Group randomized, controlled evaluation of yoga for adolescent mental health within a high school curriculum

Jessica J. Noggle & Sat Bir S. Khalsa, Brigham and Women’s Hospital, Harvard Medical School

Background• Yoga – a multi-component mind-body practice

including:– Physical postures– Breathing exercises– Relaxation techniques– Meditation techniques

• Traditional goals – optimal physical, emotional and cognitive functioning; ultimately higher states of consciousness similar to other meditation techniques

• Modern application – to prevent/treat stress-related mental and physical ailments1

• Yoga reduces psychophysiological arousal in adults2-4

• Initial studies on youth suggest similar results, e.g. better mood & reduced stress, anxiety5,6; need for: – Randomized, controlled trials– School setting to reach most youth

• In 2007, 2.1% youth <18 practicing yoga7

ObjectiveTo evaluate feasibility & efficacy of yoga

for adolescent mental health using a group randomized, controlled trial

within a school curriculum

Conclusions• Yoga prevented deterioration of affect, anxiety

& confusion over the semester relative to physical education

• For students attending yoga regularly, anger control was also maintained

• Kripalu yoga was feasible with older adolescents– 11th & 12th graders

• Suggestions for future studies:– Larger sample size– More balanced groups– Younger adolescents– Academic performance (grades)– Cognitive behavioral testing– More representative student body

Acknowledgements• Yoga teachers Janna Delgado & Iona Brigham, project

leader Debbie Cohen, research & teaching assistants at Kripalu

• Monument Mountain Regional High School• Funded by the Institute for Extraordinary Living, Kripalu

Center for Yoga and Health

Yoga Intervention• 10-wk progressive program, 2 to 3 Kripalu yoga

classes/wk lasting 30 to 40 min each– ~25 yoga classes/student

• 2 senior Kripalu yoga instructors & 5 assistants– 1 teacher + 1 assistant/class

• Key Kripalu yoga principles:– Self-inquiry– Compassionate awareness– Emotion regulation

• Each class consisted of: – 5-min centering

• Including breathing techniques– 5-min warm-up– 15 to 25-min postures– 5-min relaxation

References1 - Khalsa SBS, 2004 Indian J Physiol Pharmacol 48:269-852 - Jevning et al., 1992 Neurosci Biobehav Rev 16:415-243 - Ray et al., 2001 Indian J Physiol Pharmacol 45:37-534 - Pal et al., 2004 Indian J Med Res 120:115-215 - Galantino et al., 2008 Pediatr Phys Ther 20:66-806 - Birdee et al., 2009 Acad Pediatr 9:212-207 - Barnes et al., 2008 National Health Statistics Report

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Study Profile

Do you think the yoga was valuable enoughthat you would recommend it to your friends?

Average Visual Analog Score0 20 40 60 80 100

Num

ber o

f Sub

ject

s

0

5

10

15

20

Notatall

Verymuch

so

Did you find that the yogawas helpful for you in general?

Average Visual Analog Score0 20 40 60 80 100

Num

ber o

f Sub

ject

s

0

5

10

15

20

Notatall

Verymuch

so

Acceptability

Baseline End Program

Ave

rage

STA

XI S

core

20

21

22

23

24

25

Yoga

Controlp<0.05

Anger Control

Yoga Control

Ave

rage

Diff

eren

ce S

core

-8

-6

-4

-2

0

2

4

Total Mood DisturbanceTension-AnxietyDepression-DejectionAnger-HostilityVigor-ActivityFatigue-InertiaConfusion-Bewilderment

Improving

Worsening

*

*

* p<0.05

*

*

Mood

Baseline End ProgramBaseline End Program

Ave

rage

PA

NA

S-C

Sco

re

30

35

40

45

50

Control

Control

Yoga

Yoga

Positive Negativen.s. p<0.05

Affect

• 73% of students rated yoga as more than helpful for them in general (60 to 100 VAS)

• 31% of students gave highest rating (90-100 VAS) for recommending yoga to their friends

• Positive affect remained unchanged in both groups after one semester (ANCOVA controlling baseline)

• Negative affect worsened in controls while remaining stable in the yoga group

• Negative mood states improved in yoga group & worsened in control group (2 significant & 3 trends)– Exceptions: Vigor-Activity & Fatigue-Inertia

improved in both groups (trends)

• Ability to control expression of anger worsened in control group & remained stable in yoga group

Studentsattending25% ormoreyoga

classes

5 not analyzed

Eligibility 15

3 excluded − 1 previous yoga− 2 dropped PE

21 16 16 16

Enrollment 15 20 16 16 14

RandomCluster

Allocation15 20 16 16 14

Intervention 15 20 15 15 13

Analysis 15 58

3 dropped − 1 medical leave− 2 left study

− 5 attended <25%

• 5 PE class periods cluster randomized to:

– PE (yellow)

– Yoga (green)

• # students/class period in boxes