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 ailments 1 • Yoga reduces psychophysiological arousal in adults 2-4 • Initial studies on youth suggest similar results, e.g. better mood & reduced stress, anxiety 5,6 ; need for: – Randomized, controlled trials – School setting to reach most youth • In 2007, 2.1% youth <18 practicing yoga 7 Objective To 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 – 11 th & 12 th 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 References 1 - Khalsa SBS, 2004 Indian J Physiol Pharmacol 48:269-85 2 - Jevning et al., 1992 Neurosci Biobehav Rev 16:415-24 3 - Ray et al., 2001 Indian J Physiol Pharmacol 45:37-53 4 - Pal et al., 2004 Indian J Med Res 120:115-21 5 - Galantino et al., 2008 Pediatr Phys Ther 20:66-80 6 - Birdee et al., 2009 Acad Pediatr 9:212-20 7 - Barnes et al., 2008 National Health Statistics Report 12:24pp Study Profile Do you think the yoga was valuable enough that you would recommend it to your friends? Average Visual Analog Score 0 20 40 60 80 100 Number of Subjects 0 5 10 15 20 Not at all Very much so Did you find that the yoga was helpful for you in general? Average Visual Analog Score 0 20 40 60 80 100 Number of Subjects 0 5 10 15 20 Not at all Very much so Acceptability Baseline End Program Average STAXI Score 20 21 22 23 24 25 Yoga Control p<0.05 Anger Control Yoga Control Average Difference Score -8 -6 -4 -2 0 2 4 Total Mood Disturbance Tension-Anxiety Depression-Dejection Anger-Hostility Vigor-Activity Fatigue-Inertia Confusion-Bewilderment Improving Worsening * * * p<0.05 * * Mood Baseline End Program Baseline End Program Average PANAS-C Score 30 35 40 45 50 Control Control Yoga Yoga Positive Negative n.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 Students attending 25% or more yoga classes Eligibility 15 3 excluded − 1 previous yoga − 2 dropped PE 21 16 16 16 Enrollment 15 20 16 16 14 Random Cluster Allocation 15 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