The Bonny Method of Guided Imagery and Music as a trauma-informed approach in eating disorder treatment: theoretical framework and case illustrations

BACKGROUND: Eating disorders (EDs) are severe and complex mental health conditions with high mortality, significant psychiatric comorbidity, and increasing global prevalence. ED behaviours (e.g., restriction, bingeing, purging) may function as adaptive strategies for affect regulation, management of trauma-related distress, and avoidance of embodied experience. While trauma-informed care emphasises safety, empowerment, and relational attunement, trauma in EDs is often held somatically and may remain inaccessible through verbal therapies alone. The Bonny Method of Guided Imagery and Music (GIM), an experiential depth-oriented music psychotherapy, uses therapist-selected programmed music to evoke imagery, emotion, memory, and embodied processes within a supportive therapeutic relationship. This paper explores GIM as a trauma-informed approach targeting psychological and embodied mechanisms underlying ED symptoms. A theoretical framework is outlined in which music-evoked imagery and neuroaesthetics engagement facilitate symbolic emotional exploration, embodied integration, interoceptive reconnection, affect regulation within safety, and meaning-making and identity repair. CASE PRESENTATION: The framework is illustrated through four case examples from a qualitative feasibility study of GIM in ED treatment. Participants were four adult women (aged 26-57) engaged across levels of care, each receiving 12-16 individual GIM sessions over 12-months. The cases include selected session excerpts highlighting music and imagery processes that explore the functional role of ED symptoms. CONCLUSIONS: Across cases, GIM enabled access to unresolved emotions, trauma-related somatic distress, attachment dynamics, and identity disturbances, while supporting emotion regulation, agency, and transformation of symptom-related coping. These findings position GIM as a promising multimodal, embodied intervention for trauma-informed ED treatment, particularly for individuals with complex trauma and difficulties engaging in verbal interventions. Further research is needed to clarify mechanisms of change, clinical indications, and integration within multidisciplinary ED care.