. While eating disorder symptoms were low in our sample at the outset, this study provides preliminary evidence Eat Breathe Thrive can help prevent eating disorders before they start.
Read the Study Here
Study Four: A qualitative research study on the Eat Breathe Thrive curriculum
Study PUblished
The purpose of the study was to learn more about how the Eat Breathe Thrive program helps people with eating disorders, to shed light on the mechanisms through which yoga works. Specifically, we sought to understand how the intervention affects participants' relationship to their body and emotions, as well as their relationship with self and others. This study interviewed graduates of Eat Breathe Thrive programs offered in the United States and United Kingdom. Researchers asked participants open-ended questions about their experience, including (1) which aspects of the program were most helpful, (2) emotional changes that took place during the course, and (3) changes in body image, eating behaviours, and social relationships. Results shed light on the ways in which yoga and peer connection supports recovery and boosts mental health.
Read the Study Here
Study Five: Is Eat Breathe Thrive a safe and effective complementary treatment in a residential eating disorder treatment setting?
On pause due to COVID-19
What types of outcomes were measured?
The what and how of assessment, which will help us to answer the research questions.
Researchers used a combination of population-specific and common measures in each study. This allowed us to make comparisons between each group, as well as amass evidence that the program works as both a complementary treatment and preventative intervention.
We are studying how Eat Breathe Thrive interventions impact the following:
▶ Eating Disorder Behaviors
▶ PTSD Symptomology
▶ Anxiety and Depression Symptoms
▶ Interoceptive Awareness
▶ Emotion Regulation
▶ Interpersonal Relationships
▶ Mindful Eating
▶ Body Appreciation
▶ Self Care Activities
▶ Treatment Compliance
▶ Loneliness and Isolation
▶ Distress Tolerance
▶ Time in Treatment
▶ Substance Use
▶ Relapse Rates
What is the Eat Breathe Thrive Intervention?
Yoga + Peer Support + Psychoeducation (+ other psychotherapy modalities)
Eat Breathe Thrive is a standardized intervention that combines yoga, peer support, psychoeducation, and a variety of different psychotherapy modalities. The core program consists of educational modules that combine these elements to help individuals build skills for mindful eating, emotional resilience, and positive embodiment. The intervention is delivered by trained yoga and mental health professionals who have completed the Eat Breathe Facilitator Training. There are currently two versions of the intervention. The intervention has been tested in schools, universities, treatment centers, hospitals, and community centers. It’s been delivered to adolescents and adults in fifty-two countries around the world.
Why yoga? And why research?
Yoga is the sixth most commonly used complementary health practice among adults.1 About 30 million people practice yoga worldwide, and nearly half of them (14 million, or 6.1% of the American population) report that yoga was initially recommended by a physician or therapist.2 Yoga has been shown to improve quality of life3; reduce stress4; lower heart rate and blood pressure5; help relieve anxiety, depression, and insomnia6; and improve overall physical health, strength, and flexibility.7
Despite the known benefits of yoga, health insurers and governmental healthcare systems do not cover therapeutic yoga classes. There is a good reason for this: yoga classes vary widely in their aims, quality, and delivery. Some classes are less suitable for individuals with mental illness than others; and some yoga practices can inadvertently exacerbate the symptoms of eating disorders if not delivered at the appropriate time in the recovery process. In order to secure funding from health insurers and national healthcare systems, substantial academic research must show yoga-based interventions can improve the outcome of eating disorders.
There is precedent for adoption of a complementary intervention by insurers and government agencies. Mindfulness-based Stress Reduction (MBSR) is one of the most widely available complementary programs in the world, thanks largely to research on its efficacy. Since its inception thirty-five years ago, more than 2,000 studies have been published on the program’s efficacy. The eight-week program has been shown to improve conditions such as anxiety, asthma, cancer, eczema, insomnia, post-traumatic stress.8 Today, insurance companies including Aetna, Cigna, and Blue Shield offer reimbursement for the program.
To date, only two randomized control trials have examined the efficacy of yoga for eating disorders. One examined how five days of therapeutic yoga classes before meals affect mood, and the other explored whether two months of weekly yoga classes improved eating disorder behaviors. Neither studied a systematized yoga program, and only one was done in a residential setting. While the results were promising, both studies were relatively small and had limited effect sizes.
References
1 Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistics Report #12. 2008.
2 Macy D (2008) Yoga journal releases 2008 “Yoga in America” market study. Yoga Journal. Available: https://www.yogajournal.com/press-releases/yoga-journal-releases-2012-yoga-in-america-market-study Accessed 20 February 2013.
3 Oken BS, Zajdel D, Kishiyama S, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Alternative Therapies in Health and Medicine. 2006;12(1):40–47.
4 Kiecolt-Glaser JK, Christian L, Preston H, et al. Stress, inflammation, and yoga practice. Psychosomatic Medicine. 2010;72(2):113–121.
5 Raub, JA. Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. The Journal of Alternative and Complementary Medicine. 2002;8(6):797–812.
6 Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. Journal of Alternative and Complementary Medicine. 2010;16(1):3–12.
7 Uebelacker LA, Epstein-Lubow G, Gaudiano BA, et al. Hatha yoga for depression: a critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. Journal of Psychiatric Practice. 2010; 16(1):22–33.
8 Paul Grossman, Ludger Niemann, Stefan Schmidt, Harald Walach, Mindfulness-based stress reduction and health benefits, Journal of Psychosomatic Research, Volume 57, Issue 1, 2004, Pages 35-43, ISSN 0022-3999, http://dx.doi.org/10.1016/S0022-3999(03)00573-7.
9 Carly R. Pacanowski, Lisa Diers, Ross D. Crosby & Dianne Neumark-Sztainer (2016): Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial, Eating Disorders, DOI: 10.1080/10640266.2016.1237810
10 Carei T. R., Fyfe-Johnson A. L., Breuner C. C., Brown M. A. Randomized controlled clinical trial of yoga in the treatment of eating disorders. Journal of Adolescent Health. 2010;46(4):346–351. doi: 10.1016/j.jadohealth.2009.08.007.
11 Sundgot-Borgen J., Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004 Jan;14(1):25-32.
12 Hudson JI, Hiripi E, Pope HG, Kessler RC. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological psychiatry. 2007;61(3):348-358. doi:10.1016/j.biopsych.2006.03.040.
13 Estey, E.E., Roff, C.D., Kozlowski, M.B., Rovigab, S., Guyker, W.M., & Cook-Cottone, C.P. (2022). Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program. Body Image, 42, 427-439. https://doi.org/10.1016/j.bodyim.2022.07.009.