Yoga and mental health: A synthesis of qualitative findings

Yoga as an adjunct treatment for eating disorders: a qualitative enquiry of client perspectives

BACKGROUND

This qualitative enquiry explores the experiences and perspectives of individuals with an eating disorder (ED) regarding their perceptions of yoga as an adjunct intervention to psychotherapy. It also explores the feasibility, acceptability, and safety of yoga from their perspectives.

METHODS

This study used a practice-based evidence framework and employed semi-structured interviews with 16 females with an ED. Participants were asked about their perspectives on the use of yoga as an adjunct intervention in ED recovery, perceived risks and what factors supported or hindered engagement. Thematic template analysis was used.

RESULTS

Three topic areas were elaborated. The first included participants' perceptions of how yoga enhanced their ED recovery. The second included how and when participants came to find yoga in their ED recovery. The final topic explored factors that supported participants with ED to engage in yoga. These resulted in the development of guiding principles to consider when designing a yoga intervention for EDs.

CONCLUSIONS

This study adds further to the emerging evidence that yoga can bring complementary benefits to ED recovery and provides a biopsychosocial-spiritual framework for understanding these. Findings provide an understanding of how yoga programs can be adapted to improve safety and engagement for people with an ED. Yoga programs for people with EDs should be co-designed to ensure that the physical, social, and cultural environment is accessible and acceptable.

Can mindfulness-based interventions reduce PTSD symptoms? An umbrella review

Post-traumatic stress disorder (PTSD) is a debilitating, often chronic condition with substantial cross-national lifetime prevalence. Although mindfulness-based interventions (MBIs) may help reduce PTSD symptoms, efficacy results are inconsistent. Despite many systematic reviews (SRs) examining MBIs for PTSD, SR quality has been neither evaluated nor synthesized. We conducted an umbrella review to summarize and evaluate existing evidence regarding MBIs for PTSD, identifying 69 SRs (27 meta-analyses), consisting of 83 primary studies. Using AMSTAR2 (a valid SR quality assessment tool), we evaluated each SR on key domains relevant to methodological rigor and rated the confidence of inferences. Results found SRs were 65.2% non-rigorous, 27.5% likely rigorous, and 7.2% rigorous; common limitations included inadequate risk of bias assessment, extractions not completed in duplicate, and lack of pre-registration, highlighting the need for higher quality SRs. We then performed a meta-meta-analysis to estimate the efficacy of MBIs to reduce PTSD symptoms, yielding a medium effect size (SMD=0.41, p < .001), derived from 22 meta-analyses (with replicable data) and 35 unique articles. Analyses were consistent across control conditions and MBI type (first-generation/narrow [i.e., MBIs with well-established protocols]) versus broad (i.e., other MBI types), comparable with second-line treatments (e.g., pharmacotherapy). Findings were narratively synthesized; areas for methodological improvements in MBI research were identified.

Exploring women's experiences participating in yoga after a cancer diagnosis: a protocol for a meta-synthesis

BACKGROUND

The benefits of yoga for clinical and non-clinical populations have been summarized in published systematic reviews. The vast majority of systematic reviews on the topic are syntheses of quantitative research that evaluated the effects of yoga. As qualitative research related to women's experiences participating in yoga after a cancer diagnosis is growing in quantity, systematic synthesis and integration of qualitative research are necessary to facilitate the transfer of knowledge. This paper describes the protocol for a meta-synthesis of qualitative research exploring women's experiences participating in yoga after a cancer diagnosis.

METHODS

Using a meta-study methodology, six electronic databases were searched to identify relevant articles. Additionally, the reference lists of relevant articles retrieved during the electronic database search were scanned to identify other relevant articles. Two reviewers independently screened the titles and abstracts, retaining those that appeared to relate to the review objectives. Next, they reviewed the retained full-text articles to assess eligibility according to four inclusion criteria. They will extract data from eligible studies and assess the quality of included studies. Data analysis will involve three main analytical steps: meta-data analysis, meta-method analysis, and meta-theory analysis. Findings from the three analytical steps will be interpreted collectively to generate additional insights beyond the findings of the primary studies to facilitate a more comprehensive understanding of women's experiences participating in yoga after a cancer diagnosis.

DISCUSSION

By systematically collecting, analysing, and interpreting findings across multiple primary qualitative studies, we will develop an overarching narrative and interpretation of the role and value of yoga for women diagnosed with cancer. A synthesis of qualitative research is vital as it embraces the heterogeneity of the research so as to provide important context for understanding the experiences of various women participating in yoga.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021229253.

Integration of hatha yoga and evidence-based psychological treatments for common mental disorders: An evidence map

BACKGROUND

Interest in the use of yoga to enhance engagement with and augment the benefits of psychological treatment has grown. However, a systematic approach to reviewing existing research examining the use of yoga with psychological treatment is lacking.

MATERIALS AND METHODS

This mapping review identified and synthesised research trialling yoga as an integrated or adjunct therapy with evidence-based psychological interventions for the treatment of anxiety, depression, PTSD, and eating disorders.

RESULTS

Overall, the review identified ten published and three unpublished studies, representing either single group or small quasi-experimental research designs.

DISCUSSION

Limited but promising findings were shown for yoga with CBT for anxiety and depression, and the integration of yoga within intensive treatment models for PTSD.

CONCLUSIONS

Future research is encouraged to focus on controlled trials that enable examination of the component effect of yoga when applied with evidence-based psychological treatment and acceptability and feasibility data to further knowledge regarding a role for yoga in clinical practice.

"I Felt Grounded and Clear-Headed": Qualitative Exploration of a Mind-Body Physical Activity Intervention on Stress Among College Students During COVID-19

The COVID-19 pandemic affected college students' overall health. The aims of this qualitative inquiry were to provide a more comprehensive understanding of the effectiveness of the mind-body physical activity (MBPA) intervention and to explore the MBPA intervention experiences through the use of journals and photographs (photovoice) of a purposeful sample of 21 college students during the COVID-19 pandemic. An inductive qualitative process was used to explore the data that emerged from photovoice images and journals. Students' experiences were encapsulated in 6 key themes: (1) holistic individual well-being; (2) physical activity as a matter of necessity; (3) mind-body physical activity intervention impacts; (4) broadening strategies for adapting and reacting; (5) systemic effect of stress management changes; and (6) perceiving causes of stress. Participants reflected collective intellectual, physical, and emotional fatigue as obstacles and perceived stress. The quality of COVID-19 related perspectives and stressful experiences are defined from traumatic and overwhelming to higher than normal. Findings from this study contribute to our understanding of the distinctive factors of the COVID-19 era among college students. Health educators should consider the implementation of multilevel and multicomponent MBPA interventions, and our findings highlight the utility of supporting higher education students in a meaningful way.

Yoga complements cognitive behaviour therapy as an adjunct treatment for anxiety and depression: Qualitative findings from a mixed-methods study

OBJECTIVES

Cognitive behaviour therapy (CBT) is recommended for treating anxiety and depression, demonstrating good efficacy and moderate rates of engagement. To further improve outcomes and access to evidence-based treatments, researchers have sought to enhance CBT protocols with mindfulness-based approaches, such as yoga. This study aimed to examine whether yoga is an acceptable and complementary adjunct to CBT through exploring the lived experiences of adults with anxiety and depression who engaged in an adjunct therapeutic yoga programme alongside group CBT.

DESIGN

Single-group qualitative design with post-intervention and follow-up timepoints.

METHODS

Thirty-six adults with anxiety and depression self-selected into a therapeutic yoga programme as an adjunct to group CBT. Qualitative interviews were conducted with 27 participants immediately after the eight-week programme and again three months later. Thematic analysis was used to identify common themes from the lived experiences.

RESULTS

Three primary themes, with nine subthemes, were identified which reflect the experiences of the combined therapies, the complementary elements, and process of engagement over time. The adjunct yoga programme was highly acceptable to adults with anxiety and depression, enhancing engagement and perceived outcomes. Yoga was identified as providing a unique combination of elements that complemented processes of CBT, such as behavioural activation and thought disputation. Yoga practices represented mental health self-management tools that are accessible and available as relapse prevention strategies.

CONCLUSIONS

Therapeutic yoga warrants consideration as an adjunct treatment for anxiety and depression as it offers unique and complementary elements to CBT and can enhance engagement and perceived clinical outcomes.

PRACTITIONER POINTS

Adults with anxiety and depression experienced a therapeutic yoga programme as a suitable and appealing adjunct that enhanced engagement with psychological treatment. Yoga offers a unique combination of elements, including a values system, body-based mindfulness practices, and breathing techniques, that complement CBT processes, such as behavioural activation, awareness of maladaptive patterns, and thought disputation. A therapeutic yoga programme provides adults with anxiety and depression with an accessible and sustainable mental health self-management tool. Therapeutic yoga can be considered for integration to models of mental health service provision to enhance engagement and clinical outcomes for adults with anxiety and depression.

Virtual learning experiences in population health nursing course during the COVID-19 pandemic

Aim

To discuss the virtual learning strategies used in population health nursing course during the coronavirus disease 2019 (COVID‐19) pandemic.

Background

The School of Nursing faculty in a South Central University in the United States quickly combined innovation with digital resources and transitioned a course in population health during the COVID‐19 pandemic. Nursing faculty were challenged to develop student nursing objectives in assessment, planning, intervention and evaluation of vulnerable populations in the community through a virtual environment.

Reflections of population health nursing clinical education

The experiences of five clinical groups are described, covering adults with disabilities, older people, patients with COVID‐19 and youth populations.

Discussion

The course objectives were met through use of a digital environment. Collaborative interventions were designed and implemented with community stakeholders while maintaining social distancing policies. Successes included increased frequency of communication and learning opportunities for students and the community, and student satisfaction. Barriers to student learning were not related to the digital learning environment, although the older adults required modifications to use electronic devices.

Conclusion

Virtual classrooms are a viable platform to teach population health nursing and to benefit vulnerable populations.

Implications for nursing practice

Virtual learning offers benefits within academia and the community. Technology offers the possibility to improve mental health among older people and enhance knowledge among the general population. Students are better able to connect with clinical faculty and stakeholders through digital platforms.

Implications for nursing policy

Nurses play a vital role in improving population health and can collaborate with community stakeholders to implement innovative and sustainable solutions to nursing education, practices and policy. Digital platforms can enhance the involvement of students through these collaborations during and after the pandemic.

A Population-Practice-Based Model to Understand How Yoga Impacts on Human Global Functioning: A Qualitative Study

Introduction:Research is increasingly demonstrating a range of benefits of practicing yoga, such as improved physical and mental health, social connectedness, and self-care. Mechanisms of action are less well understood, but may include both psychological and physiological changes. The aim of this study was to understand more about benefits and mechanisms of yoga practice, using qualitative data collected from a large-scale survey of yoga use in the United Kingdom. Methods: The mixed methods, cross-sectional online survey collected data on yoga use and perceived benefits from 2434 U.K. yoga practitioners. The qualitative survey element used open-ended questions to gain "real life" data regarding practice and perceived benefits. Data were analyzed thematically and deductively. A practice-based model describing yoga practice, mechanisms, and benefits, based on the Khalsa logic model of yoga, was developed to explain the data. Findings: Findings highlighted that a diverse range of yoga practices and nonspecific contextual factors related to practicing yoga, needed to be considered to understand how yoga was benefitting people. These practices encompassed both modern and traditional conceptions of yoga as a deeper lifestyle practice. Key mechanisms for change included improvements in physical strength and flexibility, stress regulation, resilience, equanimity, mind-body awareness, and spiritual/personal growth. These mechanisms resulted in diverse improvements in global health functioning, particularly physical and mental health and well-being. Conclusions: The Khalsa model provided a useful base upon which to guide the new population-practice-based model, to understand participants' "real life" experiences of yoga, how yoga is helping people and why. It provides important information for practitioners, teachers, and those delivering yoga interventions as to the range of skills and potential benefits of yoga practice. In addition, findings indicate directions for future research, by highlighting key yoga mechanisms that researchers may choose to focus on in future studies.

"To Be Finally at Peace with Myself": A Qualitative Study Reflecting Experiences of the Meditation-Based Lifestyle Modification Program in Mild-to-Moderate Depression

Background: Meditation-Based Lifestyle Modification (MBLM) is a new mind-body intervention that is based on classical yoga; it implements virtue-based ethical living, physical yoga, and meditation in a therapeutic context. This qualitative study aimed at understanding better how depressive patients who received MBLM as a treatment experience intra- and interpersonal outcomes of their practice. Methods: In a larger randomized controlled trial of MBLM in depressive outpatients, a subsample (n = 12) completed in-depth interviews. To determine short-term and long-term effects, cohorts were interviewed at two different times after intervention onset (T₁ = 8 weeks; T₂ = 6 months). Verbatim interview transcripts were analyzed by using thematic analysis. Results: Three themes emerged in the interviews: (1) Reappraisal of past and present life patterns, leading to a reflection on one's own values; (2) Serenity, attained by states of calm, growing acceptance, and the ability to set boundaries; and (3) Mindful living as expressed by increased self-awareness, being more present, and conscious interactions. The ethical component of MBLM was identified as a key factor in individual empowerment and appreciation of one's own strengths. Systematic changes in the importance of reported themes after 6 months (T₂) reflected the sustained effects of the intervention. Conclusions: The findings speak clearly for the benefits of MBLM in the treatment of depression. In particular, the explicit therapeutic implementation of virtue-based ethics offers a valuable addition to previous yoga and meditation programs. Clinical Trial Registration number: NCT03652220.

"We really need this": Trauma-informed yoga for Veteran women with a history of military sexual trauma

OBJECTIVES

Up to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY's feasibility, acceptability, and perceived effects in the context of MST.

DESIGN

Collective case series (N = 7).

SETTING

New England Vet Center.

INTERVENTIONS

Extant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy.

MAIN OUTCOME MEASURES

Attrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2).

RESULTS

Feasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2.

CONCLUSIONS

TIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.

The experience of Trauma Center-Trauma Sensitive Yoga training on professional practice of mental health professionals and yoga instructors

BACKGROUND AND PURPOSE

Traumatic psychological events are thought to alter brain physiology, notably regions such as the thalamus and the limbic system, affecting personal choice, autonomy, and behavior. Innovative therapies are needed to address the diverse, mental and physical consequences of these changes. Trauma Center-Trauma Sensitive Yoga (TC-TSY) has shown promising results in clinical trials among individuals experiencing posttraumatic symptomatology.

MATERIALS AND METHODS

Using a qualitative, descriptive design, we examined the impact of TC-TSY training on the professional practice of seven practitioners who were certified yoga instructors and/or registered psychologists.

RESULTS

The findings suggest TC-TSY training enriched their practices, chiefly through its choice-based, widely applicable approach; invitation- and mindfulness-based language; and building of therapeutic trust and attunement. Some participants questioned the accessibility and suitability of the training, as well as the rigidity of TC-TSY terminology.

CONCLUSION

More research is needed to examine potential outcomes of TC-TSY practice related to self-efficacy, coping, quality of life, and stress reduction among traumatized individuals.