“Yoga resets my inner peace barometer”: A qualitative study illuminating the pathways of how yoga impacts one’s relationship to oneself and to others

The impact of a meditative movement practice intervention on short- and long-term changes in physical activity among breast cancer survivors

PURPOSE

Tai Chi Easy (TCE) is a low-impact, meditative movement practice that is feasible for breast cancer survivors, even in the face of post-treatment symptoms, and may even serve as a gateway into developing an active lifestyle and improving overall physical activity (PA). In the context of a randomized controlled trial testing effects of an 8-week TCE intervention on breast cancer survivors' symptoms, we examined the short- (8-week) and long-term (9-month) impact on total PA compared to an educational control group.

METHODS

Participants were recruited from two hospital systems, local community organizations, and different media platforms. Eligible participants were predominant non-Hispanic White (82%), college educated (92%), and middle- to high-income (65%), and most commonly reported stage 1 (40%) or 2 breast cancer (38%). After baseline assessments, participants were randomized to the 8-week TCE intervention (N=51) or education control (N=53). Weekly intervention TCE classes were led by a trained instructor. Weekly educational control classes focused on a series of readings and group discussions. Total PA and steps were objectively measured via accelerometry, and the international physical activity questionnaire was used to measure self-reported total PA.

RESULTS

Multilevel mixed-effects linear regression models revealed no significant short- or long-term changes in objectively measured total PA or steps in either group; however, participants in the intervention reported short- and long-term changes in self-reported total PA.

CONCLUSIONS

TCE is an appropriate PA strategy for survivors that may lead to modest improvements in PA; however, more research is needed to examine the long-term impact on PA as well as other physical and psychological outcomes (i.e., flexibility, mobility, stress).

IMPLICATIONS FOR CANCER SURVIVORS

Low-impact, low-intensity activities like meditative movement practices are needed to assist survivors in overcoming post-treatment physical and psychological limitations to initiate a more active lifestyle.

Validation and efficacy of a tele-yoga intervention for improving psychological stress, mental health and sleep difficulties of stressed adults diagnosed with long COVID: a prospective, multi-center, open-label single-arm study

The objective of this study was to validate and test the efficacy of a 16-week tele-yoga intervention for perceived stress, anxiety, depression, and insomnia in individuals who had had COVID-19 infection in the previous year, and had reported moderately high levels of psychological stress (PSS ≥14). 25 and 50-min versions of the program were developed. They were then validated using Lawshe's content validity ratio after obtaining feedback from 20 yoga therapy experts. The safety and efficacy of the two programs were subsequently tested in a prospective, multicenter, open-label single-arm study. Eighty-six adults (18 male, 68 female) were recruited from two tertiary mental healthcare institutions, 48 in NIMHANS, Bengaluru; and 38 in SCARF, Chennai. Participants were assessed at weeks zero, 4, and 16 using validated tools. Data were analyzed using a Mixed Model, Intention to Treat approach. After week 16, 31 subjects remained in the trial and continued to practice yoga without any side effects. Subjects who adhered in the trial had significantly higher levels of baseline anxiety and depression as compared to subjects who dropped out. Results at week 4 included significant reductions in levels of perceived stress, anxiety, and insomnia; improvements were maintained at week 16. Correlations between number of yoga sessions and post-intervention PSS scores were negative (r = -0.49), and significant (p<  0.05). Both tele-yoga programs proved safe, useful tools to counteract perceived stress, anxiety and insomnia. Future trials should explore the utility of tele-yoga as a tool to enhance well-being and manage stress.

The impact of yoga on occupational stress and wellbeing: exploring practitioners' experiences

Background

Workplace stress is a serious problem globally. It represents a major threat to the UN's sustainability goal of good health and wellbeing (SDG 3). The purpose of this article is to explore how yoga may be a tool for increased wellbeing and stress management at work and in everyday life.

Methods

To examine how yoga can facilitate employees' wellbeing and ability to cope with stress, we performed qualitative interviews with practitioners who did yoga regularly. We focused on how yoga was experienced by each of our interviewees and what practicing yoga meant to them. Our data material consists of 13 semi-structured lifeworld interviews. The sample consisted of 10 female and 3 male in the age range of 20-55 years old. The data were analyzed through a thematic analysis.

Results

The themes identified in the thematic analysis include: (1) yoga as a tool for increased wellbeing, (2) yoga for coping with stress and dealing with challenges, (3) the role of breathing, and (4) contextual factors. While confirming other research findings, this article elaborates on aspects informants described as induced by yoga, like self-awareness, calmness, balance, mood-lifting, focus, presence, self-care, and mastery. The reported positive outcomes of yoga constituted increased wellbeing, and also facilitated the ability to cope with stress and experience less stress. Informants also emphasized that yogic breathing was a central factor in inducing wellbeing and feeling less stressed. They also expressed that contextual factors, such as time, teacher, and location, influenced how practicing yoga was experienced and made sense of.

Conclusion

The study concludes that the interviewees experienced practicing yoga as positive, by reducing their occupational stress. Moreover, yoga increased their wellbeing, as well as their ability to cope with stress. These experienced changes were especially facilitated by yogic breathing, and influenced by contextual factors.

Effects of mind-body therapies on schizophrenia: A systematic review and network meta-analysis

OBJECTIVE

The objective of this meta-analysis is to evaluate and compare the effectiveness of different mind-body therapies in reducing the symptoms of schizophrenia.

METHODS

A systematic search was performed using databases such as PubMed, Embase, Cochrane Library, Web of Science, and Scopus. Randomized controlled trials that assessed the effects of mind-body therapies on patients with schizophrenia were included. The search covered the period between the inception of each database and November 17th, 2022. The methodological quality of the trials was assessed using the Cochrane risk of bias tool. A network meta-analysis was conducted to compare the effects of various mind-body therapies, including Yoga, Mindfulness, Tai Chi, Baduanjin, and Yijinjing.

RESULTS

The analysis included 22 randomized controlled trials involving a total of 2064 subjects. The network meta-analysis revealed that Yoga and Mindfulness interventions were more effective than other mind-body therapies in reducing the symptoms of schizophrenia. Specifically, Yoga improved PANSS-positive symptom scores (SUCRA: 74.8 %) and PANSS-negative symptom scores (SUCRA: 80.4 %), whereas Mindfulness improved PANSS-positive symptom scores (SUCRA: 85.6 %).

CONCLUSION

The findings of this study indicate that Yoga may be a promising intervention for the treatment of schizophrenia. However, the small sample size and the low quality of the included studies have limited the generalizability of our findings Therefore, this study must be understood with caution, and further investigation is warranted when more relevant studies emerge.

Lessons From India: A Narrative Review of Integrating Yoga Within the US Healthcare System

The ancient practice of yoga has gained worldwide popularity as a way for people to improve their overall health and well-being. This manuscript reviews and examines the history of yoga, its physical and mental health benefits, its incorporation into the Indian healthcare system, and the public perception of yoga in India. Many initiatives for yoga exist, including promoting research on yoga, providing education and information on its benefits, and developing evidence-based standardized yoga therapy guidelines. With this in mind, this narrative review article explores the potential benefits of incorporating yoga into the United States (US) healthcare system and the possible challenges of doing so. It also provides valuable insights for policymakers and healthcare professionals.

Promoting mental health and wellbeing in schools: the impact of yoga on young people's relaxation and stress levels

This study aimed to examine students' experiences with yoga interventions in school. The findings revealed that practicing yoga made young people more aware of their need to relax and positively impacted their mental health and wellbeing. We explored the emphasis on relaxation among our study participants and how relaxation is related to other aspects, such as their experience of stress and sleep habits. This article is based on qualitative data gathered from teenagers in Norway who participated in the Norwegian part of the European research project "Hippocampus: Promoting Mental Health and Wellbeing among Young People through Yoga." The project introduced yoga to young people in schools with an emphasis on those who were disadvantaged, including those with mental health issues and other challenges related to their background. Data were collected from nine individual, semi-structured interviews and 133 logs collected in the spring of 2019. The major themes identified through the interviews and log material included becoming more relaxed and aware of the need to unwind. Thus, the focus on relaxation is based on the importance of the participants assigned to this theme. The study results suggest that yoga enhanced the students' awareness and skills and empowered them to make healthier lifestyle choices. We viewed the importance of relaxation from a salutogenic perspective, focusing on the factors that contribute to good health in contrast to a pathogenic perspective, where curing diseases is the goal.

Delivering yoga to people with hypertension in the UK: A qualitative study to explore yoga providers' knowledge, experiences, and attitudes

Background and Aims

Yoga has become increasingly popular in the world and the UK for improving health and well-being. A growing body of research suggests that yoga could be used to improve the management of hypertension in addition to current management strategies. Previous cross-sectional studies have also reported that hypertension is one of the most commonly disclosed health conditions in yoga sessions in the United Kingdom. Therefore, semi-structured qualitative interviews were conducted with yoga providers in the United Kingdom (n = 19) to explore their knowledge, experiences, and attitudes toward delivering yoga to people with hypertension.

Methods

Interviews were audio-recorded, transcribed verbatim, and analyzed thematically.

Results

Eight themes were identified. Yoga providers were generally aware of the health conditions of their attendees, and they had a reasonable knowledge of the causes, signs and symptoms, and management of hypertension. While most had received some information about hypertension as part of their initial yoga teaching training, this was generally felt to be limited. They mentioned the biopsychosocial benefits of yoga on hypertension but also expressed their concerns about the lack of regulation, the wide disparity in what is being delivered under the label of yoga, and the competency of some yoga providers.

Conclusion

The findings suggest that yoga provision in the United Kingdom should be regulated with a better link with health service providers. A manual and training for yoga providers in the United Kingdom for managing hypertension using yoga would be helpful to address the training needs of yoga providers. However, there is a need for more robust studies before recommending the implementation of yoga in the management of hypertension in the United Kingdom.

Stretching the Peace: The Role of Kundalini Yoga in the Lives of Young People in Alexandra, South Africa

The purpose of this exploratory study is to underline the importance of a humanistic approach to peace studies against a scenario characterized by the failings and weaknesses of the liberal peacebuilding agenda. To do so, we employ a transrational peace research framework to investigate whether Kundalini yoga can be used as a peacebuilding tool by analyzing its role in the lives of young people living in an Alexandra township, in South Africa. We conducted semistructured interviews with yoga instructors, surveyed yogis online, and analyzed three annual reports of Yoga4Alex, an organization that provides young people in Alexandra with tools for a better life through Kundalini yoga (and other programs). The main findings of this study demonstrate that practicing Kundalini yoga plays a vital role in the yogis’ lives in Alexandra, creating a space where peace can grow. Many respondents consider that yoga creates a community that offers them support and mental well-being. Moreover, yoga practice helps to develop tools they can use for personal transformation, contributing to the creation of a new identity and offering a nonviolent alternative for everyday life. This study provides reflections for both research and practice.

Going within, between and beyond: An exploration of regular Ashtanga Yoga practitioners' conceptualizations of five dimensions of wellbeing

Yoga is an embodied practice underpinned by philosophical elements, seeking to evolve different dimensions of human existence for optimal functioning in relation to oneself, others and beyond. This mixed-methods research focused on 137 regular Ashtanga Yoga practitioners (AYPs) by investigating their conceptualizations of five dimensions of wellbeing (i.e., physical, emotional, psychological, social, spiritual). Conceptualizations were analysed through word count analysis and Reflexive Thematic Analysis separately for each dimension, yielding four themes in each case, which partly aligned with existing wellbeing and yoga models, and partly extended on the existing literature. Further higher level analysis identified shared meanings across these five dimensions, expressed in themes grouped within five topics (i.e., freedom from and managing suffering, a positive and integrated sense of self, a sense of equanimity and steadiness, the self in relation to others and the world, meta-awareness). Furthermore, it also portrayed each dimension as multileveled, represented in three levels of human functioning. The foundational level encompassed the absence and managing suffering, representing functioning in coping and recovery mode. The optimal functioning level included a positive and integrated sense of self, a sense of equanimity and steadiness, and the self in relation to others and the world, representing functioning in personal development and growth mode. The contemplative and transcendental level involved meta-awareness in every dimension of wellbeing, representing functioning in transpersonal mode. As a result, we propose a preliminary model informed both by this empirical work and previous theories. While the continuousness of themes across dimensions reinforces the importance of embodiment and transcendence in wellbeing frameworks, the notion of the self as a multi-level system could be further explored in relation to knowing about and cultivating wellbeing.

Aligning working in an organization with teaching yoga: An investigation into personally meaningful work

In many advanced economies, two phenomena coexist: many people struggle finding meaning in their jobs and a growing number of persons hold multiple jobs at the same time. The research stream on meaningful work calls for more qualitative studies that investigate individual experiences of meaningful work across different jobs. The field on multiple jobholding has recently focused on the psychological foundations and struggles or positive effects. Prior research shows that individuals who were pushed (e.g. by financial reasons) into an additional job will likely experience depletion through it, while those motivated by pull factors (e.g. by psychological fulfillment reasons and the desire for meaningfulness) will likely yield enrichment. To address these research gaps jointly, we empirically investigate the motivations and meaningfulness experiences of multiple jobholders with the same secondary job, that is, practicing yoga teachers. We apply a mixed-method design by conducting and analyzing narrative interviews with 27 part-time yoga teachers in Germany.

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.

'Joining a group was inspiring': a qualitative study of service users' experiences of yoga on social prescription

Background

Yoga is becoming an increasingly popular holistic approach in the West to manage long-term health conditions. This study presents the evaluation of a pilot yoga intervention, Yoga4Health, that was developed for the NHS to be socially prescribed to patients at risk of developing specific health conditions (risk factors for cardiovascular disease, pre-diabetes, anxiety/depression or experiencing social isolation). The aim of this qualitative study was to explore service users’ experiences of Yoga4Health and the acceptability of the programme.

Methods

Qualitative data were collected from three sources: 1. Open-ended questions on questionnaires completed by services users at three different time-points (baseline, post intervention and 3 months); 2. Interviews and focus groups with a subset of participants (n = 22); 3. interviews with yoga teachers delivering Yoga4Health (n = 7). Each data source was analysed thematically, then findings were combined.

Results

Of participants completing baseline questionnaires (n = 240), 82.5% were female, 50% White, with a mean age of 53 (range 23–82) years. Baseline questionnaires revealed key motivations to attend Yoga4Health were to improve psychological and physical health, and believing Yoga4Health would be accessible for people with their health condition. Post-intervention, participants reported a range of benefits across psychological, physical and social domains from Yoga4Health. Increased confidence in self-management of health was also reported, and a number of participants described making positive lifestyle changes after attending the programme. Unanticipated benefits of yoga emerged for participants, such as enjoyment and social connectedness, which facilitated ongoing attendance and practice. Also key to facilitating practice (during and after the intervention) were suitability of the classes for those with health conditions, practising with a group and qualities of the yoga teacher. Home practice was supported by course materials (manual, videos), as well as the teaching of techniques for everyday application that offered immediate benefits, such as breathing practices. Follow-up questionnaires revealed a key challenge was continuation of practice once the intervention had finished, with the structure of a class important in supporting practice.

Conclusions

Yoga4Health was a highly acceptable intervention to services users, which brought a range of biopsychosocial improvements, suggesting yoga is an appropriate intervention to offer on social prescription.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03514-3.

Can Yoga Boost Access to the Bodily and Emotional Self? Changes in Heart Rate Variability and in Affective Evaluation Before, During and After a Single Session of Yoga Exercise With and Without Instructions of Controlled Breathing and Mindful Body Awareness in Young Healthy Women

Exercise is indispensable for a healthy lifestyle. Yoga exercise can have positive effects on well-being and on cardiac autonomic activity making it an ideal intervention for improving mind-body interactions and resilience to physical and mental stressors. Emotions trigger especially strong bodily and affective-cognitive responses because of their social relevance for the self and their biological relevance of mobilizing the organism for action. This study investigates whether changes in emotion processing related to self-other referential processing and changes in cardiac autonomic activity, reflected by heart rate variability (HRV), occur immediately after already a single session of yoga exercise when yoga postures are practiced with or without breathing- and mindful body awareness instructions. Women, all university students (N = 34, final sample: n = 30, n = 25 naïve to yoga practice) were randomly assigned to two experimental groups who performed the same yoga exercises with or without controlled breathing and mindfulness instructions. Emotional, self-other referential processing, awareness of bodily signals and HRV indicators were investigated before and after the exercise using standardized experimental tasks, standardized questionnaires, and mobile recording devices. Exercising for 30 minutes changed cardiac activity significantly. HRV measures showed adaptability of cardiac activity during the exercise as well as during the affective task post- to pre-exercise. Exercising with breathing instructions and mindful body awareness had no superior effects on cardiac, particularly parasympathetic activity, compared to practicing the same movements without such explicit instructions. Self-referential processing did not change; however, participants were faster and more accurate in their affective judgments of emotional stimuli [regardless of their reference (self/other)], and showed better awareness of bodily signals after compared to before the exercise session. The results support immediate, adaptive effects of yoga exercise on cardiac and affective-cognitive processing in an all-female healthy sample. Therefore, yoga exercise could be recommended as a physical activity for boosting cardiac and emotional resilience in this target group.

How does yoga practice and therapy yield psychological benefits? A review and model of transdiagnostic processes

Interest in yoga as an intervention for psychological wellbeing has increased in recent years, with literature investigating beneficial effects in a variety of presentations and settings. The theoretical understanding of this benefit has previously focused on physiological changes involved in yoga practice, however interest has turned to the potential psychological mechanisms eliciting psychological wellbeing. The current paper builds on previous theory and argues that yoga practice targets transdiagnostic psychological processes; mechanisms that feature commonly across a wide range of presentations, thus reducing distress and increasing wellbeing across clinical and non-clinical populations. Features of yoga practice are discussed in relation to these transdiagnostic processes and the features of modern talking therapies. A new model is proposed positing specific aspects of yoga practice correlate with specific transdiagnostic processes to elicit psychological change and argues that the mechanisms by which change occurs are directly compared with the changes observed in talking therapies. The implications for future research and the potential for this to support the commissioning of holistic approaches in clinical practice are discussed.

Yoga-Based Group Intervention for In-patients With Schizophrenia Spectrum Disorders-A Qualitative Approach

Background: Yoga may pose a promising complementary therapy in the multimodal treatment of in-patients with schizophrenia spectrum disorders (SSD). However, to date, no studies have qualitatively examined in-patients' with SSD experiences of Yoga as well as their perceptions of its limitations and benefits as a treatment component. This qualitative study aimed to explore for the first time the mechanisms and processes of Yoga-based Group Intervention (YoGI) for in-patients with SSD in Germany by asking for their subjective experiences. Findings could serve as a preliminary basis for developing an effective and evidence-based YoGI manual tailored to this patient group. Materials and Methods: In total, 25 semi-structured interviews were conducted directly after YoGI, for which responses were either noted down by hand or audio-recorded. The interview guide was pilot-tested and consisted of 14 questions to explore the personal articulated experiences of participation in YoGI from in-patients with SSD. Positive, negative, depressive, and anxiety symptoms were assessed during a diagnostic interview and through questionnaires. The interview data was transcribed, coded by two independent researchers, and analysed using an inductive thematic approach. The research team collaboratively discussed emerging categories to reduce redundancy and form meaningful themes and subthemes. Results: The analysis revealed seven main themes. YoGI was perceived as feasible and focusing on individual adaptation, captured by the theme inclusivity. Nevertheless, participants encountered challenges; thus, physical limitations need to be considered. While practising together, participants experienced interconnectedness and developed a mindful stance as they accepted their limitations and adapted exercises with self-compassion. Patients described that following the flow of the asanas required physical persistence, which ultimately led many participants to experience confidence and relaxation. YoGI affected symptom representation as heightened awareness led participants to notice impeding as well as improved symptoms. Conclusion: YoGI showed various promising effects on in-patients with SSD. Future research should examine to what extent these effects can be sustained and how the mindful approach during YoGI can be transferred to areas outside the Yoga class. Furthermore, a randomised controlled trial could investigate the effectiveness of a manualised YoGI.

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.

Differential Effects of Ethical Education, Physical Hatha Yoga, and Mantra Meditation on Well-Being and Stress in Healthy Participants-An Experimental Single-Case Study

Traditionally, yoga is a multicomponent practice consisting of postures, breathing techniques, meditation, mantras, and ethics. To date, only a few studies have tried to dismantle the effects of each of these components and their combinations. To fill this gap, we examined the incremental effects of ethical education and physical Hatha yoga on mantra meditation using a single-case multiple-baseline design. This study was part of a project evaluating the new mind-body program Meditation-Based Lifestyle Modification. Fifty-seven healthy participants with no regular yoga or meditation practice were randomly assigned to three baselines (7, 14, and 21 days) and four conditions using a random number generator. The conditions were mantra meditation alone (MA), meditation plus physical yoga (MY), meditation plus ethical education (ME), and meditation plus yoga and ethical education (MYE). All the interventions lasted for 8 weeks and were run consecutively according to baseline length. During the baseline and treatment phases, participants received daily questionnaires measuring their well-being (WHO-5 Well-Being Index), stress (Perceived Stress Scale), and subjective experiences. Forty-two participants completed the treatment and were entered in the analyses. We analyzed our data using visual inspection, effect size estimation (Tau-U), and multilevel modeling. Almost all participants showed a longitudinal increase in well-being. Regarding between-group differences, participants who received ethical education exhibited the largest increases in well-being (Tau-U = 0.30/0.23 for ME/MYE), followed by participants in the MY condition (Tau-U = 0.12). Conversely, participants in the MA condition showed no change (Tau-U = 0.07). There was a tendency for the combined treatments to decrease stress. This tendency was strongest in the MY condition (Tau-U = -0.40) and reversed in the MA condition (Tau-U = 0.17). These results emphasize the incremental and differential effects of practicing meditation in combination with other practices from the eight-fold yoga path. This approach is valuable for better understanding the multifaceted practice of yoga. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04252976.

"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.

Examining the Exercise and Self-Esteem Model Revised with Self-Compassion among Hong Kong Secondary School Students Using Structural Equation Modeling

The association between physical activity in achieving mental health benefits and subjective well-being is consistently identified by empirical research. The causation of a positive self-concept created by physical exercise is empirically supported by Sonstroem and Morgan's (1988) exercise and self-esteem model (EXSEM). However, various drawbacks of maintaining high self-esteem have been identified; thus, the concept of self-compassion was conjectured to be a form of "true self-esteem." Hence, the current study aimed to investigate the relationship between physical activity and self-compassion by examining the exercise and self-esteem model revised with self-compassion (EXSEM-SC). This study recruited secondary school students from Hong Kong using convenience sampling. The structural equation modeling (SEM) approach, including path analysis and multiple indicators, multiple causes (MIMIC) modeling, were used to reveal the results of the study. The results (n = 1097) indicated that the relationship between physical activity and self-compassion could be demonstrated by the EXSEM-SC, with a satisfactory goodness-of-fit index in the SEMs. The SEM also demonstrated the direct paths from physical activity to self-compassion and mental well-being, indicating the significant effect of physical activity on self-compassion.

Meditation-Based Lifestyle Modification: Development of an Integrative Mind-Body Program for Mental Health and Human Flourishing

Mental disorders are a core health challenge in the 21st century. Integrative mental health care takes an individual, lifestyle-modifying, salutogenic approach, combining somatic, psychosocial, and spiritual perspectives from evidence-based conventional and complementary medicine. In particular, meditation and mindfulness have received growing research interest in the last decade. In this article, we present Meditation-Based Lifestyle Modification (MBLM), a new, complex mind-body intervention for mental health care. It is the first program to intensify meditation practice using classical yoga. The program (a) covers all areas of classical yoga, (b) considers ethical and spiritual aspects of daily life, (c) orients participants toward sustained lifestyle modification, and (d) is applicable in a clinical context. The scientific rationale of the program is outlined in this article, based on the Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare. Further research is planned to show the clinical feasibility of MBLM and evaluate its efficacy, processes of change, and cost-effectiveness.

Meditation Based Lifestyle Modification (MBLM) in outpatients with mild to moderate depression: A mixed-methods feasibility study

BACKGROUND

Integrative mental health care can be applied to treat depression with a person-centered, lifestyle-modifying, and more salutogenic approach to mental health and human flourishing. In this article, we report on the feasibility and acceptability of a new mind-body program, Meditation Based Lifestyle Modification (MBLM), in outpatients with mild or moderate depression.

METHODS

This is a single-arm mixed-methods feasibility study of n = 25 outpatients in psychiatric care. Depressive symptoms, scores for mindfulness, aspects of spirituality, and eudaemonic well-being based on yoga philosophy were assessed at baseline and at the end of the intervention. Adherence was monitored and face-to-face interviews were held after the program to explore the acceptability and feasibility of MBLM.

RESULTS

Twenty patients (75 %) completed at least six sessions of the course. Adherence was 87.5 % of allocated sessions. In qualitative analysis, more than half of the participants experienced novelty and inspiration through practicing the ethical aspects of yoga (e.g., nonviolence, truthfulness, etc.). Almost all participants experienced a decrease in emotional distress. Virtually all participants reported more self-confidence and self-acceptance. In quantitative analysis, participants reported a clinically important decrease in depressive symptoms of 39.23 % (p = .002), eudaemonic well-being increased significantly in a range of related scales and scores for mindfulness increased (p < .001).

CONCLUSION

MBLM is a highly acceptable and feasible program for outpatients with mild to moderate depression. This comprehensive, lifestyle-modifying approach is highly relevant to preventing and treating mental illness, and treating psychic comorbidities in patients with chronic somatic illness.

Can Adults with Mild Cognitive Impairment Build Cognitive Reserve and Learn Mindfulness Meditation? Qualitative Theme Analyses from a Small Pilot Study

BACKGROUND/OBJECTIVE

High levels of chronic stress negatively impact the hippocampus and are associated with increased incidence of mild cognitive impairment (MCI) and Alzheimer's disease. While mindfulness meditation may mitigate the effects of chronic stress, it is uncertain if adults with MCI have the capacity to learn mindfulness meditation.

METHODS

14 adults with MCI were randomized 2:1 to Mindfulness Based Stress Reduction (MBSR) or a wait-list control group. We conducted qualitative interviews with those who completed MBSR. Transcribed interviews were: a) coded using an emergent themes inductive approach informed by grounded theory; b) rated 0-10, with higher scores reflecting greater perceived benefit from, and understanding of, mindfulness meditation. Ratings were correlated with daily home practice times and baseline level of cognitive function.

RESULTS

Seven themes emerged from the interviews: positive perceptions of class; development of mindfulness skills, including meta-cognition; importance of the group experience; enhanced well-being; shift in MCI perspective; decreased stress reactivity and increased relaxation; improvement in interpersonal skills. Ratings of perceived benefit and understanding ranged from 2-10 (mean = 7) and of 0-9.5 (mean = 6), respectively. Many participants experienced substantial benefit/understanding, some had moderate, and a few had minimal benefit/understanding. Understanding the key concepts of mindfulness was highly positively correlated with ≥20 minutes/day of home practice (r = 0.90) but not with baseline cognitive function (r = 0.13).

CONCLUSIONS

Most adults with MCI were able to learn mindfulness meditation and had improved MCI acceptance, self-efficacy, and social engagement. Cognitive reserve may be enhanced through a mindfulness meditation program even in patients with MCI.

Exploring how different types of yoga change psychological resources and emotional well-being across a single session

OBJECTIVES

Yoga demonstrates beneficial effects in many populations, yet our understanding of how yoga brings about these effects is quite limited. Among the proposed mechanisms of yoga are increasing psychological resources (mindfulness, body consciousness, self-transcendence, spiritual peace, and social connectedness) that may bring about salutary effects on emotional wellbeing. Further, yoga is a complex practice comprising meditation, active and restorative postures, and breathwork; however little is known about how different components may affect mechanisms. We aimed to determine how an acute session of yoga (and its specific components) related to pre- to post- session changes in proposed mechanisms (psychological resources) and whether those changes were associated with positive changes in emotions.

DESIGN

144 regular yoga practitioners completed measures of mindfulness, body consciousness, self-transcendence, social connectedness, spiritual peace, and exercise-induced emotions (positive engagement, revitalization, tranquility, exhaustion) immediately before and after a yoga session (N = 11 sessions, each a different type of yoga). Perceived properties of each yoga session, exercise exertion and engagement with the yoga teacher were assessed immediately following the session.

RESULTS

Pre-to post- yoga, levels of positive emotions (engagement, tranquility and revitalization) increased while exhaustion decreased. Further, all psychological resources increased and closely tracked improved emotions. Additionally, aspects of the yoga session correlated with changes in psychological resources (mechanisms) and emotions.

CONCLUSIONS

Yoga may influence multiple psychological mechanisms that influence emotional well-being. Further, different types of yoga may affect different mechanisms. Results can inform yoga interventions aiming to optimize effects through specific mechanisms such as mindfulness or spirituality.

The impact of trait mindfulness on relational outcomes in novice yoga practitioners participating in an academic yoga course

OBJECTIVE

This study examined the role of dispositional mindfulness in impacting the relational benefits of yoga in novice practitioners in an undergraduate academic yoga course.

PARTICIPANTS

21 college students enrolled in a yoga course throughout a 15-week academic semester (January-April 2016).

METHODS

Participants attended lab assessments at the beginning and end of the semester and were asked to complete eight consecutive Internet-based daily surveys across six separate bursts, yielding 48 data points for each participant.

RESULTS

Multivariate time-series analyses revealed within-person subgroup differences such that in general, those in the high trait mindfulness group gleaned benefits from yoga practice with respect to relational outcomes.

CONCLUSIONS

This study demonstrated trait mindfulness impacts relational outcomes in novice yoga practitioners, suggesting those low in trait mindfulness may not garner immediate relational benefits from yoga and could benefit from additional strategies to bolster against any negative influences of initiating yoga practice.

Quality of Life in Yoga Experienced and Yoga Naïve Asian Indian Adults with Obesity

BACKGROUND

Obesity adversely affects quality of life which then acts as a barrier to weight loss and weight loss maintenance. Hence, those interventions which positively influence the quality of life along with weight reduction are considered useful for sustained weight loss in persons with obesity. An earlier study showed better quality of life in obese adults who had experience of yoga compared to yoga naïve obese adults. However, the main limitation of the study was the small sample size (n=20 in each group).

OBJECTIVE

The present study aimed to determine whether with larger sample sizes the quality of life would differ in yoga experienced compared to yoga naïve adults with obesity.

METHODS

There were 596 Asian Indian obese adults (age range 20 to 59 years; group mean age ± SD; 43.9 ± 9.9 years): of whom (i) 298 were yoga experienced (154 females; group mean age ± SD; 44.0 ± 9.8 years) with a minimum of 1 month of experience in yoga practice and (ii) 298 were yoga naïve (154 females; group mean age ± SD; 43.8 ± 10.0 years). All the participants were assessed for quality of life using the Moorehead-Ardelt quality of life questionnaire II. Data were drawn from a larger nationwide trial which assessed the effects of yoga compared to nutritional advice on obesity over a one-year follow-up period (CTRI/2018/05/014077).

RESULTS

There were higher participant-reported outcomes for four out of six aspects of quality of life in the yoga experienced compared to the yoga naïve (p < 0.008, based on t values of the least squares linear regression analyses, Bonferroni adjusted, and adjusted for age, gender, and BMI as covariates). These were enjoyment in physical activities, ability to work, self-esteem, and social satisfaction.

CONCLUSION

Obese adults with yoga experience appear to have better quality of life in specific aspects, compared to yoga naïve persons with a comparable degree of obesity.

The Daily Influences of Yoga on Relational Outcomes Off of the Mat

Background

Despite the wide array of health benefits that have been evidenced with yoga, a clear gap exists examining how yoga impacts connections with oneself and to others.

Aims

The objectives of the present study were twofold: (1) to describe the day-to-day (in)variability in daily yoga practice and relational outcomes and (2) to examine the direct and indirect effects of yoga practice on relational outcomes.

Methods

Community-dwelling yoga practitioners (n = 104, age range: 18-76 years) with a yoga practice of at least once a week were recruited for a 21-day daily diary study. Practitioners were asked to complete daily Internet surveys at the end of the day which included questions with respect to one's yoga practice and relational domains (i.e., mindfulness, [self-]compassion, and social connectedness).

Results

Multilevel analyses revealed yoga and relational outcomes to be dynamic phenomena, indicated by substantial variation (intraclass correlations = 0.34-0.48) at the within-person level. On days when an individual practiced more yoga than their usual, greater mindfulness (b = 2.93, standard error [SE] = 0.39, P < 0.05) and self-compassion (b = 1.45, SE = 0.46, P < 0.05) were also reported. 1-1-1 multilevel mediation models demonstrated that yoga has an indirect effect on both compassion and social connectedness through increases in mindfulness at the within- and between-person levels. In models testing self-compassion as the mediator, the indirect effect of daily yoga practice on compassion was significant, although limited to the within-person level.

Conclusions

These findings suggest that a routine yoga practice could positively impact how a practitioner relates to theirselves and to others, both on a day-to-day basis, and with accumulated practice.