Scientific communication

  Read the 2 article attached and answer the questions below.

  1. Who is the targeted audience for each article?

2. What is the main take-home message of each article? How do these messages compare?

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3. What do the authors report as “truth” and needs more research?

4. What biases do you see for each article? Selection bias, Attrition bias, Measurement bias, Performance bias and/or Reporting bias) 

5. Is the  consumer-oriented article an appropriate representation of the findings of the peer-reviewed article, or is the focus too narrow or broad? Provide examples from each article. For example, was one of the incidental findings of the peer-reviewed article blown out of proportion in the  consumer-targeted message?

6. Regarding  the peer-reviewed article, is this research important? Why or why not? When choosing a      scientific or health study to discuss with patients or clients, consider  what’s being contributed to the research field. Does it represent a major advance? Does it change the way people think about a problem? Not all studies are important; if you think this study is not, explain why.

7. Is the  message over-generalized, or applied to a greater population than is      reasonable? For example, did the authors conduct the study on a small  sample, but the news-media article presents the findings as though they  were applicable to all?

8. Is the research statistically and/or clinically significant? Take care not to overstate the importance of the  study. A finding that is statistically significant may not be clinically  significant.

9. What would you share with a client who brought the article to you? How would you respond? Consider      Shared Decision Making in your response.


Complementary Therapies in Medicine 59 (2021) 10272


Available online 22 April 2021
0965-2299/© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license

  • Teens’ perspectives on yoga as a treatment for stress and depression
  • L.A. Uebelacker a, b,*, J.C. Wolff a, c, J. Guo b, S. Feltus b, C.M. Caviness a, b, G. Tremont a, c,
    K. Conte c, R.K. Rosen d, S. Yen a, e

    a Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
    b Butler Hospital, Providence, RI, United States
    c Rhode Island Hospital, Providence, RI, United States
    d Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, United States
    e Massachusetts Mental Health Center at Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States

    A R T I C L E I N F O


    A B S T R A C T

    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
    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

    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

    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: (L.A. Uebelacker).

    Contents lists available at ScienceDirect

    Complementary Therapies in Medicine

    journal homepage:
    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

    2. Materials and methods

    2.1. Participants

    To meet criteria for inclusion, adolescents: 1) reported elevated
    depressive symptoms (i.e, PHQ-8 18 score > 8) including sad mood or
    anhedonia; 2) were aged 13–18; 3) were medically cleared for physical
    activity by a physician per adolescent/parent report; 4) were able to
    read and write English; 5) assented to study participation, and their
    parent/legal guardian consented to their participation (if aged 13–17);
    OR consented to participation (if aged 18). Adolescents were excluded
    for: 1) suicide ideation or behavior warranting immediate treatment; or
    2) regular attendance at yoga classes.

    2.2. Procedures

    Butler Hospital IRB approved the protocol. We recruited via social
    media and community advertisements, seeking teens with depression or
    stress. Research staff conducted a telephone screen with interested in-
    dividuals to determine eligibility. Of 122 teens expressing interest, 71
    completed the screen, 45 were not eligible (primarily due to insufficient
    depression severity, n = 36), and four chose to not participate, resulting
    in 22 teens who were enrolled.

    We conducted three focus groups with 14 teens and eight individual
    interviews (format determined by teen’s schedule). Focus groups ranged
    from 71− 84 min; interviews ranged from 23− 59 min. We used the same
    agenda for both formats; relevant questions are in Table 1. Initial
    questions were about perceptions of yoga. The interviewer then pro-
    vided a brief overview of yoga, describing yoga as a practice that in-
    cludes postures, breathing exercises, and meditation, and emphasizing
    that yoga is about the internal experience of self-exploration and
    acceptance, and NOT about being flexible or being able to do chal-
    lenging poses. Next, teens watched a short video of a yoga teacher
    illustrating simple yoga practices. While seated, the teacher invited
    participants to notice their breathing, and then led them through sitting
    cat-cow postures, side stretches, and prayer breath. The interviewer
    invited teens to simply watch the video or to engage in the practices as
    they watched. Subsequent discussion questions covered reactions to the

    Next, interviewers handed out a list of potential “messages” that
    could be emphasized in yoga classes. These included: accepting our-
    selves exactly as we are; being kind to ourselves; using breath to increase
    calm and cope with stress; gratitude; noticing thoughts, feelings, and
    sensations right now; and physical and emotional balance. These mes-
    sages were developed by the research team to be consistent with tradi-
    tional yoga philosophy and potentially relevant to teens’ experiences.
    Subsequent questions focused on these messages. Finally, the third set of
    questions covered class logistics.

    Participants were paid $30 for participation. Interviews and focus
    groups were audio recorded and transcribed.

    2.3. Data analysis

    We used applied thematic analysis 19 to guide analysis. One of the
    study PIs developed an initial codebook, with deductive codes derived
    from interview questions. Four staff members reviewed the initial codes
    and then independently coded transcripts, adding inductive codes as
    needed to capture emergent concepts. The revised codebook was
    reviewed by the study team. Each remaining transcript was then inde-
    pendently coded by two raters who met to review codes. They assigned
    final codes via consensus and entered them into NVivo qualitative data
    analysis software. One study PI and two staff members wrote thematic
    memos summarizing each code. Another staff member read each memo
    and associated codes, adding comments or clarifications as needed.
    Codes fell into three major categories: beliefs and experiences with yoga,
    reactions to study materials, and class logistics. Below, codes are
    demarcated with an underline.

    3. Results

    3.1. Demographics

    The 22 teens were aged 14–18 and predominantly female. Table 2
    provides more demographic and clinical information.

    3.2. Beliefs about and experiences with yoga

    We asked teens to tell us their first thoughts regarding “yoga.”

    Table 1
    Focus group and interview questions.

    Questions about Yoga

    • What is the first thing that comes to mind when you think of yoga?
    • Have you or your friends or family ever done yoga before?

    o What was it like?
    o What did you like about it? What did you not like?

    • What kinds of people do you think do yoga?
    • What do your friends or peers think about yoga?
    • What might make you (or other teens) uncomfortable in a yoga class? Are there

    barriers to fully participating?
    • What do you think the benefits of yoga might be for teens who are feeling stressed,

    down, or depressed?

    Reactions to Yoga Education, Video, and Materials

    [Interviewers asked these questions immediately after teens watched the video.]
    • How did you feel about that?

    o Did anything make you feel uncomfortable?
    • If you were in yoga classes, what would you hope to get out of them?

    o Physical, mental, or emotional results?
    [Interviewers asked these questions while teens reviewed a list of potential themes for

    yoga classes.]
    • What do you think of [these themes]? What do you think would be useful to you or

    others you know? What would NOT be useful?
    • What else do you think would help?

    Questions about Class Logistics

    • How would you feel about being in a class with other teens who might have

    • How would you feel about being in a class with teens of different ages?
    • What would make you feel more comfortable in such a diverse group?
    • What do you think about mixed gender in one


    o What could be done to make a mixed gender class feel more comfortable?
    • How long do you think the optimal class length is?
    • What time of day is the best time to have a yoga class?
    • What about group size?

    o What do you think the best group size is?
    • How often would you be willing and able to attend?
    • Would you be willing to practice yoga in between sessions at home?

    o What are the barriers to practicing at home?
    o What could make it easier for you to practice yoga at home?

    • How would you get to class? What kinds of transportation would you use?
    • What kinds of barriers do you think would keep you or other teens from getting to


    L.A. Uebelacker et al.

    Complementary Therapies in Medicine 59 (2021) 102723

    Responses included basic elements of yoga: stretching, postures, bal-
    ance, flexibility, relaxation, and meditation. Two teens mentioned
    thinking of their mothers (who practiced yoga). Some teens commented
    that yoga may be difficult or not easily accessible because it requires
    strength, flexibility, time, effort, or patience. Teens reflected on who
    does yoga. By far the largest group was “moms” (n = 7). Some teens
    specified middle-aged women; others talked about young adults (but not
    teenagers). Participants largely identified women as people who did
    yoga. Some teens (n = 5) talked about people with “alternative” life-
    styles – i.e., “hippies,” “vegans,” “people who are into astrology or
    essential oils,” or people who “want their chakras to be aligned” (ID#8,
    Focus Group [hereafter FG] 2). Other characteristics of people who do
    yoga included people with money and time, who want to improve
    themselves or cope with stress, or who are “super flexible.” (ID#5, FG2).
    Only one teen noted that “pretty much anyone” can do yoga (ID#16,

    We asked participants what their friends or peers think about yoga.
    Several teens thought yoga is or would be acceptable to peers, and knew
    of peers who had positive experiences with yoga (n = 6). Two teens
    talked about yoga being viewed as a workout of insufficient intensity, i.
    e., “the easy way out’” (ID#14, FG3). Two teens talked about negative
    experiences doing yoga with peers, describing yoga as this “tedious
    thing you have to do” (ID#3, FG1) or having been to a class where peers
    were “giggling and talking the whole time” (ID#14, FG3). Participants
    also stated that yoga may be seen as only for women or girls, with a male
    teen stating that he has been criticized for doing yoga and it is “frowned
    upon for boys of my age” (ID#11, FG3). One teen with some experience
    practicing yoga stated “my friends think I’m insane” (ID#6, FG2) but did
    not explain why. Three teens stated that their peers did not think or talk
    about yoga.

    We learned about teens’ prior experience with yoga. Many, but not
    all, had tried yoga at school (n = 7), with friends outside of school (n =
    4), with a parent at home (n = 3) in a studio as part of an adult class (n =
    4), or as part of an outpatient program (n = 2). Many previous experi-
    ences had been positive (n = 8): they found yoga to be calming and
    relaxing; to provide relief from stress; and even to be fun. One teen said,

    “yoga is definitely something that always calms me down and I think it’s
    really helpful for stress” (#14, FG2). However, two teens noted that they
    would be less likely to do yoga if they were feeling stressed at the time.
    Some reported feeling self-conscious in class (n = 3), not feeling it was
    enough of a workout (n = 2), and difficulty sitting still (n = 2). One
    discussed a negative first-time experience doing yoga in gym class, in
    which the teacher encouraged them to push themselves beyond their
    comfort zone when doing postures.

    We asked about attitudinal or emotional barriers and facilitators of
    yoga class attendance. Self-consciousness was a major concern (n = 15).
    Self-consciousness could be related to not being able to do yoga “right”
    (n = 10), and included worry about others being judgmental even
    though “You might think the other people think you’re bad, but… like,
    at least from what I’ve noticed, nobody really cares” (ID#6, FG2). Other
    contributors to self-consciousness included having a larger body and/or
    wearing tight clothes. Finally, two people were concerned that quiet in
    class could lead to others hearing noises their body might make,
    including breathing. Other barriers reflected characteristics of the in-
    dividual, including not being flexible, not having good balance, not
    wanting to meet new people, being anxious about coming to a new
    place, and low motivation. Yoga was perceived as being for others: older
    people, or girls/women. Finally, one person mentioned yoga being
    boring and another mentioned physical discomfort with breathing ex-
    ercises (felt like hyperventilating).

    Facilitators included being in class with others who were similar (n =
    5), i.e., yoga beginners, friends, nice people, and people doing yoga for
    similar reasons. Teaching style was important (n = 5), with preference
    for teachers who were non-judgmental, welcoming, and gave partici-
    pants alternate choices for postures. Teens mentioned aspects of the
    class environment, preferring low lights (to minimize self-
    consciousness), being allowed to bring a friend, and calming aroma-
    therapy. One teen stated that sending a fact sheet ahead of time, with a
    class description and suggestions for clothing, would be helpful. Another
    said it was important to make class “open to anyone who wants to do it”
    and “something they don’t have to do” (ID#10, FG3).

    We asked teens about benefits of yoga for stressed or depressed teens.
    Many said that it could be calming or relaxing (n = 7), or helpful (n = 8).
    Four noted that yoga might give a teen something to focus on besides
    feeling stressed or down: “Yoga can really help me … just be focused on
    something else other than what I’m feeling and just like help me feel
    really calm” (ID#18, Interview). Others commented that yoga might be
    helpful because it guided one to focus on oneself (n = 3), or allowed a
    teen to be with others (n = 2). Individual teens also noted each of the
    following: yoga could give one a sense of accomplishment, increased
    patience, more flexibility, and increased ability to cope with problems.
    One teen commented on a potential pitfall: “When you tell a teen who…
    has a lot going on in their head to just try to like clear their head, it’s
    even more frustrating” (ID#21, interview).

    Teens told us about desired features of yoga classes. Two teens
    thought it would be important to start with slower movements and have
    the class become more challenging over time; three others spoke about
    simply having the class be relaxing and calming. Two teens indicated
    they would not enjoy a vigorous class because it would be too chal-
    lenging and they were not flexible enough. Finally, one teen noted: “I
    feel like it needs to be a good balance between not like constantly
    moving and not like sitting there like doing just two different exercises
    for the whole period” (ID#22, interview).

    3.3. Reactions to study materials

    We asked teens to provide reactions to the video they viewed. Eleven
    participants had positive response: they found the video to be calming
    and relaxing, they liked that the teacher was non-judgmental, and they
    felt better after viewing it. Others commented on uncomfortable re-
    actions, with many of these relating to self-consciousness (n = 6). Teens
    stated “I was nervous that my neck was going to creak” (ID#5, FG2) and

    Table 2
    Teen Demographics.

    Demographic Category n %

    14 6 27%
    15 5 23%
    16 2 9%
    17 5 23%
    18 4 18%

    Gender Identity
    Female 18 82%
    Male 3 14%
    Non-binary 1 5%

    American Indian/ Alaskan Native 1 5%
    Asian 1 5%
    Black / African American 0 0%
    White/ Caucasian 13 59%
    Multiracial 3 14%
    Other 1 5%
    Chose not to answer 3 14%

    Hispanic / Latinx 3 14%
    Not Hispanic/ Latinx 16 73%
    Chose not to answer 3 14%

    Whom teen lives with most often
    Two parents 7 32%
    Mother 14 64%
    Father 0 0%
    Chose not to answer 1 5%

    Other treatment
    Currently engaged in psychotherapya 13 59%

    a We did not collect data on psychiatric medication use.

    L.A. Uebelacker et al.

    Complementary Therapies in Medicine 59 (2021) 102723


    “I was making fun of myself the whole time” (ID#6, FG2). Two teens
    who were individually interviewed said it would have been uncom-
    fortable to do the practices in the individual interview, but it would have
    been okay in a group. Other reactions included that the video made them
    feel tired (n = 2) or brought attention to the fact their body hurt (n = 1),
    and they thought the poses were odd (n = 1).

    After this introduction to yoga, we asked what teens want to get out
    of a yoga class. They wanted a physical, mental, and emotional experi-
    ence (n = 3), to feel good (n = 1), to feel relief or relaxation (n = 4), to
    reduce stress or anxiety (n = 3), and to learn something that they could
    practice at home (n = 2).

    We asked teens to provide reactions to the yoga messages handout.
    Overall the messages were acceptable; several said that all the messages
    were appealing (n = 4), and at least a few participants commented
    positively on each message. For example, regarding being kind to our-
    selves, one teen said: “Yeah especially since in our society we are judging
    ourselves a lot based off …social media and … magazines and… TV”
    (ID#4, FG1). Another teen said “Well, accepting ourselves exactly as we
    are, that’s important. Whether in yoga or in life … if you don’t accept
    yourself, you’re not going to be happy” (ID#7, FG2). A few teens had
    nuanced understandings of the messages, including the need to balance
    self-acceptance with motivation to change, or the fact that it may be
    overwhelming for someone who is depressed to focus on (negative)
    thoughts. Three teens asked to have the word “gratitude” explained,
    suggesting this was an unfamiliar word.

    3.4. Class Logistics

    Teens had a mix of responses about being in class with other
    depressed teens. Many reacted positively because they would not feel
    judged or isolated – they would be with people who could relate to their
    experience. Two participants were indifferent and two were ambivalent.
    For example, one thought that teens would like being with others “in the
    same boat” but also said “it might make someone uncomfortable
    knowing that the people around them know that they’re depressed”
    (ID#19, Interview). With regard to age range in class, many (n = 7) had
    indifferent or positive responses to being in a class with teens from aged
    13–18, although four expressed concern about older teens not wanting
    to be with younger teens, and one was concerned about younger teens
    being intimidated by older teens. Regarding gender composition of class,
    many were indifferent or responded positively to mixed gender classes
    (n = 8), with one teen commenting that having gender-specific classes
    may not feel inclusive to transgender or non-binary people. Three teens
    expressed some level of discomfort with mixed gender classes, but also
    said they would be willing to try it. Finally, when considering a class of
    people with diverse body sizes and physical abilities, two teens com-
    mented that people with larger body sizes may feel uncomfortable in a
    yoga class.

    We asked about timing and frequency of class attendance. Teens
    mostly preferred early evening during the week (n = 7) or sometime on
    the weekend (n = 6). Only three preferred the afternoon immediately
    after school. Teens had a variety of opinions on how often they’d like to
    attend class. Responses included once per week (n = 3) or twice per
    week (n = 4); however, one person said more than once every other
    week might be too much. Teens also had a variety of ideas about the
    optimal class size, ranging from 1 to 2 people, to 20 people. As one teen,
    who preferred 15 people, said “it’s just enough where it is not a ridic-
    ulous amount of people, but where I don’t have to worry about people
    staring at me” (ID#6, FG2). Optimal class length was varied, with teens
    suggesting 20 min. (n = 2), 30–35 min (n = 2), 30− 45 min. (n = 2), 45
    min. (n = 5), one hour (n = 2), and one hour or longer (n = 4). Three
    participants thought that an hour was too long, one thought 1 h 30 min
    was too long, and one thought 45 min felt “like that’s a long period of
    time, but might be okay with a break in the middle” (ID#19, Interview).
    Reasons for concern about longer classes included “you think whoa
    that’s a long time” (ID#4, FG1), difficulty fitting class into schedules, an

    hour and half feeling tedious, and loss of focus over time. One teen said
    “Because after like 60 min, you’re kind of like ‘okay, I’m done here.
    Yeah, I got it’” (ID#22, Interview). In contrast, some teens thought
    longer was better, with one stating: “Definitely an hour….I mean like
    you could do yoga for 30 min but is it really going to help? Are you really
    going to be stress free in 30 min?” (ID#16, Interview). Finally, some
    teens had creative ideas about class length: one suggested one longer
    class and a couple of shorter classes per week; one stated that the length
    of class depended on when it was offered, with classes during the school
    week needing to be shorter; and one suggested starting initially with a
    45 min class then gradually increasing class length as participants
    became more comfortable.

    When asked about potential practical barriers to class attendance,
    teens identified the following barriers: school work (n = 2), paid work (n
    = 1), cost (n = 3), and living too far away (n = 1). We asked teens to
    comment on transportation to class. Some said they would get a ride
    from a family member (n = 7), three said they would drive themselves,
    one mentioned possibly taking the bus, and another mentioned taking
    an app-based rideshare, although another teen noted that their parent
    probably would not allow that. Summing up potential barriers to
    attendance, one teen said “some people can’t like just take the bus or
    walk, so like finding a time when your parents can drive you. And also,
    everybody, a lot of people I know are crazy, crazy busy after school, so
    it’d be difficult to get people who are not all busy at the same time every
    week who can all have like a reliable mode of transportation to get here”
    (ID#8, FG 2).

    We asked about barriers and facilitators to home practice. One bar-
    rier was making time to practice (n = 5), with teens suggesting that
    scheduling a time could be a solution. Another teen stated that spending
    time on video games and other hobbies would take precedence over
    home practice. Three teens were concerned about boredom with home
    practice, and suggested a solution may be to have short videos (5–10
    mins) for home practice. Another teen was concerned about not
    knowing what to do for home practice, with a potential solution being to
    use a video or to practice what they had done in class. One teen said that
    finding a quiet place to practice at home was a barrier, and another cited
    the need for a yoga mat. One teen was unable to provide specific bar-
    riers, but said “I think just knowing myself, I probably wouldn’t, but like
    there wouldn’t be anything stopping me” (ID#8, FG2). Possible moti-
    vators for home practice included having another person to practice
    with, or making it into a competition.

    4. Discussion

    We interviewed 22 teens as preparation for developing a yoga
    intervention for depressed or stressed teens. We discuss results with a
    focus on implications for increasing feasibility and acceptability of such
    a yoga intervention.

    Given that these teens agreed to an interview or focus group on this
    topic, it is not surprising that many teens were open to engaging in yoga
    and/or had tried yoga, and understood how it could be helpful. Many
    had positive experiences with yoga previously, and they thought that it
    could help reduce stress. Many also enjoyed the brief yoga practice
    during the focus group or interview, finding it relaxing. This is consistent
    with a survey of adults, in which one of the most common reasons re-
    ported for starting yoga was relaxation.20 Some teens, however reported
    negative experiences with yoga, including being pushed outside of their
    physical comfort zone, friends being critical of them, others in a yoga
    class not taking it seriously, and finding yoga to be tedious or odd. Im-
    plications for development of a yoga program for teen depression or
    stress include: making sure that participants are listening to their own
    bodies and not feeling pressure to move outside their comfort zone,
    providing enough variety in classes that teens find them to be inter-
    esting, and minimizing aspects of yoga that might considered “odd” such
    as extensive use of Sanskrit or chanting.

    Concerns about feeling self-conscious pervaded many responses.

    L.A. Uebelacker et al.

    Complementary Therapies in Medicine 59 (2021) 102723


    Teens were concerned about self-judgment and judgment by others for
    how they looked and even how they sounded (e.g., when breathing).
    Related, previous researchers have reported that teens may be con-
    cerned about what clothing to wear to a yoga class and may be self-
    conscious about removing their shoes.21 Other researchers have noted
    that adolescent girls are very vulnerable to body-related embarrassment
    or self-consciousness,22 although adults with chronic pain may also have
    concerns about being embarrassed or judged by others.23 The perva-
    siveness of this particular concern suggests that this is very important to
    consider when designing a class for teens. Principles from
    trauma-informed yoga may be useful;24 i.e., taking concrete steps to
    make sure yoga participants feel safe in their environment and empha-
    sizing choice in classes. Class may be set up so that no one is physically
    behind another person; everyone is side by side. Teachers may specif-
    ically emphasize the importance of the internal experience of yoga (vs.
    trying to have a “perfect” external form), and may emphasize that they
    expect that each person will look different in each posture. Quiet music
    and low lights may also help decrease self-consciousness and concern
    about audible body sounds.

    With regard to what yoga classes for depressed or stressed teens
    should look like and include, there was consensus that “yoga messages”
    were appreciated. Teens were mixed on whether a class should be
    calming, more vigorous, or balanced. There was no consensus on best
    day/time of classes, frequency of classes, class length, or optimal size of
    class. Regarding class composition, being with other depressed or
    stressed teens was mostly considered to be a positive attribute. Some had
    concerns about a wide 13–18 age range, although others did not. Finally,
    although a few teens expressed some discomfort with multi-gender
    classes, most did not, and all were willing to try them. These results
    suggest that there is no single best option for classes, and “middle” op-
    tions might be the best place to start. That is, teachers could strive for a
    medium level of physical activity that incorporates a mix of challenge
    and relaxation. It appears acceptable to introduce aspects of yoga phi-
    losophy using every-day language. Teens might be invited to attend class
    once per week; and 45 min may be long enough to hold a substantive
    class while avoiding anxiety about the class being too long.

    Teens discussed both practical and attitudinal barriers to attending
    yoga class. A recurring theme was that yoga was for “moms.” For boys,
    one significant barrier may be the belief that yoga is not appropriate for
    boys or men. Adult men have reported similar concerns.25 In addition,
    the belief that one must be flexible, strong, or have a certain body type
    can serve as a barrier. Others have noted similar barriers in US adults,26

    and have critiqued prevalent images of “yoga bodies” in the West.27

    These results suggest an opportunity to promote a counter-image of
    hatha yoga. When marketing classes, yoga should be portrayed as being
    accessible to teens, regardless of gender or body type. The focus should
    be not on appearance, but on yoga as method for improving mental and
    physical strength and flexibility over time. One way to make yoga more
    appealing to some teen male participants may be to emphasize how it
    could help with sports skills.21 Furthermore, it will be important to
    provide teens with information about classes prior to attendance so that
    they know what to expect.

    There were limitations to this research. First, we were able to recruit
    very few boys. It is likely that advertisements focused on stress and
    physical activity more generally would yield more interest from boys,
    enabling questions about yoga in the context of other options. Second,
    we used a mix of focus groups and individual interviews. It is possible
    that varying methods of data collection led to somewhat different re-
    sponses. However, interviews were shorter than focus groups, making
    the time available to collect data from each participant more compa-
    rable. To provide transparency, for each quote, we provided information
    on whether it was from a focus group or individual interview. Third, this
    study was not broadly focused on teens’ attitudes toward yoga, but was
    instead more tightly focused on understanding ways to increase
    acceptability and feasibility of a yoga intervention for depressed teens.

    In sum, teens provided useful information about their experiences

    with, and perceptions of, hatha yoga. We will use this feedback to
    develop and test a hatha yoga program for depressed teens.

    Author statement

    Lisa Uebelacker: Conceptualization, Methodology, Formal analysis,
    Investigation, Writing – Original Draft, Supervision, Funding acquisi-
    tion. Jennifer Wolff: Methodology, Investigation, Writing – Review and
    Editing. Jennifer Guo: Methodology, Formal analysis, Investigation,
    Writing – Review and Editing. Sage Feltus: Formal analysis, Investiga-
    tion, Writing – Review and Editing. Celeste Caviness: Conceptualiza-
    tion, Investigation, Writing – Review and Editing. Geoffrey Tremont:
    Conceptualization, Investigation, Writing – Review and Editing.
    Katherine Conte: Methodology, Investigation, Writing – Review and
    Editing. Rochelle Rosen: Formal analysis, Writing – Reviewing and
    Editing. Shirley Yen: Conceptualization, Methodology, Investigation,
    Writing – Review and Editing, Supervision, Funding acquisition.


    This research was funded by grant # R34 AT009886 from the Na-
    tional Center for Complementary and Integrative Health (NCCIH), Na-
    tional Institutes of Health and Grant # U54 GM115677 from the
    National Institute of General Medical Sciences, National Institutes of
    Health. This research was also supported by Advance Clinical and
    Translational Research (Advance – CTR; grant # U54 GM115677). Study
    sponsors had no role in the design, collection, analysis and interpreta-
    tion of data, or the manuscript writing.

    Declaration of Competing Interest

    Dr. Uebelacker’s spouse is employed by Abbvie Pharmaceuticals.


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      Teens’ perspectives on yoga as a treatment for stress and depression
      1 Introduction
      2 Materials and methods
      2.1 Participants
      2.2 Procedures
      2.3 Data analysis
      3 Results
      3.1 Demographics
      3.2 Beliefs about and experiences with yoga
      3.3 Reactions to study materials
      3.4 Class Logistics
      4 Discussion
      Author statement
      Declaration of Competing Interest

    R.I. study finds group yoga helps stressed-out
    Gagosz, Alexa . Boston Globe (Online) ; Boston [Boston]. 18 Oct 2021.

    ProQuest document link

    The Boston Globe’s weekly Ocean State Innovators column features a Q&A with Rhode Island innovators who are

    starting new businesses and nonprofits, conducting groundbreaking research, and reshaping the state’s economy.

    Send tips and suggestions to reporter Alexa Gagosz at

    Researchers at Butler Hospital recently conducted a study of how group yoga programs could help teens who had

    elevated levels of stress and who are depressed.

    Dr. Lisa Uebelacker is a clinical psychologist at Butler Hospital and Brown University was the lead on the study. It’s

    not the first time she’s researched the impact hatha yoga can have on people suffering from depression or chronic


    In various ongoing and completed clinical trials, Uebelacker has focused on people with a partial response to

    antidepressant treatments, people with chronic pain enrolled in medication-assisted treatment for opioid disorder,

    people in prison, and pregnant depressed women.

    Q: What is the study about?

    Uebelacker: We are piloting a group of teens that had elevated levels of depression or stress and comparing the

    yoga program to a group cognitive behavioral therapy treatment, which is an evidence-based treatment for

    depression. With the pilot study, we’re really looking at, can we do this? Are kids interested? Will they come to class

    and how can we make the classes accessible for them?

    We took the feedback from the pilot to prepare to be able to do a larger-scale study where we want to ultimately

    compare a yoga class to a group CBT and whether they both are helpful for teens with depression, whether the

    yoga is not inferior to the group CBT, and then that will allow us to look at for whom will a yoga class be better or

    for whom will a group CBT be better?

    (The pilot study was funded by the National Center for Complementary and Integrative Health at the National

    Institutes of Health; Dr. Shirley Yen was the director of the study)

    Q: Why yoga?

    Uebelacker: Yoga really incorporates aspects of meditation, of breath awareness and breath control, as well as

    movement. What I also really like about yoga is that for both adults and kids with depression, if you think about

    meditation, it may be hard for some people to start a sitting-meditation practice. They are just sitting there with all

    of these negative thoughts constantly. In yoga, though, it incorporates all of those things that you need: focusing

    on their breathing, focusing on their movement, it teaches mindfulness but in the context where it might be easier

    to access for some people with depression.

    Plus, if you think about people who are depressed, who are sort of lethargic, it really helps to get them to move in

    gentle ways.

    Q: And when you say “elevated levels of depression,” what does that mean?

    Uebelacker: It varies quite a bit. Some of the teens in our program absolutely did have individual therapy that they

    were engaged in, have a psychiatrist, and might be receiving some kind of medication.

    Q: When did this program begin and how many participants did you have?

    Uebelacker: It was a three-year study that we’re just at the tail-end of now. In the beginning, we did focus groups



    with teens and parents. We looked at their needs and ideas about how yoga for teens and stress might look like.

    Then we enrolled 11 kids in the yoga program.

    In our third phase, we randomly assigned more than 40 kids in either the yoga program or the group CBT program.

    Q: How did COVID-19 impact the program?

    Uebelacker: Partway through the study, COVID-19 hit and we had to transition everything from in-person to online.

    But, the silver-lining was that all the kids continued to attend, so they clearly liked it. If kids and parents don’t think

    something is working for them or they don’t like it, they just won’t return and waste their time. So it seems like the

    program has been acceptable to these teens, and even doing it online.

    Q: The study is nearly over. What have you found so far?

    Uebelacker: Many of the teens have said they found it relaxing and helped them get through the stresses of

    everyday life, especially during the last year. Now they can go to school and if there’s a stressful moment where

    their heart starts beating hard, they have techniques that they can use (like breathing exercises) to cope in the

    moment. And that’s exactly what they are reporting to us.

    Q: You’ve looked at how yoga has helped other populations as well. What do you see with that data?

    Uebelacker: I’m currently wrapping up a study that looks at how health education and yoga compare for depressed,

    pregnant women. We don’t have results yet, but there’s also preliminary data that shows that yoga can help with

    chronic pain that could help people with opioid use disorders who were prescribed medication to help with their

    pain. We want to give them an alternative. So we’re getting read to start a study in both Providence and in Boston

    of yoga for chronic pain in that population.


    Subject: Pain; Mental depression; Coronaviruses; Yoga; COVID-19; Narcotics

    Publication title: Boston Globe (Online); Boston

    Publication year: 2021

    Publication date: Oct 18, 2021

    Section: Rhode Island Health

    Publisher: Boston Globe Media Partners, LLC

    Place of publication: Boston

    Country of publication: United States, Boston

    Publication subject: General Interest Periodicals–United States

    Source type: Newspaper

    Language of publication: English

    Document type: News

    ProQuest document ID: 2582728502


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    Last updated: 2021-10-18

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    • R.I. study finds group yoga helps stressed-out teens


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