Advertisement

Feasibility, Acceptability, and Effects of Gentle Hatha Yoga for Women With Major Depression: Findings From a Randomized Controlled Mixed-Methods Study

Published:April 11, 2013DOI:https://doi.org/10.1016/j.apnu.2013.01.003
      Major depressive disorder (MDD) is a common, debilitating chronic condition in the United States and worldwide. Particularly in women, depressive symptoms are often accompanied by high levels of stress and ruminations, or repetitive self-critical negative thinking. There is a research and clinical imperative to evaluate complementary therapies that are acceptable and feasible for women with depression and that target specific aspects of depression in women, such as ruminations. To begin to address this need, we conducted a randomized, controlled, mixed-methods community-based study comparing an 8-week yoga intervention with an attention-control activity in 27 women with MDD. After controlling for baseline stress, there was a decrease in depression over time in both the yoga group and the attention-control group, with the yoga group having a unique trend in decreased ruminations. Participants in the yoga group reported experiencing increased connectedness and gaining a coping strategy through yoga. The findings provide support for future large scale research to explore the effects of yoga for depressed women and the unique role of yoga in decreasing rumination.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Psychiatric Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Agar M.
        Speaking of ethnography.
        Sage Publications, Inc., Thousand Oaks, CA1986
        • Alexander G.K.
        • Taylor A.G.
        • Innes K.E.
        • Kulbok P.
        • Selfe T.K.
        Contextualizing the effects of yoga therapy on diabetes management: A review of the social determinants of physical activity.
        Family & Community Health. 2008; 31: 228-239
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders: Fourth edition, text revision (DSM-IV-TR).
        4th ed. American Psychiatric Association, Arlington, VA2000
        • Atkinson N.L.
        • Permuth-Levine R.
        Benefits, barriers, and cues to action of yoga practice: A focus group approach.
        American Journal of Health Behavior. 2009; 33: 3-14
        • Barnes P.M.
        • Bloom B.
        • Nahin R.L.
        Complementary and alternative medicine use among adults and children: United States, 2007.
        National Health Statistics Reports. 2009; 12: 1-23
        • Beal C.C.
        • Stuifbergen A.
        • Volker D.
        • Becker H.
        Women's experiences as members of attention control and experimental intervention groups in a randomized controlled trial.
        Canadian Journal of Nursing Research. 2009; 41: 16-31
        • Bennett S.
        • Weintraub A.
        • Khalsa S.
        Initial evaluation of the LifeForce yoga program as a therapeutic intervention for depression.
        International Journal of Yoga Therapy. 2008; 28: 49-57
        • Benson H.
        The relaxation response.
        Avon Books, New York1975
        • Birdee G.S.
        • Legedza A.T.
        • Saper R.B.
        • Bertisch S.M.
        • Eisenberg D.M.
        • Phillips R.S.
        Characteristics of yoga users: Results of a national survey.
        Journal of General Internal Medicine. 2008; 23: 1653-1658
        • Branchi I.
        • Schmidt M.
        In search of the biological basis of mood disorders: Exploring out of the mainstream.
        Psychoneuroendocrinology. 2011; 36: 305-307
        • Broota A.
        • Dhir R.
        Efficacy of two relaxation techniques in depression.
        Journal of Personality and Clinical Studies, India1990
        • Brown R.P.
        • Gerbarg P.L.
        Sudarshan kriya yogic breathing in the treatment of stress, anxiety, and depression. part II—Clinical applications and guidelines.
        Journal of Alternative and Complementary Medicine. 2005; 11: 711-717
        • Brown R.P.
        • Gerbarg P.L.
        Sudarshan kriya yogic breathing in the treatment of stress, anxiety, and depression: Part I—Neurophysiologic model.[erratum appears in J altern complement med. 2005 apr;11(2):383–384].
        Journal of Alternative and Complementary Medicine. 2005; 11: 189-201
        • Brown R.P.
        • Gerbarg P.L.
        Yoga breathing, meditation, and longevity.
        Annals of the New York Academy of Sciences. 2009; 1172: 54-62
        • Burwell R.A.
        • Shirk S.R.
        Subtypes of rumination in adolescence: Associations between brooding, reflection, depressive symptoms, and coping.
        Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53. 2007; 36: 56-65
        • Butler L.D.
        • Waelde L.C.
        • Hastings T.A.
        • Chen X.H.
        • Symons B.
        • Marshall J.
        • et al.
        Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: A randomized pilot trial.
        Journal of Clinical Psychology. 2008; 64: 806-820
        • Cohen M.
        • Kahn D.
        • Steeves R.
        Hermeneutic phenomenological research: A practical guide for nurse researchers.
        Sage Publications, Inc., Thousand Oaks, CA2000
      1. Cohen, S. (1994). Perceived stress scale. Retrieved February 2, 2010, from www.mindgarden.com/docs/PerceivedStressScale.pdf.

        • Cohen S.
        • Williamson G.
        Perceived stress in a probability sample of the United States.
        in: Oskamp S. Spacapan S. The social psychology of health. Sage Publications, Inc., Thousand Oaks, CA1988: 31-67
        • Cohen S.
        • Tyrrell D.A.
        • Smith A.P.
        Negative life events, perceived stress, negative affect, and susceptibility to the common cold.
        Journal of Personality and Social Psychology. 1993; 64: 131-140
        • Conway M.
        • Csank P.A.R.
        • Holm S.L.
        • Blake C.K.
        On assessing individual differences in rumination on sadness.
        Journal of Personality Assessment. 2000; 75: 404-425
        • Cotter K.A.
        • Lachman M.E.
        No strain, no gain: Psychosocial predictors of physical activity across the adult lifespan.
        Journal of Physical Activity and Health. 2010; 7: 584-594
        • Crane C.
        • Barnhofer T.
        • Williams J.M.
        Reflection, brooding, and suicidality: A preliminary study of different types of rumination in individuals with a history of major depression.
        British Journal of Clinical Psychology. 2007; 46: 497-504
        • Cuijpers P.
        • van Straten A.
        • Schuurmans J.
        • van Oppen P.
        • Hollon S.D.
        • Andersson G.
        Psychotherapy for chronic major depression and dysthymia: A meta-analysis.
        Clinical Psychology Review. 2010; 30: 51-62
        • Curley J.P.
        • Jensen C.L.
        • Mashoodh R.
        • Champagne F.A.
        Social influences on neurobiology and behavior: Epigenetic effects during development.
        Psychoneuroendocrinology. 2011; 36: 352-371
        • Davis L.
        • Broome M.
        • Cox R.
        Maximizing retention in community-based clinical trials.
        Journal of Nursing Scholarship. 2002; 34: 47-53
        • Deary L.
        • Roche J.
        • Plotkin K.
        • Zahourek R.
        Intentionality and hatha yoga: An exploration of the theory of intentionality, the matrix of healing- a growth model.
        Holistic Nursing Practice. 2011; 25: 246-253
        • Derogatis L.
        • Melisaratos N.
        The brief symptom inventory: An introductory report.
        Psychological Medicine. 1983; 13: 595-605
        • Desikachar K.
        • Bragdon L.
        • Bossart C.
        The yoga of healing: Exploring yoga's holistic model for health and well-being.
        International Journal of Yoga Therapy. 2005; 15: 17-39
        • Doyle L.
        • Brady A.
        • Byrne G.
        An overview of mixed-methods research.
        Journal of Nursing Research. 2009; 14: 175-185
        • Gross C.R.
        • Kreitzer M.J.
        • Thomas W.
        • Reilly-Spong M.
        • Cramer-Bornemann M.
        • Nyman J.A.
        • et al.
        Mindfulness-based stress reduction for solid organ transplant recipients: A randomized controlled trial.
        Alternative Therapies in Health and Medicine. 2010; 16: 30-38
        • Halbreich U.
        • Kahn L.S.
        Atypical depression, somatic depression and anxious depression in women: Are they gender-preferred phenotypes?.
        Journal of Affective Disorders. 2007; 102: 245-258
        • Hauenstein E.J.
        A nursing practice paradigm for depressed rural women: Theoretical basis.
        Archives of Psychiatric Nursing. 1996; 10: 283-292
        • Hewitt P.L.
        • Flett G.L.
        • Mosher S.W.
        The perceived stress scale: Factor structure and relation to depression symptoms in a psychiatric sample.
        Journal of Psychopathology and Behavioral Assessment. 1992; 14: 247-257
        • Innes K.E.
        Abstracts from the North American Research Conference on Complementary and Integrative Medicine. May 12-15, 2009. Minneapolis, MN.
        Journal of Alternative and Complementary Medicine (New York, N.Y.). 2009; 15: 446-458
        • Janakiramaiah N.
        • Gangadhar B.N.
        • Naga Venkatesha Murthy P.J.
        • Harish M.G.
        • Subbakrishna D.K.
        • Vedamurthachar A.
        Antidepressant efficacy of sudarshan kriya yoga (SKY) in melancholia: A randomized comparison with electroconvulsive therapy (ECT) and imipramine.
        Journal of Affective Disorders. 2000; 57: 255-259
        • Keita G.P.
        Psychosocial and cultural contributions to depression in women: Considerations for women midlife and beyond.
        Journal of Managed Care Pharmacy: JMCP. 2007; 13: S12-S15
        • Kendler K.S.
        • Thornton L.M.
        • Gardner C.O.
        Stressful life events and previous episodes in the etiology of major depression in women: An evaluation of the “kindling” hypothesis.
        The American Journal of Psychiatry. 2000; 157: 1243-1251
        • Kessler R.
        • Berglund P.
        • Demler O.
        • Jin R.
        • Koretz D.
        • Merikangas K.
        • et al.
        The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R).
        Journal of the American Medical Association. 2003; 289: 3095-3105
        • Kinser P.A.
        • Goehler L.E.
        • Taylor A.G.
        How might yoga help depression? A neurobiological perspective.
        EXPLORE: The Journal of Science and Healing. 2012; 8: 118-126
        • Kirkwood G.
        • Rampes H.
        • Tuffrey V.
        • Richardson J.
        • Pilkington K.
        Yoga for anxiety: A systematic review of the research evidence.
        British Journal of Sports Medicine. 2005; 39: 884-891
        • Kroenke K.
        • Spitzer L.
        • Williams J.
        MOS short-form general health survey.
        Journal of General Internal Medicine. 2001; 16: 606-613
        • Lafrance M.N.
        • Stoppard J.M.
        Constructing a non-depressed self: Women's accounts of recovery from depression.
        Feminism & Psychology. 2006; 16: 307-325
        • Lengacher C.A.
        • Gonzalez L.L.
        • Giuliano R.
        • Bennett M.P.
        • Cox C.E.
        • Reintgen D.S.
        The process of clinical trials: A model for successful clinical trial participation.
        Oncology Nursing Forum. 2001; 28: 1115-1120
        • Lindquist R.
        • Wyman J.F.
        • Talley K.
        • Findorff M.J.
        • Gross C.R.
        Design of control-group conditions in clinical trials of behavioral interventions.
        Journal of Nursing Scholarship. 2007; 39: 214-221
        • Logsdon M.C.
        • Hutti M.H.
        Readability: An important issue impacting healthcare for women with postpartum depression.
        MCN: The American Journal of Maternal Child Nursing. 2006; 31: 350-355
        • Lopez C.M.
        • Driscoll K.A.
        • Kistner J.A.
        Sex differences and response styles: Subtypes of rumination and associations with depressive symptoms.
        Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53. 2009; 38: 27-35
        • Löwe B.
        • Kroenke K.
        • Herzog W.
        • Gräfe K.
        Measuring depression outcome with a brief self-report instrument: Sensitivity to change of the patient health questionnaire (PHQ-9).
        Journal of Affective Disorders. 2004; 81: 61-66
        • Lox C.L.
        • Martin K.A.
        • Petruzzello S.J.
        Physical activity interventions.
        in: The psychology of exercise: Integrating theory and practice. 2nd ed. Holcomb Hathaway, Scottsdale, AZ2006: 147-218
        • Luyten P.
        • Blatt S.J.
        • Van Houdenhove B.
        • Corveleyn J.
        Depression research and treatment: Are we skating to where the puck is going to be?.
        Clinical Psychology Review. 2006; 26: 985-999
        • Lyubomirsky S.
        • Tkach C.
        The consequences of dysphoric rumination.
        in: Papageorgiou C. Wells A. Depressive rumination: Nature, theory, and treatment (). John Wiley & Sons Ltd., Chicester, England2004
        • Marcus S.M.
        • Kerber K.B.
        • Rush A.J.
        • Wisniewski S.R.
        • Nierenberg A.
        • Balasubramani G.K.
        • et al.
        Sex differences in depression symptoms in treatment-seeking adults: Confirmatory analyses from the sequenced treatment alternatives to relieve depression study.
        Comprehensive Psychiatry. 2008; 49: 238-246
        • Mather A.
        • Rodriguez C.
        • Guthrie M.
        • McHarg A.
        • Reid I.
        • McMurdo M.
        Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder: Randomised controlled trial.
        The British Journal of Psychiatry. 2002; 180: 411-415
        • Mathew S.J.
        • Charney D.S.
        Publication bias and the efficacy of antidepressants.
        The American Journal of Psychiatry. 2009; 166: 140-145
        • Mead G.
        • Morley W.
        • Campbell P.
        • Greig C.
        • McMurdo M.
        • Lawlor D.
        Exercise for depression.
        Cochrane Database of Systematic Reviews. 2009; 3 (CD004366)
        • Morrison R.
        • O'Connor R.
        A systematic review of the relationship between rumination and suicidality.
        Suicide and Life-Threatening Behavior. 2008; 38: 523-538
      2. National Center for Complementary and Alternative Medicine (NCCAM). (2010). About yoga. Retrieved 9/26, 2010, from http://nccam.nih.gov/health/yoga/.

      3. National Institute of Mental Health, National Advisory Mental Health Council, National Institutes of Health. (2005). Treatment research in mental illness: Improving the nation's public mental health care through NIMH funded interventions research. Report of the National Advisory Mental Health Council's Workgroup on Clinical Trials. U.S. Department of Health and Human Services. Retrieved from http://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/interventions-research.pdf.

        • Nolen-Hoeksema S.
        The etiology of gender differences in depression.
        in: Keita G.P. Understanding depression in women: Applying empirical research to practice and policy. American Psychological Association, Washington, DC,US2006: 9-43
        • Nolen-Hoeksema S.
        • Hilt L.M.
        Gender differences in depression.
        in: Hammen C.L. Handbook of depression. 2nd ed. Guilford Press, New York, NY,US2009: 386-404
        • Nolen-Hoeksema S.
        • Wisco B.E.
        • Lyubomirsky S.
        Rethinking rumination.
        Perspectives on Psychological Science. 2008; 3: 400-424
        • Pigott H.
        • Leventhal A.
        • Alter G.
        • Boren J.
        Efficay and effectiveness of antidepressants: Current status of research.
        Psychotherapy and Psychosomatics. 2010; 79: 267-279
        • Pilkington K.
        • Kirkwood G.
        • Rampes H.
        • Richardson J.
        Yoga for depression: The research evidence.
        Journal of Affective Disorders. 2005; 89: 13-24
        • Sandelowski M.
        Whatever happened to qualitative description?.
        Research in Nursing and Health. 2000; 23: 334-340
        • Segrin C.
        • Rynes K.N.
        The mediating role of positive relations with others in associations between depressive symptoms, social skills, and perceived stress.
        Journal of Research in Personality. 2009; 43: 962-971
        • Sharma V.K.
        • Das S.
        • Mondal S.
        • Goswampi U.
        • Gandhi A.
        Effect of sahaj yoga on depressive disorders.
        Indian Journal of Physiology and Pharmacology. 2005; 49: 462-468
        • Sheehan D.V.
        • Lecrubier Y.
        • Sheehan K.H.
        • Amorim P.
        • Janavs J.
        • Weiller E.
        • et al.
        The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.
        The Journal of Clinical Psychiatry. 1998; 59 ([quiz 34-57]): 22-33
        • Smith J.M.
        • Alloy L.B.
        A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct.
        Clinical Psychology Review. 2009; 29: 116-128
        • Son J.
        • Kerstetter D.
        • Mowen A.
        • Payne L.
        Global self-regulation and outcome expectations: Influences on constraint self-regulation and physical activity.
        Journal of Aging and Physical Activity. 2009; 17: 307-326
        • Sparrowe L.
        • Walden P.
        The woman's book of yoga and health: A lifelong guide to wellness.
        Shambala, Boston, MA2002
        • Spielberger C.
        • Gorsuch R.
        • Lushene R.
        State-trait anxiety inventory.
        Consulting Psychologists Press, Palo Alto, CA1970
        • Spielberger C.D.
        State-Trait Anxiety Inventory (STAI). Mind Garden, Menlo Park, CA1983
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.W.
        • the Patient Health Questionnaire Primary Care Study Group
        Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study.
        JAMA: The Journal of the American Medical Association. 1999; 282: 1737-1744
        • Street L.L.
        • Luoma J.B.
        Control groups in psychosocial intervention research: Ethical and methodological issues.
        Ethics & Behavior. 2002; 12: 1-30
        • Taylor A.
        • Goehler L.
        • Galper D.
        • Innes K.
        • Bourguignon C.
        Top-down and bottom-up mechanisms in mind–body medicine: Development of an integrative framework for psychophysiological research.
        Explore. 2010; 6: 29-41
        • Tilton S.R.
        Review of the State-Trait Anxiety Inventory (STAI).
        NewsNotes. 2008; 48 (June 2, 2010)
        • Treynor W.
        • Gonzalez R.
        • Nolen-Hoeksema S.
        Rumination reconsidered: A psychometric analysis.
        Cognitive Therapy and Research. 2003; 27: 247-259
        • Trivedi M.H.
        • Greer T.L.
        • Grannemann B.D.
        • Church T.S.
        • Galper D.I.
        • Sunderajan P.
        • et al.
        TREAD: Treatment with exercise augmentation for depression: Study rationale and design.
        Clinical Trials. 2006; 3: 291-305
        • Turner E.H.
        • Matthews A.M.
        • Linardatos E.
        • Tell R.A.
        • Rosenthal R.
        Selective publication of antidepressant trials and its influence on apparent efficacy.
        The New England Journal of Medicine. 2008; 358: 252-260
        • Uebelacker L.A.
        • Epstein-Lubow G.
        • Gaudiano B.A.
        • Tremont G.
        • Battle C.L.
        • Miller I.W.
        Hatha yoga for depression: Critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research.
        Journal of Psychiatric Practice. 2010; 16: 22-33
        • Uebelacker L.A.
        • Tremont G.
        • Epstein-Lubow G.
        • Gaudiano B.A.
        • Gillette T.
        • Kalibatseva Z.
        • et al.
        Open trial of vinyasa yoga for persistently depressed individuals: Evidence of feasibility and acceptability.
        Behavior Modification. 2010; 34: 247-264
        • Vealey R.S.
        Mental skills training in sport.
        in: Tenenbaum G. Eklund R.C. Handbook of sport psychology. 3rd ed. John Wiley & Sons, Hoboken, NJ2007: 287-309
        • Weinstein N.
        • Brown K.W.
        • Ryan R.M.
        A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being.
        Journal of Research in Personality. 2009; 43: 374-385
        • Weintraub A.
        Yoga for depression: A compassionate guide to relieve suffering through yoga.
        Broadway Books, New York, NY2004
        • Weintraub A.
        • Duncan D.
        LifeForce yoga to beat the blues: Level 1.
        [Video/DVD] Pennsauken, NJ: Disc Makers2007
        • Whaley D.E.
        Seeing isn't always believing: Self-perceptions and physical activity behaviors in adults.
        in: Weiss M.R. Developmental sport and exercise psychology: A lifespan perspective. Fitness Information Technology, Morgantown, WV2004: 289-311
        • Williams K.L.G.
        • Renee V.
        Predicting depression and self-esteem from social connectedness, support, and competence.
        Journal of Social and Clinical Psychology. 2006; 25: 855-874
        • Williams J.M.
        • Russell I.T.
        • Crane C.
        • Russell D.
        • Whitaker C.J.
        • Duggan D.S.
        • et al.
        Staying well after depression: Trial design and protocol.
        BMC Psychiatry. 2010; 10: 23