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Effectiveness of a School-Based Yoga Program on Adolescent Mental Health and School Performance: Findings from a Randomized Controlled Trial

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The purpose of this study was to assess the effectiveness of a yoga-based social-emotional wellness promotion program, Transformative Life Skills (TLS), on indicators of adolescent emotional distress, prosocial behavior, and school functioning. Participants included 159 students attending an inner-city school district who were randomly assigned to treatment or business-as-usual comparison conditions. Results suggested that students who participated in the TLS program demonstrated significant reductions on unexcused absences, detentions, and increases in school engagement. Significant concurrent improvements in primary engagement stress-coping strategies and secondary engagement stress-coping strategies were noted as well. Specifically, significant increases in student emotion regulation, positive thinking, and cognitive restructuring in response to stress were found. No effects were found for measures of somatization, suspensions, academic grades, or general affect. Student report of treatment acceptability indicated that the intervention was generally well-received and strategies were perceived as socially valid by most participants. Implications and directions for future research are discussed.
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ORIGINAL PAPER
Effectiveness of a School-Based Yoga Program on Adolescent
Mental Health and School Performance: Findings
from a Randomized Controlled Trial
Jennifer L. Frank
1
&Kimberly Kohler
1
&Adam Peal
1
&Bidyut Bose
2
Published online: 25 October 2016
#Springer Science+Business Media New York 2016
Abstract The purpose of this study was to assess the effec-
tiveness of a yoga-based social-emotional wellness promotion
program, Transformative Life Skills (TLS), on indicators of
adolescent emotional distress, prosocial behavior, and school
functioning. Participants included 159 students attending an
inner-city school district who were randomly assigned to treat-
ment or business-as-usual comparison conditions. Results sug-
gested that students who participated in the TLS program dem-
onstrated significant reductions on unexcused absences, deten-
tions, and increases in school engagement. Significant concur-
rent improvements in primary engagement stress-coping strat-
egies and secondary engagement stress-coping strategies were
noted as well. Specifically, significant increases in student emo-
tion regulation, positive thinking, and cognitive restructuring in
response to stress were found. No effects were found for mea-
sures of somatization, suspensions, academic grades, or general
affect. Student report of treatment acceptability indicated that
the intervention was generally well-received and strategies
were perceived as socially valid by most participants.
Implications and directions for future research are discussed.
Keywords Mindfulness .Yog a .Randomized controlled
trial .RCT .Engagement .Coping .Stress .Student .Emotion
regulation .Positive thinking .Somatization .Suspensions .
Academic .Grades .Affect .Asanas .Breathing .
Pranayama .Schools .Education .Stress .Adolescent
Introduction
Recent national surveys of mental health in the USA
suggest that poorly managed stress exerts a seriously
negative physical and psychological effect on our popu-
lation, which a majority of households reporting stress
levels exceeding what is considered healthy (American
Psychological Association 2013). Adolescence, a period
of development marked by substantial developmental
gains in cognitive skills, physical strength, and improved
immune function (Dahl 2004), may be a particularly sen-
sitive time during which the effects of chronic stress take
hold, manifesting in anxiety disorders which affects an
estimated 31.9 % of this population (Merikangas et al.
2010).
Heightened vulnerability for developing several serious
psychological disorders and engaging in anti-social be-
haviors, depression, anxiety, schizophrenia, and substance
use markedly increases in prevalence during adolescence
(Andersen 2003; Conger and Petersen 1984;Dahl2004;
Patton and Viner 2007; Spear 2000). Although the specif-
ic mechanisms underlying the development of each of
these disorders during this timeframe is not entirely un-
derstood, exposure to stress during adolescence has been
suggested to play an important role in the onset and pro-
gression of these disorders (Grant et al. 2003,2004;
Turner and Lloyd 2004). Additionally, research has con-
sistently linked stressful life events during adolescence
with the onset of drug use, depression, and the develop-
ment of other mental health problems (Costello et al.
2003;PattonandViner2007).
Even fairly normative stress is heightened during this
period. During the middle school years, an adolescents
teacher, classroom, and school experiences have impor-
tant effects that set the stage for future educational and
*Jennifer L. Frank
jfrank@psu.edu
1
Department of Educational Psychology, Counseling, and Special
Education, Pennsylvania State University, 308 Cedar Building,
University Park, PA 16808, USA
2
Niroga Institute, Oakland, CA, USA
Mindfulness (2017) 8:544553
DOI 10.1007/s12671-016-0628-3
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... As the literature demonstrates, yoga appears to provide various benefits for middle-school students. It also appears acceptable and feasible to implement yoga practice for at-risk adolescents in middle school settings (Frank et al., 2017;Hagins et al., 2013;Kwasky & Serowoky, 2018;McMahon et al., 2021). A great deal can be learned from reviewing how middle schools have implemented yoga programs in previous studies. ...
... The studies reviewed were categorized in terms of the time during the school day when yoga was implemented. Yoga was most frequently implemented while school was in session (45%); this was done in English, Homeroom, and Physical Education classes, or interspersed throughout the school day (Bergen-Cico et al., 2015;Butzer, LoRusso, Windsor et al., 2017;Frank et al., 2017;Hagins et al., 2013;Rangan et al., 2008). Two studies implemented yoga after school (Kwasky & Serowoky, 2018;McMahon et al., 2021). ...
... The middle school studies we reviewed differed in terms of how students of different genders were involved. Most studies (64%) combined genders for their yoga classes (Banerjee, 2014;Bergen-Cico et al., 2015;Bhardwaj & Agrawal, 2013;Butzer, LoRusso, Windsor et al., 2017;Frank et al., 2017;Hagins et al., 2013;Jain, 2019 ...
Article
Full-text available
Middle school is a time of adjustments in youth: physical, intellectual, and social changes often result in stress. Middle school students are vulnerable to academic, behavioral, and mental health problems. Yoga is an Indian discipline practiced for health and relaxation. School-based yoga programs are becoming increasingly common given their potential benefits for students. We conducted a literature review of studies of middle school-based yoga programs, focusing on the reported benefits for students. We identified and retrieved 12 studies from electronic databases including Education Resources Information Center, PsycINFO, and Google Scholar that met inclusion criteria: (a) examined the benefits of yoga as the primary intervention conducted in a middle school setting with students ages 10 to 15 years old, (b) was published by June 2022, (c) was reviewed either by a journal editorial board or by a student's dissertation or thesis committee, (d) was available in English, and (e) a full text copy was available. Results of studies were synthesized by clustering findings into common domains. Study results suggested that middle school-based yoga interventions showed mental health, executive functioning, physical, social, and academic benefits for students. Yoga also showed benefits for middle school students who were stressed, anxious, or depressed, and those at risk. We provide considerations for those contemplating the implementation of yoga in middle schools.
... Sixteen trials investigated the effects of practising yoga on stress, thirteen on anxiety and five trials on self-esteem (Bhardwaj and Agrawal, 2013;Butzer et al., 2017;Conboy et al., 2013;Telles et al., 2013;White, 2012), twelve trials on depression symptoms (mood) (Bazzano et al., 2018;Butzer et al., 2017;Conboy et al., 2013;Fishbein et al., 2016;Frank et al., 2017;Gaurav et al., 2013;Haden et al., 2014;Halliwell et al., 2018;Khalsa et al., 2012;Mendelson et al., 2010;Noggle et al., 2012;Velásquez et al., 2015), ten trials on anger/self-regulation and five trials on body awareness (Bhardwaj and Agrawal, 2013;Butzer et al., 2017;Daly et al., 2015;Halliwell et al., 2018;Khalsa et al., 2012). Ten trials were classified as having a high risk of bias, and twelve trials with some concerns. ...
... Four trials used Kripalu yoga (Butzer et al., 2017;Conboy et al., 2013;Khalsa et al., 2012;Noggle et al., 2012); Bazzano et al. (2018) used Yoga Education Ashtanga Vinyasa (Bazzano et al., 2018), two trials used Hatha Yoga (Fishbein et al., 2016;Quach et al., 2016), Velásquez et al., (2015) used the Satyananda Yoga tradition. Frank et al. (2017) used Transformative Life Skills (TLS), a yoga and mindful awareness-based program. Haden et al. (2014) used Ashtanga-informed yoga practice that consisted of physical postures, breathing practices, and relaxation techniques, including short meditation practices and class rules that reflected yoga's moral and ethical components. ...
... The evidence regarding yoga interventions in children shows promise; however, it has methodological limitations, including small samples and little detail regarding the intervention. In some studies where the yoga practice was beneficial for the students, the study sessions were short or condensed and lasted 30 minutes (Anusuya et al., 2021;Conboy et al., 2013;Frank et al., 2017;Haden et al., 2014;Noggle et al., 2012). The recommended time for yoga is 45 minutes to 1 hour (Pandit & Satish, 2014). ...
Article
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It is becoming increasingly common for frontline clinicians to see children and teenagers struggle with their mental health. Since mental health issues have increased over the past ten years in the UK, they are now the leading cause of disability and cost the British economy £105 billion annually. The review discusses the evidence base underpinning the effect of yoga on children's mental health and summarises the results of 21 research papers. The Cumulative Index to Nursing and Allied Health Literature, PsycINFO, ERIC, Web of Science, PubMed, Medline and Cochrane Library were searched through Ovid from January 2008 until May 2022. The keywords 'yoga OR mindfulness - AND school AND children OR child OR youth OR adolescent' were used. The search was limited to studies in the English language. The quality of each study was rated against Version 2 of the Cochrane risk-of-bias tool for randomised control trials and a set of inclusion and exclusion criteria. The evidence for yoga therapies in children is encouraging, although studies include methodological flaws such as small sample sizes and sparse information on interventions. This review has highlighted that yoga interventions may be implemented in schools as a preventative and therapeutic measure for mental health issues.
... Eight of the 15 studies which generated quantitative findings explored the outcomes of stress, anxiety, depression and emotion regulation (Beets, 2010;Felver, 2015;Frank, 2017;Noggle, 2012;Schulte, 2015;and Weaver, 2019). Six of these reported difference means, pooled standard deviations and effect sizes (Cohen's d) or reported the relevant data from which to calculate these statistics and were included in the statistical meta-analyses. ...
... See Figure 11. The other two studies did not report any significant effects by gender on measures including; school engagement, student academic and behavioural measures, attitudes towards violence, positive and negative affect, responses to stress, somatisation, self-report of personality, mood, resilience, perceived stress and positive psychological attitudes (Frank et al, 2017 andKhalsa et al, 2012). ...
... could not be computed for theFishbein (2015) study as they did not report the means pre-post intervention. The measures used in theFrank (2017) study along with one of the measures in the Butzer et al(2017)study found increases in emotion regulation for the yoga group and are plotted in Figure 7. Butzer et al (2017) also measured emotion dysregulation and these findings are plotted in Figure 8. As can be seen, all measures indicated an increase in emotion regulation pre-post the yoga intervention, with the control demonstrating a decrease. ...
Thesis
Yoga has been found to improve mental health conditions in adults with preliminary research into its effects on children and young people showing promise. Primary studies exploring the impact of school-based yoga interventions have generated positive albeit small findings for mental health, including improved mood and stress reduction. Previous reviews have focused on a range of outcomes including cognitive, psychological and physical, across both child and adolescent populations. Gard et al (2014) formulated a theoretical model proposing the regulatory mechanisms via which yoga mediates the stress response. This review aims to update the findings from previous systematic reviews investigating the effects of yoga on mental health outcomes and seeks to include current UK based research. It explores the impact of school-based yoga on quantitative mental health outcomes in adolescence using statistical meta-analysis to estimate a pooled effect size. It seeks to synthesise the findings from qualitative research exploring adolescents’ experiences of school-based yoga. It considers whether yoga may impact on mental health outcomes differentially according to gender. The process outlined by Petticrew and Roberts (2006) for conducting a systematic review was utilised. The GRADE method and TAPUPAS frameworks were used to critically appraise studies. A narrative synthesis was conducted to reflect the quantitative findings across studies reviewed including differential gender effects with a statistical meta-analysis using Stata (Version 17) employed to estimate the overall pooled effect size for specific mental health outcomes Thematic Analysis informed by Braun and Clarke (2006) was conducted to analyse qualitative studies with a secondary analysis performed by gender. These findings were then synthesised narratively. Research exploring anxiety, depression, stress and emotion regulation was appraised as being of low to very low quality and the strength of any recommendations made about the suitability of using yoga to support these outcomes in adolescence is weak. Trends in the data suggest marginally increased beneficial effects for the yoga condition for the majority of outcomes, with most studies employing a PE control. The statistical meta-analysis generated a non-significant pooled effect size of theta 0.20. Some differences were found between males and females, with emotion regulation increasing more for females than males after yoga compared with PE. The qualitative analysis yielded some favourable findings with the following themes emerging: yoga and emotion regulation, cognitive impact including enhanced mindfulness, yoga as stress reducing/relaxation inducing, integration between the mind, the body and the breath and interpersonal benefits. Females were more likely to identify that yoga reduced feelings of stress than males, yet teachers were more likely to observe this in males rather than females. Only females identified that yoga helped them to feel more connected to others. Conversely, teachers identified males as demonstrating improved social communication and interaction, but not for females. Overall, males and females were found to enjoy PE and cited a number of physical benefits, however only females reported a preference of PE over yoga. A minority of students reported that yoga did not really help with stress or emotion regulation, that they had not enjoyed yoga or that yoga had not supported their physical wellbeing. Trends in the quantitative data alongside the qualitative findings provide partial support for Gard et al’s (2014) framework, notably that feedback from students suggests that yoga may improve cognitive, top-down skills comparable with mindfulness, combined with the use of breathing practices to support their self-regulation in a bottom-up way.
... Nine experimental studies assessed either subjective or psychological well-being outcomes as part of an SBYP and found significant improvements including quality of life [53], mood [61,74], positive affect [70,98], negative affect [70,74], happiness [71], satisfaction [71], and non-significant improvements in positive affect [63,67] and negative affect [63,97]. However, a number of studies failed to find any significant improvements in negative affect [64], positive affect [64,74], or well-being measures [68,82]. Furthermore, Haden et al. [67] and Sarkissian et al. [98] reported increases in negative affect following an SBYP. ...
... Nine experimental studies assessed either subjective or psychological well-being outcomes as part of an SBYP and found significant improvements including quality of life [53], mood [61,74], positive affect [70,98], negative affect [70,74], happiness [71], satisfaction [71], and non-significant improvements in positive affect [63,67] and negative affect [63,97]. However, a number of studies failed to find any significant improvements in negative affect [64], positive affect [64,74], or well-being measures [68,82]. Furthermore, Haden et al. [67] and Sarkissian et al. [98] reported increases in negative affect following an SBYP. ...
... Experimental studies found significant improvements in academic performance as a result of an SBYP [57,68,81,84], whereas two studies [59,85] found improvements in academic performance but not at a statistically significant level. Contrary to this, Frank et al.'s [64] results showed no significant differences in academic achievements compared to the control groups. Another study [56] did not find direct improvement in GPA (grade point average) scores; however, they suggested that an SBYP may have had a preventive effect by reducing declines in GPA over time, especially compared to the control who revealed a steeper downward trend in GPA. ...
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... Dies ließ sich nicht zuletzt mittels des SSKJs aufgrund des Programms ‚AISCHU feststellen (Vgl. Kohls & Sauer, 2012 Cico et al., 2015;Butzer et al., 2015;Felver et al., 2015;Frank et al., 2017;Khalsa et al., 2012;Metri, 2018;Saxena et al., 2020;Thoma & Neumüller-Rauscher, 2021 et al. und Sheinman et al. übereinstimmen (Vgl. Gould et al., 2012;Sheinman et al., 2018). ...
Thesis
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Das Ziel dieser Masterarbeit ist es, die Auswirkungen einer achtsamkeitsbasierten Intervention auf das Stresserleben und die Stressbewältigungsstrategien von Schüler*innen der Sekundarstufe I zu erforschen. Dazu wurde eine quantitative Studie mit 59 Proband*innen durchgeführt. Die Schüler*innen der 5., 7. und 10. Klasse der Realschule Bramsche führten über zwei Monate wöchentlich 15-25 minütige Hatha-Yoga-Einheiten sowie Progressive Muskelentspannung durch. Zur Messung möglicher Auswirkungen beantworteten die Schüler*innen den Fragebogen zur Erhebung von Stress und Stressbewältigung im Kindes- und Jugendalter (SSKJ 3-8). Die Erhebung wurde zu zwei Zeitpunkten durchgeführt, einmal vor der Intervention und nach der Intervention. In Einklang mit bereits vorhandenen Forschungsergebnissen weisen die erhobenen Daten eine signifikante Abnahme der ‚Stressvulnerabilität‘ sowie physischer und psychischer Stresssymptome infolge der Intervention auf. Zudem konnte eine Zunahme der ‚konstruktiv-palliativen Emotionsregulation‘ nachgewiesen werden. Dies zeigt, dass der Einbezug achtsamkeitsbasierter Techniken in den Schulalltag positive Auswirkungen auf die stressbedingte Gesundheit der Schüler*innen der Sekundarstufe I hat. Auf dieser Grundlage ist die Überprüfung dieser Auswirkungen sowie deren Persistenz im größeren Stil innerhalb der Sekundarstufe I als empfehlenswert anzusehen.
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