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IEL: Research

Read “Yoga Research at Kripalu: The Power of Possibility,” by Stephen Cope

Yoga and PTSD

Nearly 16 percent of returning troops develop symptoms of post-traumatic stress disorder (PTSD). In response, the Department of Defense (DOD) is seeking effective methods of treating PTSD in war veterans and active duty military personnel. In 2008, IEL partner Dr. Sat Bir Khalsa received a grant from the DOD to study the effects of Kripalu Yoga on military personnel with PTSD. The IEL collaborated with trauma and yoga experts to develop a comprehensive yoga program specifically designed to relieve symptoms of trauma. During the 10-week study, veterans attend two 90-minute Kripalu Yoga classes each week and practice at home every day for 15 minutes. The primary goals are to reduce PTSD severity and symptoms and decrease nervous system arousal. Pre-, mid-, post-, and long-term follow-up treatment measures include questionnaires and interviews that measure PTSD symptoms, subjective well-being, and mood; electrocardiogram readings to monitor heart-rate variability; and 24-hour urine samples to assay the presence of stress hormones.

Meet the Principal Investigator
Sat Bir S. Khalsa, PhD, is an assistant professor of medicine at Harvard Medical School in the department of sleep medicine at Brigham and Women’s Hospital. His projects have focused on the therapeutic applications of yoga in a number of settings, including public schools, and for several conditions, including insomnia, performance anxiety, and PTSD. Dr. Khalsa is one of the most active, skillful, and experienced researchers in the yoga world today.

Yoga and the Brain

IEL partner Dr. Sara Lazar has scanned the brains of longtime Kripalu practitioners with state-of-the-art fMRI imaging technology to determine if yoga practice can change the actual structure of the brain. This study will also evaluate positive changes on attention, fluid intelligence, and enhanced emotional and cognitive functioning.

Meet the Principal Investigator
Sara Lazar, PhD, is an instructor in psychology at Harvard Medical School and a professor of psychiatry at Massachusetts General Hospital, where she specializes in functional magnetic resonance imaging (fMRI). Dr. Lazar employs the latest techniques in brain imaging in her research and has been widely cited in the mainstream press for her work on brain plasticity and meditation.

FLUID INTELLIGENCE AND BRAIN FUNCTIONAL ORGANIZATION IN AGING YOGA AND MEDITATION PRACTITIONERS


AUTHOR(S): Tim Gard, Maxime Taquet, Rohan Dixit, Britta K. Hölzel, Yves-Alexandre de Montjoye, Narayan Brach, David H. Salat, Bradford C. Dickerson, Jeremy R. Gray, and Sara W. Lazar

SOURCE: Frontiers in Aging Neuroscience

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ABSTRACT: Numerous studies have documented the normal age-related decline of neural structure, function, and cognitive performance. Preliminary evidence suggests that meditation may reduce decline in specific cognitive domains and in brain structure. Here we extended this research by investigating the relation between age and fluid intelligence and resting state brain functional network architecture using graph theory, in middle-aged yoga and meditation practitioners, and matched controls. Fluid intelligence declined slower in yoga practitioners and meditators combined than in controls. Resting state functional networks of yoga practitioners and meditators combined were more integrated and more resilient to damage than those of controls. Furthermore, mindfulness was positively correlated with fluid intelligence, resilience, and global network efficiency. These findings reveal the possibility to increase resilience and to slow the decline of fluid intelligence and brain functional architecture and suggest that mindfulness plays a mechanistic role in this preservation.

Yoga and Weight Loss

PSYCHOLOGICAL WELL-BEING, HEALTH BEHAVIORS, AND WEIGHT LOSS AMONG PARTICIPANTS IN A RESIDENTIAL, KRIPALU YOGA–BASED WEIGHT LOSS PROGRAM


AUTHOR(S): Tosca D. Braun, Crystal L. Park, Lisa Ann Conboy

SOURCE: International Journal of Yoga Therapy

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ABSTRACT: The increasing prevalence of overweight and obesity in humans is a growing public health concern in the United States. Concomitants include poor health behaviors and reduced psychological well-being. Preliminary evidence suggests yoga and treatment paradigms incorporating mindfulness, self-compassion (SC), acceptance, nondieting, and intuitive eating may improve these ancillary correlates, which may promote long-term weight loss. Methods: We explored the impact of a 5-day residential weight loss program, which was multifaceted and based on Kripalu yoga, on health behaviors, weight loss, and psychological well-being in overweight/obese individuals. Thirty-seven overweight/obese program participants (age 32-65, BMI>25) completed validated mindfulness, SC, lifestyle behavior, and mood questionnaires at baseline, postprogram, and 3-month follow-up and reported their weight 1 year after program completion. Results: Significant improvements in nutrition behaviors, SC mindfulness, stress management, and spiritual growth were observed immediately postprogram (n=21, 84% retention), which medium to large effect sizes. At 3-month follow-up (n=18, 49% retention), most changes persisted. Physical activity and mood disturbance had improved significantly postprogram but failed to reach significance at 3-month follow-up. Self-report weight loss at 1 year (n= 19, 51% retention) was significant. Conclusion: These findings suggest a Kripalu yoga-based, residential weight loss program may foster psychological well-being, improved nutrition behaviors, and weight loss. Given the exploratory nature of this investigation, more rigorous work in this area is warranted.

Yoga and Police Recruits

EVALUATION OF THE PSYCHOLOGICAL BENEFITS OF A YOGA PROGRAM FOR POLICE ACADEMY RECRUITS


AUTHOR(S): Pamela E. Jeter, Susan Cronin, Sat Bir S. Khalsa

SOURCE: International Journal of Yoga Therapy

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ABSTRACT: Law enforcement ranks as one of the most stressful occupations in the world. Occupational stress can lead to detrimental health outcomes such as depression, as well as maladaptive coping behaviors such as domestic abuse. Police academy training may not prepare recruits adequately to handle the long-term effects of occupational stress. Yoga is a mind-body practice composed of postures, breathing, and meditation techniques and is known for its beneficial effects on stress and mood disturbances. The present pilot study evaluated the effects of a 6-class Kripalu Yoga program on perceived stress, mood and mindfulness during police academy recruit training. Outcome measures included the Perceived Stress Scale (PSS), Profile of Mood States-Short Form (POMSSF) and the Five Facet Mindfulness Questionnaire (FFMQ) and were collected from 39 cadets pre and post- yoga program. An exit survey to determine perceived benefits was obtained on the last day. Overall improvements were observed for perceived stress (p=0.03) and mood (p=0.001). A qualitative assessment of the exit survey indicated perceived benefits however the specifics varied by individual. These preliminary results are promising and warrant further investigation.

Yoga and Musicians

A YOGA INTERVENTION FOR MUSIC PERFORMANCE ANXIETY IN CONSERVATORY STUDENTS


AUTHOR(S): Judith R. S. Stern, Sat Bir S. Khalsa, Stefan G. Hofmann

SOURCE: Medical Problems of Performing Artists

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ABSTRACT: Music performance anxiety adversely affects a large minority of musicians. There is a need for additional treatment strategies, especially those that might be more acceptable to musicians than existing therapies. This pilot study examined the effectiveness of a 9-week yoga practice on reducing music performance anxiety in undergraduate and graduate music conservatory students, including both vocalists and instrumentalists. The intervention consisted of fourteen 60-minute yoga classes approximately twice a week and a brief daily home practice. Of the 24 students enrolled in the study, 17 attended the post-intervention assessment. Participants who completed the measures at both pre- and post-intervention assessments showed large decreases in music performance anxiety as well as in trait anxiety. Improvements were sustained at 7- to 14-month follow-up. No changes were observed in mood or in music performance anxiety as retrospectively perceived in group performance or practice settings. Participants generally provided positive comments about the program and its benefits. This study suggests that yoga is a promising intervention for MPA in conservatory students, and therefore warrants further research.



YOGA AMELIORATES PERFORMANCE ANXIETY AND MOOD DISTURBANCE IN YOUNG PROFESSIONAL MUSICIANS


AUTHOR(S): Sat Bir S. Khalsa, Stephanie M. Shorter, Stephen Cope, Grace Wyshak, Elyse Sklar

SOURCE: Appl Psychophysiol Biofeedback

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ABSTRACT: Yoga and meditation can alleviate stress, anxiety, mood disturbance, and musculoskeletal problems, and can enhance cognitive and physical performance. Professional musicians experience high levels of stress, performance anxiety, and debilitating performance-related musculoskeletal disorders (PRMDs). The goal of this controlled study was to evaluate the benefits of yoga and meditation for musicians. Young adult professional musicians who volunteered to participate in a 2-month program of yoga and meditation were randomized to a yoga lifestyle intervention group (n = 15) or to a group practicing yoga and meditation only (n = 15). Additional musicians were recruited to a no-practice control group (n = 15). Both yoga groups attended three Kripalu Yoga or meditation classes each week. The yoga lifestyle group also experienced weekly group practice and discussion sessions as part of their more immersive treatment. All participants completed baseline and end-program self-report questionnaires that evaluated music performance anxiety, mood, PRMDs, perceived stress, and sleep quality; many participants later completed a 1-year follow up assessment using the same questionnaires.

Both yoga groups showed a trend towards less music performance anxiety and significantly less general anxiety/tension, depression, and anger at end-program relative to controls, but showed no changes in PRMDs, stress, or sleep. Similar results in the two yoga groups, despite psychosocial differences in their interventions, suggest that the yoga and meditation techniques themselves may have mediated the improvements. Our results suggest that yoga and meditation techniques can reduce performance anxiety and mood disturbance in young professional musicians.

Yoga and Flourishing

EFFECTS OF A YOGA LIFESTYLE INTERVENTION ON PERFORMANCE-RELATED CHARACTERISTICS OF MUSICIANS: A PRELIMINARY STUDY


AUTHOR(S): Sat Bir S. Khalsa, Stephen Cope

SOURCE: Med Sci Moni

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SUMMARY:

Background: Previous research has suggested that yoga and meditation practices are effective in stress management, alleviating anxiety and musculoskeletal problems and improving mood and cognitive and physical performance. Musicians experience a number of challenges in their profession including high levels of stress, performance anxiety and performance-related musculoskeletal conditions. Yoga and meditation techniques are therefore potentially useful practices for professional musicians.

Material/Methods: Musicians enrolled in a prestigious 2-month summer fellowship program were invited to participate in a regular yoga and meditation program at a yoga center during the course of the program. The 10 participants in the yoga program completed baseline and end-program questionnaires evaluating performance-related musculoskeletal conditions, performance anxiety, mood and flow experience. Fellows not participating in the yoga program were recruited to serve as controls and completed the same assessments (N=8).

Results: The yoga participants showed some improvements relative to control subjects on most measures, with the relative improvement in performance anxiety being the greatest.

Conclusions: The results from this preliminary study suggest that yoga and meditation may be beneficial as a routine practice to reduce performance anxiety in musicians.



YOGA REDUCES PERFORMANCE ANXIETY IN ADOLESCENT MUSICIANS


AUTHOR(S): Sat Bir S. Khalsa, Bethany Butzer, Stephanie M. Shorter, Kristen M. Reinhardt, and Stephen Cope

SOURCE: Alternative Therapies

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ABSTRACT: Professional musicians often experience high levels of stress, music performance anxiety (MPA), and performance-related musculoskeletal disorders (PRMDs). Given the fact that most professional musicians begin their musical training before the age of 12 (Nagel, 1987), it is important to identify interventions that will address these issues from an early age. The present study is the first to examine the effects of yoga on MPA and PRMDs in a group of adolescent musicians (mean age = 16 years). Participants took part in a 6-week yoga intervention (n = 84) or a no-treatment control condition (n = 51). Yoga participants showed significant baseline to end-program reductions on several measures of MPA; however, the results for PRMDs were inconsistent. The findings suggest that yoga is an effective and enjoyable way for adolescents to reduce MPA and perhaps even prevent it in the future.



MOVING BEYOND HEALTH TO FLOURISHING: THE EFFECTS OF YOGA TEACHER TRAINING


AUTHOR(S): L. A. Conboy, A. Wilson, and T. Braun

SOURCE: The Scientific World Journal

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ABSTRACT: Research in the medical and psychological fields has primarily followed a “disease-focused” approach to health. Although there is growing research on the components and outcomes of well-being, very few studies have focused on traditional practices that can be used as interventions to encourage human flourishing. The current study was developed to address this research gap. We suggest one effective method of increasing psychological well-being, the practice of yoga, an age-old practice that has been said to produce physical and psychological health. In this observational study, we examined associations with participation in a 4-week yoga teacher training resident program. Measurement instruments were chosen to capture changes in psychosocial health and human flourishing. Measurements were taken before the start of the program, immediately after the program, and 3 months postprogram. As expected, in this healthy population, the human flourishing scales showed more change than the psychosocial health scales. For example, in this healthy sample, there were no significant changes in perceived social support, quality of life, or self-efficacy from baseline to the 3-month follow-up. However, optimism, a positive psychology research measure, improved from baseline to follow-up. The mindfulness subscales of observation, awareness, and nonreactivity all improved following the training, suggesting that one benefit of yoga practice is a more refined ability to attend to one’s inner experience. This study adds to the growing literature focusing on interventions that move beyond relieving pathology to those that produce optimal functioning and human thriving.



AYURVEDA AND PANCHAKARMA: MEASURING THE EFFECTS OF A HOLISTIC HEALTH INTERVENTION


AUTHOR(S): Lisa Conboy, Ingrid Edshteyn, and Hilary Garivaltis

SOURCE: The Scientific World Journal

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ABSTRACT: Ayurveda, the traditional medical system of India, is understudied in western contexts. Using data gathered from an Ayurvedic treatment program, this study examined the role of psychosocial factors in the process of behavior change and the salutogenic process. This observational study examined associations with participation in the 5-day Ayurvedic cleansing retreat program, Panchakarma. Quality of life, psychosocial, and behavior change measurements were measured longitudinally on 20 female participants. Measurements were taken before the start of the program, immediately after the program, and 3 months postprogram. The program did not significantly improve quality of life. Significant improvements were found in self-efficacy towards using Ayurveda to improve health and reported positive health behaviors. In addition, perceived social support and depression showed significant improvements 3 months postprogram after the subjects had returned to their home context. As a program of behavior change, our preliminary results suggest that the complex intervention Panchakarma may be effective in assisting one’s expected and reported adherence to new and healthier behavior patterns.

Yoga and Research

PERCEIVED BENEFITS OF KRIPALU YOGA CLASSES IN DIVERSE AND UNDERSERVED POPULATIONS


AUTHOR(S): Angela Wilson, Kate Marchesiello, and Sat Bir Khalsa

SOURCE: International Journal of Yoga Therapy

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ABSTRACT:

Objective: To determine if diverse and underserved populations report benefit from Yoga practices and report an intention to continue with Yoga, meditation, or breathing practices.

Design: This was a retrospective study using archival data from exit questionnaires acquired at the end of Yoga programs serving diverse populations. Qualitative data was also collected from the Yoga teachers.

Setting: Free Kripalu Yoga classes offered to diverse and underserved/underprivileged populations (e.g., minority groups, the elderly, gay populations), as part of the Teaching for Diversity (TFD) program through the Kripalu Center for Yoga and Health (KCYH).

Participants: 220 participants, ranging in age from adolescence through old age.

Measures: Nine questions about the perceived benefits and usefulness of Yoga practices in everyday life were administered to participants on the last day of class. Qualitative data was collected from teachers regarding their experience teaching underserved populations.

Results: Of the 220 respondents, 89% reported that the Yoga class left them with a feeling of overall wellness, and 83% found the practices helpful. 98% reported that they would recommend this Yoga class to others. Participants found the individual Yoga components of the breathing, Yoga postures, and meditation practices effective and said they were useful in their daily life. Pairwise t-test comparisons of average scores between these three practices indicated that participants were more likely to rate breathing useful as compared to either the postures or meditation (p < 0.01).

Conclusion: Diverse and underserved populations report benefit from and interest in Yoga, meditation, and breathing practices.



WHY DO YOGA RESEARCH: WHO CARES AND WHAT GOOD IS IT?


AUTHOR(S): Sat Bir Khalsa

SOURCE: International Journal of Yoga Therapy

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ABSTRACT: Although IAYT’s publications include both original research and summaries of research published in other peer-reviewed journals, the question of why we should be involved in research on Yoga in the first place is a valid one. Full-time research on Yoga or Yoga therapy involves substantial resources both in labor and in costs. For example, a small Yoga therapy clinical trial grant from the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) requires substantial involvement of trained scientists and Yoga instructors and can cost the taxpayer over a half-million dollars. Yet all of this cost and effort will yield but one small publishable preliminary study. These resources might easily be devoted elsewhere for the public good, perhaps through providing more Yoga classes to underserved populations.



YOGA AS A THERAPEUTIC INTERVENTION: A BIBLIOMETRIC ANALYSIS OF PUBLISHED RESEARCH STUDIES


AUTHOR(S): Sat Bir Khalsa

SOURCE: Indian Journal of Physiology & Pharmacology

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ABSTRACT: Although yoga is historically a spiritual discipline, it has also been used clinically as a therapeutic intervention. A bibliometric analysis on the biomedical journal literature involving research on the clinical application of yoga has revealed an increase in publication frequency over the past 3 decades with a substantial and growing use of randomized controlled trials. Types of medical conditions have included psychopathological (e.g. depression, anxiety), cardiovascular (e.g. hypertension, heart disease), respiratory (e.g. asthma), diabetes and a variety of others. A majority of this research has been conducted by Indian investigators and published in Indian journals, particularly yoga specialty journals, although recent trends indicate increasing contributions from investigators in the U.S. and England. Yoga therapy is a relatively novel and emerging clinical discipline within the broad category of mind-body medicine, whose growth is consistent with the burgeoning popularity of yoga in the West and the increasing worldwide use of alternative medicine.

Yoga in the Schools

Qualitative Evaluation of a High School Yoga Program: Feasibility and Perceived Benefits


AUTHOR(S): Lisa A. Conboy, Jessica J. Noggle, Jessica L. Frey, Ravi S. Kudesia, Sat Bir S. Khalsa

SOURCE: EXPLORE: The Journal of Science & Healing

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ABSTRACT: This is the first published qualitative assessment of a yoga program applied in a high school setting. This qualitative interview study was nested in a randomized, controlled trial studying the effects of a yoga program offered in place of a semester of physical education classes at a rural public high school. Student interviews were conducted following a semester of the yoga program. A formal passive consent with information about the qualitative study was sent home to parents/guardians of all students in the parent study prior to the interviews. Most students enjoyed the yoga classes and felt benefits. Negative reports of yoga practice were associated with gender as most males sensed peer pressure against practicing yoga. Despite this finding, most students wanted to continue yoga and would continue if it were offered in school. Positive reports include a greater kinesthetic awareness, which some students association with a greater respect for the body, and improved self-image. Among students reporting psychological benefits, many cited stress reduction; many used yoga to manage negative emotions; some propagated more optimism. Most thought yoga could reduce interest in the use of drugs and alcohol and increase social cohesion with family and peers. We found that a yoga program is feasible in this sample of 9th and 10th graders, especially after benefits are perceived. We also found evidence that yoga may lead to emergent positive benefits in health behaviors not directly prescribed by the program. These results suggest that school-based yoga programs may be appropriate for promoting healthy behaviors at a societal level by focusing on the prevention of negative patterns during the adolescent transition.



Effects of a Yoga-Based Intervention for Young Adults on Quality of Life and Perceived Stress: The Potential Mediating Roles of Mindfulness and Self-Compassion


AUTHOR(S): Tim Gard, Narayan Brach, Britta K. Hölzel, Jessica J. Noggle, Lisa A. Conboy, Sara W. Lazar

SOURCE: The Journal of Positive Psychology

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ABSTRACT: The purpose of this pilot study was to investigate the effects of a yoga-based program on quality of life, perceived stress, mindfulness, and self-compassion in young adults. These variables were measured in 33 self-selected participants of a four-month residential yoga intervention before and after the program. Forty-three demographically matched controls completed the same questionnaires at two time points with a four-month interval in between. Participation in the program predicted increases in quality of life and decreases in perceived stress, mediated by mindfulness and self-compassion. Multiple mediator models revealed that the effect of group on quality of life was simultaneously mediated by mindfulness and self-compassion, while the effect of group on perceived stress was only mediated by self-compassion. These positive effects on perceived stress and quality of life suggest that yoga-based interventions may be of value in cultivating subjective well-being in young adults. Furthermore, yoga-based and mindfulness-based interventions may share underlying mechanisms.



Benefits of Yoga for Psychosocial Well-Being in a US High School Curriculum: A Preliminary Randomized Controlled Trial


AUTHOR(S): Jessica J. Noggle, Naomi J. Steiner, Takuya Minami, Sat Bir S. Khalsa

SOURCE: Journal of Developmental & Behavioral Pediatrics

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ABSTRACT: Objective: To test feasibility of yoga within a high school curriculum and evaluate preventive efficacy for psychosocial well-being. Methods: Grade 11 or 12 students (N = 51) who registered for physical education (PE) were cluster-randomized by class 2:1 yoga:PE-as-usual. A Kripalu Yoga program of physical postures, breathing exercises, relaxation, and meditation was taught two to three times a week for 10 weeks. Self-report questionnaires were administered to students one week before and after. Primary outcome measures of psychosocial well-being were Profile of Mood States—Short Form and Positive and Negative Affect Schedule for Children. Additional measures of psychosocial well-being included Perceived Stress Scale and Inventory of Positive Psychological Attitudes. Secondary measures of self-regulatory skills included Resilience Scale, State Trait Anger Expression Inventory-2™, and Child Acceptance Mindfulness Measure. To assess feasibility, yoga students completed a program evaluation. Analyses of covariance were conducted between groups with baseline as the covariate. Results: Although PE-as-usual students showed decreases in primary outcomes, yoga students maintained or improved. Total mood disturbance improved in yoga students and worsened in controls (p .015), as did Profile of Mood States-Short Form (POMS-SF) Tension-Anxiety subscale (p .002). Although positive affect remained unchanged in both, negative affect significantly worsened in controls while improving in yoga students (p .006). Secondary outcomes were not significant. Students rated yoga fairly high, despite moderate attendance. Conclusions: Implementation was feasible and students generally found it beneficial. Although not causal due to small, uneven sample size, this preliminary study suggests preventive benefits in psychosocial well-being from Kripalu Yoga during high school PE. These results are consistent with previously published studies of yoga in school settings.



Evaluation of the Mental Health Benefits of Yoga in a Secondary School: A Preliminary Randomized Controlled Trial


AUTHOR(S): Sat Bir S. Khalsa, Lynn Hickey-Schultz, Deborah Cohen, Naomi Steiner, Stephen Cope

SOURCE: The Journal of Behavioral Health Services and Research

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ABSTRACT: The goal of this study was to evaluate potential mental health benefits of yoga for adolescents in secondary school. Students were randomly assigned to either regular physical education classes or to 11 weeks of yoga sessions based upon the Yoga Ed program over a single semester. Students completed baseline and end-program self-report measures of mood, anxiety, perceived stress, resilience, and other mental health variables. Independent evaluation of individual outcome measures revealed that yoga participants showed statistically significant differences over time relative to controls on measures of anger control and fatigue/inertia. Most outcome measures exhibited a pattern of worsening in the control group over time, whereas changes in the yoga group over time were either minimal or showed slight improvements. These preliminary results suggest that implementation of yoga is acceptable and feasible in a secondary school setting and has the potential of playing a protective or preventive role in maintaining mental health.