Low Distress Tolerance and Body Image Concerns May Keep People from Yoga Practice

Yoga research is often plagued by high rates of drop out and noncompliance with practice recommendations. To date we have little information as to why some individuals stick with regular yoga practice while others do not. A study recently published in Behavior Modification suggests that distress tolerance, or the ability to cope with negative and painful emotions, as well as body image concerns and body mass index (BMI) may be important factors in understanding why some avoid yoga and how we may better engage them.

Why Yoga Doesn’t Appeal to Everyone 

As anyone who has tried to recruit a friend to a yoga class will attest, it can sometimes be difficult for some individuals to develop or maintain an interest in yoga. While many factors including fear of injury, physical inflexibility and poor fit have been proposed, we still know very little about why some stick with the practice while others do not.

Yoga is not a one-size-fits-all endeavor. For some, postures can and do create physical discomfort and elicit negative emotions. For others, body image concerns can make participating in physical positions in a room filled with fit and flexible others stressful if not impossible. Many if not most Western yoga settings have little or no awareness of how these factors may be deterring interested practitioners from returning to the mat.

A group of researchers based at the University of Texas at Austin decided to investigate whether individual differences in distress tolerance, or the ability to tolerate emotional discomfort, body image and body mass index (BMI) might predict whether or not participants engage in regular hot yoga practice.

Study Examines Factors that Correlate with Steady Participation in Yoga Practice 

Participants included 27 adult women (mean = 31.52 years of age, SD = 5.47 years) who were assigned to a Bikram yoga intervention as part of a larger randomized controlled trial examining the effects of yoga on stress, cortisol reactivity and emotional eating. Women were selected if they reported high levels of perceived stress, dietary restraint and affective eating on or during an intake procedure.

Eight weeks of Bikram yoga classes were offered to the yoga group for 90-minutes twice per week at no cost to participants. Classes were conducted in a room heated to 104° F and included a standardized series of 26 postures, two breathing exercises and two periods of Savasana (rest/relaxation). Participants were encouraged to complete the class but cautioned to not push beyond their limits. Posture modifications were offered as needed.

Each woman’s participation in the yoga program was tracked using a self-report online survey as well as the yoga studio’s computer system. Individuals also completed a number of self-report surveys regarding distress tolerance (DT), perceived stress, body image and general health. Height and weight of each participant was measured at intake to establish a BMI value. Distress tolerance data were collected weekly to examine the relationship between DT and attendance.

More than 79% of yoga participants who completed the follow-up evaluation met or exceeded the required two classes per week. Of the 20 participants (74.1%) who completed the one-week post-yoga program assessment, average attendance ranged from .25 to 3.13 yoga classes per week (mean = 1.79, SD = 0.71).

Yoga Class Attendance, Distress Tolerance and Body Image are Related

Researchers discovered a direct relationship between levels of distress tolerance and yoga class participation. Women attended more classes during weeks in which they reported higher levels of distress tolerance regardless of age, reported stress or general health concerns.

The relationship between body image, BMI and distress tolerance also predicated class attendance. Those with higher body image concerns attended fewer classes overall. Also, overweight women with both low distress tolerance and body image concerns were less likely to attend Bikram yoga classes that typically include high temperature, mirrors and “revealing clothing.”

Similarly, obese women with poor body image were unlikely to attend classes. This was particularly the case even if they reported high levels of distress tolerance. This suggests that this form of yoga may not be suitable for overweight or obese women with body image concerns.

This is the first published study to address specifically how individual differences in distress tolerance, body image and BMI might impact a woman’s likelihood to adopt a Bikram yoga practice. Findings suggest that although greater distress tolerance may be linked with regular attendance, factors such as BMI and body image may serve to make this tradition of yoga inaccessible to overweight women.

Yoga in Western cultures has long been known to cater to the needs of the fit and flexible. Given what we know of its benefits for long-term physical and psychological health, it is essential that we create programs and contexts in which yoga instruction is delivered mindfully, and in which practices are offered in the service of the practitioner rather than the tradition or its aesthetic values.

Another thought provoking article brought to you by YogaUOnline and Julie Norman- Yoga for Stress Relief: Appreciating Your Body, Just as It Is.

B Grace Bullock, PhD, E-RYT 500 is a psychologist, research scientist, educator, yoga and mindfulness expert and author of Mindful Relationships: 7 Skills for Social Change. Her mission is to reduce stress, increase health and well-being and improve the quality of relationships. She offers classes, workshops, writing and research that combine the wisdom of applied neuroscience, psychophysiology, psychology and contemplative science and practice. Her goal is to empower individuals, groups, leaders and organizations to reduce chronic stress and increase awareness, attention, compassion, mindfulness and effective communication to strengthen relationships, release dysfunctional patterns and unlock new and healthy ways of being. Dr. Bullock is also the Founding Director and Principal Consultant of the International Science & Education Alliance, an organization devoted to exceptional research, program evaluation, assessment design, strategic planning and capacity building to support equity, programmatic diversity and scientific integrity, and promote effective leadership, decision-making and social change. Bullock is a Certified Viniyoga Therapist and Faculty at the Integrated Health Yoga Therapy (IHYT) Training program. She is the former Senior Research Scientist at the Mind & Life Institute and former Editor-in-Chief of the International Journal of Yoga Therapy. For more information see www.bgracebullock.com.


Baird, S. O., Hopkins, L.B., Medina, J.L., Rosenfield, D., Powers, M.B. & Smits, J.A.J. (2015).  Distress tolerance as a predictor of adherence to a yoga intervention: Moderating roles of BMI and body image. Behavior Modification, 1-19. DOI: 10.1177/0145445515612401

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