You Can Be the Person That You Like to Be in Yoga

Amy Morgan

“You can be the person that you like to be in yoga”

How young people explain the benefits of mindfulness-based yoga

[200621953]

[2014]

A PSYC3520 Major Project supervised by

Dr Siobhan Hugh-Jones

A dissertation submitted in partial fulfilment of the

requirements for the degree of

Psychology

and in agreement with the University of Leeds’

Declaration of Academic Integrity

Acknowledgements

I would like to thank my supervisor Siobhan Hugh-Jones for all the help and support she gave throughout the year and for all the times I left her office feeling enthused and inspired. I would also like to thank CharlottaMartinus for introducing me to the wonderful practice of yoga and for also providing support, as this research would not have been possible without her and the students of her yoga classes.

Contents Page

Introduction...... Pages 1 – 8

Method...... Pages 9– 13

Analysis...... Pages 14– 22

Discussion...... Pages 23– 29

References

Appendices

Abstract

The aim of this exploratory study was to explore how young people explain the benefits of mindfulness-based yoga using a qualitative approach. A convenience sample of ten high school students, aged between 11 and 13, were recruited through their yoga instructor to take part in the present study. Participants had been voluntarily attending the after school yoga classes for between one month and a year, although some had previous yoga or meditation experience. The University of Leeds research ethics committee approved the ethics of the study and information and consent forms were given to the participants, parents of participants and head teacher of the school. Each participant took part in a semi-structured interview, which was recorded and transcribed. Transcripts were analysed using thematic analysis and six themes were found in the data; shifting states, personal achievement, autonomy, commitment, social cohesion and sports performance. The themes reported showed that participants were able to articulate a range of physical and psychological benefits from the mindfulness-based yoga classes and responded positively to it being taught in schools. This study also gives a greater insight into the mental health needs of young people and how negative influences, such as stress and pressure, can be reduced.

1

Introduction

This introduction explores the serious concern of mental health in the youth, as well as the current understanding of what is meant by good health. A background to yoga and mindfulness is given, accompanied by the existing adult literature showing what psychological and physical effects of these practices are already known. The limited research into children and adolescents is then presented followed by the purpose of the current study.

Mental health in young people

One in ten students in English secondary schools say they are not happy and one in three reports feeling low each week (Morgan et al., 2006). Furthermore one in ten young people between the ages of 5 and 16 suffer from a diagnosable mental health disorder (Green et al., 2005). Research has shown that the number of young people reporting feelings of depression and anxiety is rising (Collishaw et al., 2010), with a trend for the rates of these mental health disorders to increase in the transition between childhood and adolescence (Costello et al., 2011). Although there is a significant amount of research surrounding this issue, only a small percentage of children suffering from depression and anxiety, receive the mental health treatment they need (Ford et al., 2008; Kieling et al., 2011).

School services are often the most common point of entry for the families and young people experiencing these emotional and psychological difficulties (Vostanis et al., 2013), thus the education system has a significant role in students’ wellbeing (Ford et al., 2008). For example, Brière et al. (2013) found that students who attended secondary schools with a better social and educational environment, had a reduced risk of developing depression. However in a scoping survey of primary and secondary schools in England, Vostanis et al. (2013) reported an overemphasis on reactive interventions, where most schools aimed to help students already affected by mental health problems, rather than preventing these problems from arising. Thus there is a need for more of a holistic approach, as it would be more efficacious as well as cost-effective to promote wellbeing and mental health provision in all young people, rather than just targeting vulnerable groups (Khalsa, 2013). The National Institute for Health and Clinical Excellence (NICE) (2009) proposed that schools have a responsibility in providing an environment that will develop and protect young people’s mental well being, which will have various impacts on their physical, social, psychological and emotional health, from childhood through to later in life.

Definition of good mental health

In order to develop effective preventative interventions, there is need for a complete understanding of what is meant by good mental health. The World Health Organization (WHO) (1946) defined health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” Following this definition, Huppert and So (2013) suggested that subjective wellbeing could be defined through finding the mirror versions of the symptoms for the two most common mental disorders, anxiety and depression. For example, some of the key aspects they identified included: emotional stability, competence, positive relationships, engagement and self-esteem. Other elements of positive mental health that have been proposed are self-actualization (Jahoda, 1958), autonomy (Ryan & Deci, 2001), personal growth and self-acceptance (Ryff, 1989). This illustrates the multidimensionality of wellbeing, suggesting a need for a greater focus on one’s personal positive experiences, rather than their mental illness (Seligman, 2002).

Traditional approaches in psychology have put too much emphasis on the pathology of mental illness (Gard et al., 2012), whereas more recent development into a branch known as positive psychology, has given more attention to positive human development (Seligman & Csikszentmihalyi, 2000). This concept is based on a greater appreciation of what makes life worth living, leading to a better understanding of aspects such as autonomy, self-regulation, creativity and most importantly, happiness.

Positive psychology incorporates more of a holistic approach to mental health, through addressing people as individuals with active roles in their lives and not merely treating their illness (Seligman, 2002). In parallel with this novel method, the use of alternative medicines has increased over recent years and practices such as yoga, meditation and mindfulness have a growing body of research supporting their effects on subjective wellbeing. Research has shown that there is a relationship between the practice of yoga and the principles of positive psychology. For example, in a study of 124 young adults with a range of yoga experience, positive correlations were identified between the number of years practicing yoga and participants’ sense of meaning in life and gratitude, two concepts in positive psychology which reflect overall psychological wellbeing (IvtzanPapantoniou, 2013).

Background of yoga and mindfulness

The practice of yoga originates from ancient India, with various traditions found in Hinduism and Buddism (Feuerstein, 1998). The term “yoga” refers to the connection between the mind, body and spirit (Salmon et al., 2009) and usually consists of a blend of both physical and psychological aspects (Vera et al., 2009). In the Western world it is regarded as a holistic approach to health and is classified by the National Institute of Health as a form of Complementary and Alternative Medicine (CAM) (Williams et al., 2003). Yoga is recognised as a mind-body exercise due to it’s emphasis on a non judgmental awareness of the body (Impett et al., 2006) and it works through integrating physical, mental and spiritual components to improve one’s quality of life (Woodyard, 2011). One of the main principles of yoga is the fact that it is ‘self-empowering’; it enables the practitioner to take an active, individual approach to their practice (Desikachar et al., 2005). Furthermore it should not be viewed as a short-term solution, but rather a way of life that requires commitment to practice (Chandratreya, 2011; Woodyard, 2011).

In the Western culture, yoga practice is usually built upon three main components: asanas (postures), pranayama (breathing exercises) and dhyana (meditation) (Birdee et al., 2009; Pilkington et al., 2005). Shelov et al. (2009) found that yoga was effective in increasing levels of mindfulness, which has been defined as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4). Derived from Buddhist roots, mindfulness has been characterized by curiosity, openness and acceptance and refers to being aware of present thoughts, emotions and sensations without judgment or evaluation (Bishop et al., 2004). Kabat-Zinn was responsible for popularizing mindfulness through his mindfulness-based stress reduction (MBSR) programme, which incorporates aspects of yoga and meditation in order to help people cope with stress, pain and illness (Kabat-Zinn, 2013). Mindfulness has been shown to be associated with increased self-knowledge and autonomy, suggesting that when people practice mindfulness, their behaviour becomes self-governed and congruent with their interests and values (Brown & Ryan, 2003). Yoga provides a way of practicing ‘mindfulness in motion’ (Salmon et al. 2009) and enhances the effectiveness of MBSR through increasing body awareness and attention to the movements and breath (White, 2012).

Research into yoga and mindfulness in adults

There is a growing body of research supporting the effects of yoga and mindfulness in adults, as benefits have been shown for a broad range of physical illnesses such as chronic pain (Cramer et al., 2013; Evans et al., 2013; Rosenzweig et al., 2010; Williams et al., 2005), asthma (Agnihotri et al., 2014; Bidwell et al., 2012; Sodhi et al. 2014) and cancer (Carlson et al., 2004; Sudarshan et al., 2013; Speca et al., 2000; ÜlgerYağlı, 2010; van Uden-Kraan et al., 2013). Yoga and mindfulness teach people, especially those with chronic physical conditions, to push their physical limits leading to an increase in feelings of control and self-efficacy when dealing with their pain (Hamilton et al., 2006; Evans et al., 2011). Yoga practices have also been shown to improve flexibility (Kawade et al., 2011; Ray et al., 2001), as well as quality of sleep (Alexander et al., 2013; Vera et al., 2009).

Furthermore, yoga provides psychological as well as physical benefits, such as decreasing levels of depression and anxiety (BonuraTenenbaum, 2013; Hofmann et al., 2010;Woolery et al., 2004). Sharma et al. (2008) investigated the effects of a 10-day yoga programmein both healthy participants and those suffering from physical or psychiatric disorders, and found a significant increase in subjective wellbeing, as well as a greater sense of achievement and satisfaction with life compared to controls. Research has also shown that frequent yoga practice leads to an increase in bodily awareness, life satisfaction and self-acceptance (Impett et al., 2006). Women in this study objectified their bodies less after a2-month yoga programme; focusing more on how their bodies felt to themselves as opposed to how it looked to others. Furthermore, Bayne et al. (2007) interviewed students, aged between 18 and 37 years, after a yoga intervention and using qualitative analysis found themes such relaxation, where participants reported a deep feeling of calmness after the yoga class. They also found that the yoga intervention gave the participants a greater self-awareness so they were able to have a deeper understanding of themselves, as well as having a greater awareness of their own strengths and limitations.In addition, a systematic review of yoga-based interventions showed beneficial effects for depressive disorders, however many of the studies reported didn’t include important methodological details such as method of randomisation, compliance and attrition rates, thus there is need for further research in this area (Pilkington et al., 2005).

The use of neuroimaging and biological studies hasalso contributed to the understanding of the mechanisms behind the effects of yoga and mindfulness.

For example, in a controlled longitudinal study, Hölzel et al (2011) used anatomical magnetic resonance imaging (MRI) to show that an eight-week MBSR programmelead to increases in brain gray matter density in regions responsible for processes such as emotional regulation and perspective taking. Furthermore, an extensive literature review showed that yoga lead to positive physical and mental health outcomes through down-regulating the hypothalamic pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), which are triggered in response to stress (Ross & Thomas, 2010). For example, participants had significantly decreased levels of salivary cortical after participation in a yoga programme (Michalsen et al., 2005; West et al., 2004). However Ross and Thomas (2010) reported that there is a need for further research to distinguish between the different types of yoga, as well as explore these effects in both patient and healthy samples.

Despite some methodological limitations, these studies indicate a wide range of physical and psychological benefits of yoga and mindfulness in adults. This suggests sufficient justification for exploring these effects in children and adolescents, especially considering the current concern of mental health in the youth.

Research into yoga and mindfulness in young people

Emerging evidence has shown similar effects of yoga and mindfulness in young people, for example, Kauts and Sharma (2009) found that practicing yoga regularly lead to an improvement in students’ academic performance as a result of reduced stress. Yoga has also been shown to be especially effective in children with attention deficit-hyperactivity disorder (ADHD) (Bahrani & Krishnan, 2011; Hariprasad et al., 2013) through improving behaviour, self-esteem and relationships (Harrison et al., 2004).

In addition, research has explored the effects of yoga and mindfulness in disadvantaged youth, for example, a qualitative study using in-depth interviewsinvestigated the effects of an eight-week MBSR in young people, aged between 13 and 19 years, from an outpatient clinic located in ‘one of the poorest areas of Baltimore’(Kerrigan et al., 2011). Participants experienced a range of benefits, including enhanced self-awareness and stress reduction and they all reported a positive shift in perspective after the MBSR programme.Furthermore Mendelson et al. (2010) explored the outcomes of a 12-week school-based mindfulness and yoga intervention in four ‘urban’ public schools in Baltimore City using a pilot randomized control trial. The intervention aimed to improve the ability to self-regulate in 97 nine and ten year olds from low-income neighbourhoods with high levels of violence. Student and teacher focus groups showed high acceptability of the programmeand self-report questionnaires suggested that it had a positive effect on reducing problematic responses to stress, such as worrying thoughts and rumination. These studies offer promising insights into school-based yoga and mindfulnessprogrammes, however it is difficult to generalize these findings to students who aren’t from impoverished and disadvantaged backgrounds.

One of the first studies to qualitatively assess the effects of yoga in a high school setting was based in the USA (Western Massachusetts) and used a randomized controlled trial, where participants were randomly assigned to either a regular physical education class (control group) or a 12-week long yoga programmes (Conboy et al., 2013). Self-report questionnaires were administered before and after the yoga programmes, as well as qualitative interviews, which were conducted a week after completion of the programme. The students, aged 15, reported benefits such as stress reduction, improved sleep quality, greater respect for the body, as well as heighted performance in other sports through loosening tight muscles and preventing injury. Participants also described greater depth in relationships through the yoga practice, such as increasing friendship and kindness. However the authors reported negative gender associations with the yoga classes, as most males felt peer pressured against practicing yoga. Despite this finding, the study showed a wide range of physical and psychological benefits, as well as high feasibility for school-based yoga programmes.

Limitations of current research into young people

Existing research has shown high levels of acceptability and effectiveness of school-based yoga and mindfulness interventions (Khalsa et al., 2012; Noggle et al., 2012; Weare, 2012), with young people reporting significantly lower levels of anxiety and depressive symptoms. However many of these studies used quantitative methods, such as self-report questionnaires, which only provide a limited understanding of the subjective and personal experiences of participants in these studies (Mackenzie et al., 2007). The use of qualitative approaches are more effective in yielding in-depth, complex data, as well as providing greater ecological reliability (Cochrane & Possamai-Inesedy, 2013), which is essential when investigating the use of yoga and mindfulness in natural, school settings. Furthermore qualitative methods may be more appropriate in younger populations (Mishna et al., 2004), for example, high school students preferred in-person interviews to self-report questionnaires (Conboy et al., 2013). Although quantitative approaches, such as randomized controlled trials, are important in assessing whether an intervention is statistically effective, they do not measure how subjects’ explain and interpret their experience (Verhoef et al., 2002). Thus, qualitative research would be useful in this context by giving a greater comprehension of participants’ lived experiences and perceptions of yoga and mindfulness, such as why it works for them (Kerrigan et al., 2011).

Furthermore, there is an extensive amount of literature showing the benefits of yoga and mindfulness in adults, however the research into children and adolescents is limited. Young people are now viewed as having an active role in research, independently able to voice their own opinions and provide a valid account of their experiences (Mishna et al., 2004). Thus there is a need for studies exploring the effects of mindfulness-based yoga in young people, especially below the age of 15, considering there is an increased likelihood of developing mental disorders, such as depression and anxiety, between the ages of 10 and 15 (Costello et al., 2011).

In addition, a large proportion of the research into yoga and mindfulness has used patients or vulnerable groups (Waters et al., 2014), with a lack of focus on the healthy, non-clinical population. It is important to investigate the effects of mindfulness-based yoga in vulnerable samples, but it is also essential to build preventative interventions through assessing participants who are not already suffering from a mental illness (Department of Health, 2011).

Present study

The present study used qualitative research to investigatethe research question, how do young people explain the benefits of mindfulness-based yoga?The aim of the study was to gain a better insight into a sample ofyoung peoples’ understanding of the mechanisms behind the practice and how they feel it works for them. Their ability to articulate their understanding of mindfulness-based yoga would be an important contribution to developing interventions to increase wellbeing in young people, especially through schools.