The Effects of Yoga on Mood in Psychiatric Inpatients

Abstract

The effects of yoga on mood were examined in 13 psychiatric inpatients at New Hampshire Hospital. Participants completed the Profile of Mood States (POMS) prior to and following participation in a yoga class. Analyses indicated that participants reported significant improvements on all five of the negative emotion factors on the POMS, including tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, and confusion-bewilderment. There was no significant change on the sixth POMS factor, vigor-activity. Improvements in mood were not related to gender or diagnosis. The results suggest that yoga was associated with improved mood, and may be a useful way of reducing stress during inpatient psychiatric treatment.

Full text

Citation: Lavey, R., Sherman, T., Mueser, K. T., Osborne, D. D., Currier, M., & Wolfe, R.
(2005). The effects of yoga on mood in psychiatric inpatients. Psychiatric Rehabilitation
Journal, 28, 399-402.
The Effects of Yoga on Mood in Psychiatric Inpatients
Roberta Lavey, Tom Sherman, Kim T. Mueser,* Donna D. Osborne, Melinda Currier, and
Rosemarie Wolfe
Authors’ positions, titles, places of employment, and addresses:
Roberta Lavey, Med, CRC, RPRP
Director of Rehabilitation Services
New Hampshire Hospital
36 Clinton St.
Concord, NH 03301
Thomas Sherman, Certified Yoga Instructor
New Hampshire Hospital
36 Clinton St.
Concord, NH 03301
Kim T. Mueser, Ph.D. (*corresponding author)
Center for Psychiatric Rehabilitation
Boston University
940 Commonwealth Ave. West
Boston, MA 02215
Donna D. Osborne, Certified Therapeutic Recreation Specialist
Rehabilitation Services
New Hampshire Hospital
36 Clinton St.
Concord, NH 03301
Melinda Currier, Certified Therapeutic Recreation Specialist
Rehabilitation Services
New Hampshire Hospital
36 Clinton St.
Concord, NH 03301
Rosemarie Wolfe, M.S.
Research Associate
New Hampshire-Dartmouth Psychiatric Research Center
Main Building
105 Pleasant St.
Concord, NH 03301

Abstract
The effects of yoga on mood were examined in 113 psychiatric inpatients at New
Hampshire Hospital. Participants completed the Profile of Mood States (POMS) prior to and
following participation in a yoga class. Analyses indicated that participants reported significant
improvements on all five of the negative emotion factors on the POMS, including tension-
anxiety, depression-dejection, anger-hostility, fatigue-inertia, and confusion-bewilderment.
There was no significant change on the sixth POMS factor, vigor-activity. Improvements in
mood were not related to gender or diagnosis. The results suggest that yoga was associated with
improved mood, and may be a useful way of reducing stress during inpatient psychiatric
treatment.

Yoga is a widely practiced form of meditation and relaxation, with approximately 20
million regular yoga practitioners in the U.S. and Europe (Feuerstein, 1998). While yoga enjoys
widespread use in the general population, its utility for persons with severe psychiatric symptoms
has received little attention. People with severe mental illnesses often experience prominent
negative emotions (Bartels & Drake, 1989), cognitive difficulties (Heaton et al., 1994),
sensitivity to stress (Nuechterlein & Dawson, 1984), and poor physical health (Dixon et al.,
1999). Many of these difficulties are worst during periods of psychiatric hospitalization, when
symptoms are exacerbated and stress is high due to living in a highly controlled and confined
environment. Yoga may be a promising activity that could lower the stress of being in a hospital
and distress due to persistent symptoms.
This study was conducted in order to evaluate the effects of a yoga program at New
Hampshire Hospital. Yoga is one of a variety of different group activities offered at the hospital,
with other groups focusing on skills training, psychotherapy, recreational activities, wellness, or
work. Because of the use of yoga to reduce stress among persons in the general population, we
hypothesized that participation in yoga would improve negative emotions among psychiatric
inpatients.
Method
Participants
The participants were 113 psychiatric inpatients at New Hampshire Hospital (NHH).
People were admitted to NHH from any one of ten local community mental health centers in
New Hampshire. The average length of stay for acute admissions was ten days.
All information except psychiatric diagnosis was obtained via a self-report questionnaire.
The gender composition included 59 (52.2%) women, 52 (46.0%) men; 2 participants (1.8%)
were missing data on gender. Mean age was 27.7 (SD = 12.83) years old (range: 14-81).
Diagnostic composition of the group included 43 (38.1%) mood disorder (including bipolar
disorder, major depression, dysthymic disorder), 36 (31.9%) psychotic disorder (including
schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder, brief

reactive psychosis), 9 (8.0%) borderline personality disorder, 5 (4.4%) adjustment disorder, and
20 (17.7%) other.
Yoga Program
The Yoga Program has been in operation at NHH for the past eight years. The program
is based on the principles of Hatha Yoga, and is modeled after the program described by Kabat-
Zinn (1990). Yoga is offered once per week and lasts approximately one hour.
Yoga classes consist of gentle stretching and strengthening exercises done slowly with
the attention focused on breathing and sensations that are experienced as the participants assume
various yoga postures. Participants are guided through the sequence of postures, with their
awareness focused on moving their bodies and limbs. Participants are grounded in the present
moment by constantly refocusing on how their bodies are feeling.
All psychiatric inpatients were invited to participate in the Yoga Program. The format of
the program included: welcome (introduction to the class), centering (awareness of present
posture, attention to breathing), warm-ups (gentle movements to open major joints and muscle
groups), classical yoga postures (a sequence of yoga postures with focus on deep breathing,
body sensation, relaxation, and gently pressing into the extremities of the body), and relaxation
(lying in a comfortable position with attention on deep complete breathing and body sensations).
Measures
Changes in mood were evaluated with the Profile of Mood States (POMS) (McNair, Lorr,
& Droppleman, 1992). The POMS is a 65-item self-report questionnaire in which individuals
rate their current mood on 5-point scales ranging from “not at all” to “extremely.” Factor
analyses of the POMS have yielded six factors, including tension-anxiety, depression-dejection,
anger-hostility, fatigue-inertia, confusion-bewilderment, and vigor-activity. The first five factors
are scored negatively (higher scores correspond to more negative emotions). The sixth factor
(vigor-activity) is scored positively (higher scores correspond to greater vigor).
Procedure
When participants arrived for the class the POMS surveys were already placed on the

mats and chairs. An explanation of the survey was read out loud, which explained that the
hospital (NHH) was using the information from the survey for quality assurance purposes (the
survey was approved by the State of New Hampshire Institutional Review Board). The survey
included basic demographic information and the POMS. Participants were informed that they
could participate in the Yoga Program without completing the survey. Participants were invited
to complete the POMS before and after the yoga session.
Results
In order to evaluate changes in the POMS subscales from before the yoga class to after
the class, paired t-tests were computed for the first class attended by the participants. The results
of these analyses are summarized in Table 1. Inspection of the table indicates that participants
reported statistically significant improvements in all five of the negative emotion factors on the
POMS: tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, confusion-
bewilderment. In contrast, the sixth factor, vigor-activity, did not change significantly from
before to after the yoga session.
--------------------------------
Insert Table 1 About Here
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Participants were able to be in as many yoga sessions (conducted weekly) as they chose.
Among the 113 participants who participated in at least one group and who completed pre-post
POMS ratings, 38 (33.6%) participated in two or more groups and completed another set of pre-
post POMS ratings. To evaluate changes in mood for participants who were in more than one
yoga session, we conducted a similar set of paired t-tests to that described above comparing the
POMS ratings before and after the last yoga class in which they participated. The pattern of
results was nearly identical to that found for the first group: t-tests were significant for all five of
the negative emotion factors on the POMS (ts = 4.75, 4.11, 3.54, 4.69, 2.67 for tension-anxiety,
depression-dejection, anger-hostility, fatigue-inertia, confusion-bewilderment, respectively, dfs =
37, ps < .01), whereas the sixth factor, vigor-activity, did not change significantly from before to

after the last yoga session (t = 1.49, df = 37, ns). Thus, participants showed similar
improvements in negative mood from before to after their first yoga class as before and after
their last yoga class.
To evaluate whether gender or diagnosis (mood disorder vs. psychotic disorder) were
differentially related to changes in mood in the first yoga session, we performed six repeated
measures analyses of variance, with the pre-post POMS subscales as the repeated dependent
variables, and gender and diagnosis as the independent variables. Significant gender by time,
diagnosis by time, or gender by diagnosis by time interactions would indicate differential rates of
change on the POMS subscales as a function of gender or diagnosis. None of the interaction
effects from these analyses were significant, indicating that both men and women, as well as
people with mood and psychotic disorders, reported comparable improvements in mood from
before to after the yoga class.
Discussion
The findings indicated that participation in the Yoga Program was associated with
significant improvements in the five negative emotions subscales on the POMS (tension-anxiety,
depression-dejection, anger-hostility, fatigue-inertia, confusion-bewilderment), where as the
sixth subscale (vigor-activity) did not change significantly. The fact that one POMS subscale did
not change, in contrast to the others, suggests that participants’ responses to the POMS were
specific to negative emotions, and did not reflect a general response bias in completing the
POMS. Finally, participant gender and diagnosis were unrelated to improvements in negative
mood, suggesting that all the inpatients were able to benefit equally from yoga.
Participants who attended more than one class showed similar benefits in mood from the
first to the last class. This finding raises the question as to why greater benefits of yoga were not
observed in participants who participated in more than one yoga class, as might be expected
when people learn more about how to do yoga. It is possible that the relatively small sample size
of individuals who participated in multiple classes limited the statistical power to detect greater
improvement in mood with more yoga experience. Alternatively, taking a break from the routine

of inpatient treatment, and sharing in a relaxing, non-socially demanding experience may confer
major benefits in terms of negative mood, even in the absence of formal learning of yoga
techniques. More research is needed to address this intriguing question.
The findings provide support for the feasibility of conducting yoga classes in inpatient
settings with acutely ill and long-term ill individuals. Furthermore, participation in the class was
associated with significant improvements in negative moods from before to after the class,
including reductions in confusion, and these improvements were evident in both the first and the
last class people participated in. These results are consistent with the beneficial effects of yoga
on mood reported by people in the general population (Arpita, 1990), and suggest that yoga may
be a useful adjunctive treatment for people receiving psychiatric inpatient treatment.
The present study was not a controlled study, and thus it is possible that the observed
improvements in negative mood could be attributed to factors other than participation in the
Yoga Program, including demand characteristics (i.e., participants reporting improved mood
following yoga because they believed they were expected by staff to report such improvements).
It is also possible that another type of relaxation group not based on the principles of yoga would
produce similar benefits in mood. However, the positive results of this study support the
feasibility and possible benefits of yoga, suggest that controlled research to evaluate the effects
of yoga on mood in psychiatric inpatients is warranted. In addition to more rigorously evaluating
the effects of yoga on mood in psychiatric inpatients, controlled research should examine the
possible longer-term effects of participation in yoga on client behavior in the hospital. For
example, it is possible that participation in yoga is associated with fewer requests for p.r.n.
medication, assaults, and need for seclusion and restraint due to reduced stress levels.
The present study provided encouraging results for the potential role of yoga in an
inpatient psychiatric setting. There is a pressing need for more research to establish which
therapeutic activities are most beneficial for psychiatric inpatients. Controlled research is needed
to examine the effects of yoga in hospitalized persons.

References
Arpita. (1990). Physiological and psychological effects of Hatha Yoga: A review of the
literature. The Journal of the International Association of Yoga Therapists, 1, 1-28.
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treatment. Psychiatric Quarterly, 60, 333-345.
Dixon, L., Postrado, L., Delahanty, J., Fischer, P. J., & Lehman, A. (1999). The association of
medical comorbidity in schizophrenia with poor physical and mental health. The Journal
of Nervous and Mental Disease, 187, 496-502.
Feuerstein, G. (1998). What is yoga? http://www.yrec.org/what_is_yoga.html
Feuerstein, G., & Bodian, J. (1993). Living Yoga: A Comprehensive Guide for Daily Life. New
York: Tarcher.
Heaton, R., Paulsen, J. S., McAdams, L. A., Kuck, J., Zisook, S., Braff, D., Harris, M. J., &
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Face Stress, Pain, and Illness. New York: Delta Trade Paperbacks.
McNair, D. M., Lorr, M., & Droppleman, L. F. (1992). Profile of Mood States (Revised ed.). San
Diego, CA: Educational and Industrial Testing Service.
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About the Authors
Roberta Lavey is a certified Rehabilitation Counselor and the Director of Rehabilitation
Services at New Hampshire Hospital.
Tom Sherman is a certified Kripalu Yoga Teacher, a Phoenix Rising Yoga Therapist, and
a Universal Tao Instructor who teaches to a wide range of people in the New Hampshire area.
Kim T. Mueser is a clinical psychologist and Professor in the Departments of Psychiatry
and Community and Family Medicine at Dartmouth Medical School in Hanover, New
Hampshire.
Donna D. Osborne is a Certified Therapeutic Recreation Specialist at New Hampshire
Hospital in Concord, New Hampshire.
Melinda Currier is a Certified Therapeutic Recreation Specialist at New Hampshire
Hospital in Concord, New Hampshire.
Rosemarie Wolfe is a data manager and analyst at the New Hampshire-Dartmouth
Psychiatric Research Center in Concord, New Hampshire.

Table 1. Changes in Profile of Mood States (POMS) Subscales From Before First
Session to After First Session
POMS Subscale
Before
Session
Mean (SD)
After
Session
Mean (SD)
t-Value
P
Tension-Anxiety
5.70 (4.77)
3.33 (4.44)
6.67
.000*
Depression-Dejection
5.56 (5.17)
3.31 (4.35)
6.82
.000*
Anger-Hostility
4.36 (4.64)
2.34 (4.29)
5.63
.000*
Fatigue-Inertia
5.75 (5.36)
3.16 (4.5)
6.51
.000*
Confusion-Bewilderment
6.42 (4.12)
4.95 (3.37)
5.12
.000*
Vigor-Activity
8.22 (5.16)
8.85 (5.04)
1.41
.16
* Meets Bonferroni Bounds correction for multiple statistical tests at p < .05 level.