understanding adolescents


Keywords: Yoga Adolescent Depression


Objective: To understand adolescents’ experiences and attitudes toward yoga, with a particular focus on acceptability and feasibility of a yoga intervention for depressed adolescents. Design: Qualitative analysis of data from three focus groups and eight individual interviews, for a total of 22 teen participants. Setting: Outpatient setting in a psychiatric hospital in the U.S. Main outcome measures: Teens were asked about their own and their peers’ attitudes toward, and experiences with, hatha yoga; reactions to a study-created yoga video; and opinions on class logistics. Results: Teens had both positive and negative attitudes toward, and experiences with, hatha yoga. They com- mented on “who does yoga;” many responses suggested a limited group (e.g., moms; people with money and time). Participants agreed that yoga could be potentially beneficial for depressed or stressed teens. Self- consciousness while being in a yoga class was a major concern. Overall, teens reacted favorably to the study- created yoga video. Teens had varied opinions about class logistics including class duration and size. Teens cited barriers to class, such as transportation, as well as barriers to home yoga practice. Conclusions: Key points for developing a yoga class that might be appealing to depressed or stressed teens include: creating a class with variety that teens will find interesting; taking concrete steps to decrease teen self- consciousness; incorporating messages relevant for teens and consistent with yoga philosophy; and actively countering stereotypes about who practices yoga. Limitations of this study include the lack of data from male teens.

1. Introduction

Depression is a leading cause of disability for adolescents globally.1

In the US, the 12-month prevalence rate of Major Depressive Episodes in teens increased from 8.7 % in 2005 to 13.2 % in 2017.2 However, many adolescents do not receive treatment for depression.3 Barriers to existing treatments include low perceived need, a preference to manage depression on one’s own,4 cost, medication side effects, and a limited number of adolescent behavioral health professionals. Thus, there is an urgent need to develop and test novel approaches for depressed adolescents.

Yoga is a system of philosophy and practice with roots in ancient India.5 In addition to physical practices, yoga includes ethical precepts

for healthy living, called yamas and niyamas. In the west, hatha yoga, which emphasizes physical aspects of yoga, is the most commonly practiced form of yoga. Although hatha yoga may include breath control exercises, physical postures, and meditation, styles of hatha yoga vary greatly in vigor and emphasis.6 Despite heterogeneity, a meta-analysis of 12 randomized controlled trials (RCTs) of yoga for depression in adults documented that yoga was significantly better than usual care, relaxa- tion exercises, or aerobic exercise, in decreasing depressive symptoms.7

Recent research supports these findings.8–10 There is also evidence that yoga reduces stress.11

Several studies have examined yoga for adolescents; however, to date, no published study addresses yoga specifically for adolescent depression. Single yoga classes can have a positive impact on mood or

* Corresponding author at: Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States. E-mail address: lisa_uebelacker@brown.edu (L.A. Uebelacker).

Contents lists available at ScienceDirect

Complementary Therapies in Medicine

journal homepage: www.elsevier.com/locate/ctim

https://doi.org/10.1016/j.ctim.2021.102723 Received 5 October 2020; Received in revised form 15 March 2021; Accepted 19 April 2021



Complementary Therapies in Medicine 59 (2021) 102723


distress in non-depressed adolescents12 and adolescent psychiatric pa- tients.13 Studies of yoga for other conditions, including weight man- agement,14 eating disorders,15,16 and irritable bowel syndrome,17

demonstrate the acceptability of yoga with adolescents. In this study, we conducted individual interviews and focus groups to

collect qualitative data from adolescents regarding their experiences with and attitudes toward yoga, with a particular focus on how yoga may ameliorate stress or depression. We also asked logistical questions about conducting yoga classes. All questions were developed to inform marketing, content, and structure of a yoga program for depressed ad- olescents. That is, we were interested on learning how to increase acceptability and feasibility of a yoga intervention for depressed adolescents.

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