Effectiveness of Hatha Yoga and From Feeling to Seeing the Body (FSB) in Female Adolescents and Young Adults With Eating Disorders.

A Randomized Control Pilot Study With a Parallel Group Design, on the Effectiveness of Hatha Yoga and From Feeling to Seeing the Body - Embodied Experience Intervention for Body Image (FSB) in the Treatment of Body Image in Female Adolescents and Young Adults With Eating Disorder.

The goal of this clinical trial is to investigate the effectiveness of two types of intervention (Hatha Yoga and FSB From Feeling to Seeing the Body - Embodied Experience Intervention for body image) on eating behaviour and body dissatisfaction in females aged 16-25 with eating disorders. The main questions the study aims to answer are:

• Do Hatha Yoga and FSB Intervention have an impact on eating behavior and reductions in body dissatisfaction?
• How do Hatha Yoga and FSB Intervention influence underlying mechanisms such as embodiment, interoceptive awareness, body and functionality appreciation, mindfulness and self-compassion? Researchers will compare the outcomes with a control group that will receive only standard treatment to determine whether the specific Hatha Yoga and FSB interventions have an impact on body dissatisfaction and eating behaviors.

Participants will be divided into three groups:

• Control Group (C): patients will continue with treatment as usual (TAU) which consists of periodic psychiatric, psychotherapeutic, nutritional and dietetic visits.
• Hatha Yoga Group (Y): patients will continue TAU and will additionally attend one weekly Hatha Yoga session.
• From Feeling to Seeing the Body Group (FSB): patients will continue TAU and will additionally attend one weekly FSB session.

Study Overview

• Status: Completed
• Conditions: Anorexia Nervosa; Bulimia Nervosa; Body Image; Eating Disorders
• Intervention / Treatment: Behavioral: Hatha Yoga Group (Y); Behavioral: From Feeling to Seeing the Body Group (FSB); Behavioral: Control Group (C)

Detailed Description

Background: Eating Disorders (EDs) are characterized by significant disturbances in eating behaviors and body image, where the body itself becomes a primary medium for the expression of psychological distress. Body image plays a crucial role in both the development and maintenance of EDs. Historically, research has focused on negative body image, with substantial evidence linking body image distortion to long-term outcomes in anorexia nervosa, both during adolescence and adulthood. However, recent research has shifted towards exploring the multidimensional construct of Positive Body Image (PBI) and the integration of body-focused interventions into standard therapeutic protocols. The Embodied Self Model provides a comprehensive framework that supports self-esteem, positive body image, and intuitive eating as protective factors against EDs and related symptoms. According to this model, the core of ED symptoms lies in the relationship an individual has with their own body. This relationship is reflected in how the body is experienced, nurtured, cared for, and accepted-collectively referred to as embodiment. The model offers strategies to reconnect individuals with themselves through the development of Body Appreciation, Body Functionality, Body Image Flexibility, Mindful Attunement, and Self-Compassion. Recent studies have evaluated the effectiveness of embodiment-based interventions, such as yoga, demonstrating their utility in treating EDs and improving positive embodiment outcomes. In this context, an intervention called From Feeling to Seeing the Body (FSB) was developed, which aims to enhance body awareness through sensory, motor, cognitive, and emotional experiences.

Endpoints: The primary aim of this study is to demonstrate that embodiment interventions can improve body image and eating behaviors in patients with Eating Disorders. Primary Endpoint: 1. Dysfunctional eating behaviors and body dissatisfaction, measured by the Thinness Drive, Bulimia, and Body Dissatisfaction subscales of the Eating Disorder Inventory-3 (EDI-3). Each subscale will be scored and reported independently, collected at four time points (T0, T1, T2, and T3). Secondary Endpoint: 2. Embodiment, measured by the Experience of Embodiment Scale (EES), collected at four time points (T0, T1, T2, and T3). Other Endpoints: 3. Interoceptive awareness, measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA). 4. Body appreciation, measured by the Body Appreciation Scale-2 (BAS-2). 5. Functionality appreciation, measured by the Functionality Appreciation Scale (FAS). 6. Mindfulness, measured by the Five Facet Mindfulness Questionnaire (FFMQ). 7. Self-compassion, measured by the Self-Compassion Scale (SCS). 8. Body image perception and representation, measured by the "Mi Disegno" body drawing task. Analysis Method: Each instrument will be scored and reported independently. Endpoints 3-7 will be collected at four time points (T0, T1, T2, and T3); endpoint 8 will be collected at T0 and T3 only.

Methods: This study will involve 54 patients from the Provincial Center for Eating Disorders of Treviso (AULSS2), who are receiving outpatient care and meet the inclusion criteria. Patients will be randomly assigned to one of the following three groups: Control (C), Yoga (Y), and FSB (From Feeling to Seeing the Body).

Procedures: Screening Phase: Eligibility for participation will be assessed based on the inclusion/exclusion criteria before enrollment. Enrollment Procedure: Eligible patients will be invited to participate in the study, and informed consent will be provided. Intervention Assignment: Participants will be randomly assigned to one of the three groups (C, Y, FSB) using a Research Randomizer. Intervention: Each group will participate in an identical number of sessions, with the same structure maintained across all groups.

Data Collection: Self-report questionnaires will be administered at four time points: T0 (pre-treatment), T1 (post-treatment), T2 (one month post-treatment), and T3 (three months post-treatment). Self-Report Questionnaires: The following validated self-report questionnaires will be used to measure the key variables: Negative Body Image and Eating Behaviors: Subscales of Thinness Drive, Bulimia, and Body Dissatisfaction from the Eating Disorder Inventory-3 (EDI-3). Embodiment: Experience of Embodiment Scale (EES). Interoceptive Awareness: Multidimensional Assessment of Interoceptive Awareness (MAIA). Body Appreciation: Body Appreciation Scale-2 (BAS-2). Functionality Appreciation: Functionality Appreciation Scale (FAS). Mindfulness: Five Facet Mindfulness Questionnaire (FFMQ). Self-Compassion: Self-Compassion Scale (SCS). Body Image: "Mi Disegno".

• Study Type: Interventional
• Enrollment (Actual): 54
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Italy
  • Treviso, Italy, 31100
    • Centro Provinciale per i Disturbi dell'Alimentazione

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Outpatients receiving treatment at the CPD DNA (Centro Provinciale per i Disturbi della Nutrizione e dell'Alimentazione) in Treviso;
• Diagnosis of Anorexia Nervosa (AN) and/or Bulimia Nervosa (BN);
• Body mass index (BMI) ≥ 17 kg/m²;
• Clinically stable condition during the previous month (i.e., stable weight and no worsening of clinical symptomatology);
• No planned hospital admissions or discharges within the 3 months following enrollment.

Exclusion Criteria:

• Sudden worsening of clinical condition;
• Transition during the treatment phase to a higher level of care (i.e., partial hospitalization, residential treatment, or inpatient admission);
• Irregular attendance (i.e., participation in less than 80% of the total scheduled sessions);
• Discharge during the treatment phase;
• Pregnancy: pregnant women will be excluded, as pregnancy is associated with physiological changes in weight and body shape and may exacerbate body dissatisfaction during the pre- and postpartum periods. Therefore, the exclusion of pregnant women is consistent with the study objectives;
• Previous continuous yoga practice (i.e., for more than 6 months).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hatha Yoga Group (Y); Patients will continue Treatment as Usual (TAU) and will additionally attend one weekly Hatha Yoga session.	Behavioral: Hatha Yoga Group (Y); Hatha Yoga is an ancient Indian discipline aimed at promoting psychophysical well-being through the integration of bodily movement, regulated breathing, and cultivated awareness across different forms of practice. It is suitable for individuals of all ages, levels of physical fitness, and prior experience. Hatha Yoga encompasses a broad range of postures (Asana) and breathing techniques (Pranayama), which can be adapted to various clinical conditions. Each session will follow a standardized structure: 5 minutes of mindfulness practice and mantra recitation; 25 minutes of Asana practice; 10 minutes of Pranayama; 18 minutes of Yoga Nidra; and 2 minutes of concluding mantra recitation. Throughout the intervention period, different practices will be introduced progressively, in accordance with participants' increasing familiarity with yoga. For research purposes, the sessions delivered to the two groups will be identical.
Experimental: From Feeling to Seeing the Body Group (FSB); Patients will continue Treatment As Usual and will additionally attend one weekly FSB session.	Behavioral: From Feeling to Seeing the Body Group (FSB); Thirteen weekly 60-minute sessions will be conducted. The first session will be delivered individually, and the subsequent sessions will take place in pairs. One introductory session focused on the concept of body image and the experiential implementation of the silhouette task (body figure drawing). FEELING - The initial sessions involve predominantly passive experiences (e.g., massage with balls and fabrics), whereas the subsequent sessions focus on active experiential practices (e.g., movement with fabrics, exploration of muscle tone, and movement under blindfolded conditions). SEEING - The second phase of the intervention involves the gradual experiential exploration of one's body image, beginning with shadow-based activities and distorted mirrors, and culminating in structured mirror exposure.
Active Comparator: Control Group (C); Patients will continue with treatment as usual (TAU) which consists of periodic psychiatric, psychotherapeutic, nutritional and dietetic visits.	Behavioral: Control Group (C); The integrated multidisciplinary standard intervention, SSCM (Specialist Supportive Clinical Management), includes periodic psychiatric, psychotherapeutic, nutritional, and dietetic consultations. Specialist Supportive Clinical Management (SSCM) combines clinical management and supportive psychotherapy within individual sessions, primarily focusing on the normalization of eating behaviors and weight restoration. It provides specialized psychoeducation regarding the core features of eating disorders and addresses additional personal difficulties identified by the patient. Treatment as usual (TAU), which is also provided to participants in the other two intervention groups (Y and FSB), consists of periodic individualized sessions tailored to the patient's clinical needs. Each patient will have access to outpatient specialist consultations with the following professionals: Psychiatrist, Medical nutritionist, Psychologist-psychotherapist, Dietitian.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body Dissatisfaction and Dysfunctional Eating Behaviors as Measured by the Eating Disorder Inventory-3 (EDI-3)	Change from baseline in dysfunctional eating behaviors and body dissatisfaction, measured by three subscales of the Eating Disorder Inventory-3 (EDI-3): Drive for Thinness (7 items, range 0-28), Bulimia (8 items, range 0-32), and Body Dissatisfaction (9 items, range 0-36). Each subscale is scored and reported independently. Higher scores indicate greater symptom severity. Scores are compared across the Hatha Yoga (Y), From Feeling to Seeing the Body (FSB), and Control (C) groups.	Baseline (T0), Week 13 (T1, post-treatment), Week 17 (T2, 1-month follow-up), Week 26 (T3, 3-month follow-up).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Embodiment as Measured by the Experience of Embodiment Scale (EES)	Change from baseline in embodiment, measured by the Experience of Embodiment Scale (EES; 34 items, range 34-170). Higher scores indicate a more positive experience of embodiment. Scores are compared across the Hatha Yoga (Y), From Feeling to Seeing the Body (FSB), and Control (C) groups.	Baseline (T0), Week 13 (T1, post-treatment), Week 17 (T2, 1-month follow-up), Week 26 (T3, 3-month follow-up).

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Interoceptive Awareness as Measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA)	Change from baseline in interoceptive awareness, measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA; 37 items across 8 subscales, each scored 0-5). Higher scores indicate greater adaptive interoceptive awareness. Subscales are scored and reported independently. Scores are compared across the Hatha Yoga (Y), From Feeling to Seeing the Body (FSB), and Control (C) groups.	Baseline (T0), Week 13 (T1, post-treatment), Week 17 (T2, 1-month follow-up), Week 26 (T3, 3-month follow-up).
Body Appreciation as Measured by the Body Appreciation Scale-2 (BAS-2)	Change from baseline in body appreciation, measured by the Body Appreciation Scale-2 (BAS-2; 10 items, range 1-5, mean score). Higher scores indicate greater body appreciation. Scores are compared across the Hatha Yoga (Y), From Feeling to Seeing the Body (FSB) and Control (C) groups.	Baseline (T0), Week 13 (T1, post-treatment), Week 17 (T2, 1-month follow-up), Week 26 (T3, 3-month follow-up).
Functionality Appreciation as Measured by the Functionality Appreciation Scale (FAS)	Change from baseline in functionality appreciation, measured by the Functionality Appreciation Scale (FAS; 7 items, range 0-28). Higher scores indicate greater appreciation of body functionality. Scores are compared across the Hatha Yoga (Y), From Feeling to Seeing the Body (FSB), and Control (C) groups.	Baseline (T0), Week 13 (T1, post-treatment), Week 17 (T2, 1-month follow-up), Week 26 (T3, 3-month follow-up).
Mindfulness as Measured by the Five Facet Mindfulness Questionnaire (FFMQ)	Change from baseline in mindfulness, measured by the Five Facet Mindfulness Questionnaire (FFMQ; 39 items across 5 subscales, range 39-195). Higher scores indicate greater dispositional mindfulness. Subscales are scored and reported independently. Scores are compared across the Hatha Yoga (Y), From Feeling to Seeing the Body (FSB), and Control (C) groups.	Baseline (T0), Week 13 (T1, post-treatment), Week 17 (T2, 1-month follow-up), Week 26 (T3, 3-month follow-up).
Self-Compassion as Measured by the Self-Compassion Scale (SCS)	Change from baseline in self-compassion, measured by the Self-Compassion Scale (SCS; 26 items across 6 subscales, range 26-130). Higher scores indicate greater self-compassion. Subscales are scored and reported independently. Scores are compared across the Hatha Yoga (Y), From Feeling to Seeing the Body (FSB), and Control (C) groups.	Baseline (T0), Week 13 (T1, post-treatment), Week 17 (T2, 1-month follow-up), Week 26 (T3, 3-month follow-up).
Body Image Perception and Representation as Measured by the "Mi Disegno" Body Drawing Task	Change from baseline in body image perception and representation, measured by the "Mi Disegno" body drawing task (Confalonieri, 2011; total score range 0-27, across three domains: Formal Level, Details, and Sexual Characterization, each scored 0-9). Higher scores indicate a more accurate and articulated body representation. Scores are compared across the Hatha Yoga (Y), From Feeling to Seeing the Body (FSB), and Control (C) groups.	Baseline (T0) and Week 26 (T3, 3-month follow-up).

Collaborators and Investigators

• Sponsor: Azienda Ulss 2 Marca Trevigiana
• Investigators: Principal Investigator: Chiara Fuligno, TNPEE, Azienda ULSS 2 Marca Trevigiana

Publications and helpful links

General Publications

• Cook-Cottone CP. Incorporating positive body image into the treatment of eating disorders: A model for attunement and mindful self-care. Body Image. 2015 Jun;14:158-67. doi: 10.1016/j.bodyim.2015.03.004. Epub 2015 Apr 15.
• Torres S, Vieira AI, Vieira FM, Miller KM, Guerra MP, Lencastre L, Reis AC, Timoteo S, Nunes P, Barbosa MR. A Comprehensive Study of Positive Body Image as a Predictor of Psychological Well-Being in Anorexia Nervosa. Nutrients. 2024 Jun 6;16(11):1787. doi: 10.3390/nu16111787.
• Tylka Tracy L. , Piran Niva , Handbook of Positive Body Image and Embodiment. Construct, Protective Factors and Interventions. Oxford University Press (2019).
• Tylka, T.L.; Wood-Barcalow, N.L. What is and what is not positive body image? Conceptual foundations and construct definition. Body Image 2015, 14, 118-129.
• Pavani F, Galfano G. Self-attributed body-shadows modulate tactile attention. Cognition. 2007 Jul;104(1):73-88. doi: 10.1016/j.cognition.2006.05.007. Epub 2006 Jul 12.
• O'Brien J, Evans S, McIver S, O'Shea M. A scoping review of integrated yoga and psychological approaches for the treatment of eating disorders. J Eat Disord. 2023 Sep 8;11(1):152. doi: 10.1186/s40337-023-00845-5.
• Korsak, Emilia. (2022). Body-oriented therapy in the prevention of eating disorders. A systematic review. Przegląd Psychologiczny. 65. 177-195.
• Cox AE, Tylka TL. A conceptual model describing mechanisms for how yoga practice may support positive embodiment. Eat Disord. 2020 Jul-Aug;28(4):376-399. doi: 10.1080/10640266.2020.1740911. Epub 2020 Mar 22.
• Cook-Cottone, C. (2006), The attuned representation model for the primary prevention of eating disorders: An overview for school psychologists. Psychol. Schs., 43: 223-230.
• Cerea S, Iannattone S, Mancin P, Bottesi G, Marchetti I. Eating disorder symptom dimensions and protective factors: A structural network analysis study. Appetite. 2024 Jun 1;197:107326. doi: 10.1016/j.appet.2024.107326. Epub 2024 Mar 27.
• Alleva JM, Tylka TL. Body functionality: A review of the literature. Body Image. 2021 Mar;36:149-171. doi: 10.1016/j.bodyim.2020.11.006. Epub 2020 Dec 13.

Study record dates

Study Major Dates

• Study Start (Actual): March 10, 2025
• Primary Completion (Actual): October 1, 2025
• Study Completion (Actual): January 27, 2026

Study Registration Dates

• First Submitted: March 17, 2026
• First Submitted That Met QC Criteria: April 1, 2026
• First Posted (Actual): April 6, 2026

Study Record Updates

• Last Update Posted (Actual): April 6, 2026
• Last Update Submitted That Met QC Criteria: April 1, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: yoga; eating disorders; anorexia; body image; mirror; embodiment; bulimia; body; body functionality; body appreciation; From Feeling to Seeing the Body (FSB)
• Additional Relevant MeSH Terms: Mental Disorders; Hyperphagia; Signs and Symptoms, Digestive; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Bulimia; Feeding and Eating Disorders; Anorexia; Anorexia Nervosa; Bulimia Nervosa; Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Control Groups
• Other Study ID Numbers: 2024-129 (ID studio CET)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: A data sharing plan will be developed by the research team after the publication of the first manuscript.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No