Differential Effects of Ethical Education, Physical Hatha Yoga, and Mantra Meditation on Well-Being and Stress in Healthy Participants-An Experimental Single-Case Study

Karin Matko, Peter Sedlmeier, Holger C Bringmann, Karin Matko, Peter Sedlmeier, Holger C Bringmann

Abstract

Traditionally, yoga is a multicomponent practice consisting of postures, breathing techniques, meditation, mantras, and ethics. To date, only a few studies have tried to dismantle the effects of each of these components and their combinations. To fill this gap, we examined the incremental effects of ethical education and physical Hatha yoga on mantra meditation using a single-case multiple-baseline design. This study was part of a project evaluating the new mind-body program Meditation-Based Lifestyle Modification. Fifty-seven healthy participants with no regular yoga or meditation practice were randomly assigned to three baselines (7, 14, and 21 days) and four conditions using a random number generator. The conditions were mantra meditation alone (MA), meditation plus physical yoga (MY), meditation plus ethical education (ME), and meditation plus yoga and ethical education (MYE). All the interventions lasted for 8 weeks and were run consecutively according to baseline length. During the baseline and treatment phases, participants received daily questionnaires measuring their well-being (WHO-5 Well-Being Index), stress (Perceived Stress Scale), and subjective experiences. Forty-two participants completed the treatment and were entered in the analyses. We analyzed our data using visual inspection, effect size estimation (Tau-U), and multilevel modeling. Almost all participants showed a longitudinal increase in well-being. Regarding between-group differences, participants who received ethical education exhibited the largest increases in well-being (Tau-U = 0.30/0.23 for ME/MYE), followed by participants in the MY condition (Tau-U = 0.12). Conversely, participants in the MA condition showed no change (Tau-U = 0.07). There was a tendency for the combined treatments to decrease stress. This tendency was strongest in the MY condition (Tau-U = -0.40) and reversed in the MA condition (Tau-U = 0.17). These results emphasize the incremental and differential effects of practicing meditation in combination with other practices from the eight-fold yoga path. This approach is valuable for better understanding the multifaceted practice of yoga. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04252976.

Keywords: differential effects; ethical education; incremental effects; mantra meditation; mixed-method; multilevel modeling; single-case research; yoga components.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Matko, Sedlmeier and Bringmann.

Figures

Figure 1
Figure 1
Multiple-baseline design employed in the present study. B, baseline; FU, follow-up; PT, Posttest.
Figure 2
Figure 2
CONSORT flow chart of participants in the study.
Figure 3
Figure 3
Well-Being scores in four conditions during baseline and treatment phases for each participant with regression lines for each phase. MA, Mantra meditation only; ME, meditation and ethical education; MY, meditation and physical yoga; MYE, meditation, physical yoga, and ethical education.
Figure 4
Figure 4
Box plots for averaged Tau-U well-being estimates in each condition. Individual well-being estimates are scattered across the box plots. MA, Mantra meditation only; ME, meditation and ethical education; MY, meditation and physical yoga; MYE, meditation, physical yoga, and ethical education. Whiskers represent the largest and lowest values within a distance of 1.5 times the interquartile range.
Figure 5
Figure 5
Stress scores during baseline and treatment phases for each participant with regression lines for each phase. MA, Mantra meditation only; ME, meditation and ethical education; MY, meditation and physical yoga; MYE, meditation, physical yoga, and ethical education.
Figure 6
Figure 6
Box Plots for averaged Tau-U stress estimates in each condition. Individual stress estimates are scattered across the box plots. MA, Mantra meditation only; ME, meditation and ethical education; MY, meditation and physical yoga; MYE, meditation, physical yoga, and ethical education. Whiskers represent the largest and lowest values within a distance of 1.5 times the interquartile range.

References

    1. Attkisson C. C., Zwick R. (1982). The client satisfaction questionnaire: psychometric properties and correlations with service utilization and psychotherapy outcome. Eval. Program Plann. 5, 233–237. 10.1016/0149-7189(82)90074-x
    1. Bai S., Elavsky S., Kishida M., Dvoráková K., Greenberg M. T. (2020). Effects of mindfulness training on daily stress response in college students: ecological momentary assessment of a randomized controlled trial. Mindfulness 11, 1433–1445. 10.1007/s12671-020-01358-x
    1. Barlow D. H., Nock M., Hersen M. (2009). Single Case Experimental Designs: Strategies for Studying Behavior for Change, 3rd Edn. Boston, MA: Pearson.
    1. Bhat P. S., Chopra V., Mehta S. G., Srivastava K., Kumar S. R., Prakash J. (2012). Psychological benefits of yoga in industrial workers. Ind. Psychiatry J. 21, 98–103. 10.4103/0972-6748.119592
    1. Brähler E., Mühlan H., Albani C., Schmidt S. (2007). Teststatistische prüfung und normierung der deutschen versionen des EUROHIS-QOL lebensqualität-index und des WHO-5 wohlbefindens-index. Diagnostica 53, 83–96. 10.1026/0012-1924.53.2.83
    1. Breedvelt J. J. F., Amanvermez Y., Harrer M., Karyotaki E., Gilbody S., Bockting C. L. H., et al. . (2019). The effects of meditation, yoga, and mindfulness on depression, anxiety, and stress in tertiary education students: a meta-analysis. Front. Psychiatry 10:193. 10.3389/fpsyt.2019.00193
    1. Bringmann H. C., Bringmann N., Jeitler M., Brunnhuber S., Michalsen A., Sedlmeier P. (2020). Meditation-based lifestyle modification: development of an integrative mind-body program for mental health and human flourishing. Complement. Med. Res. 28, 252–262. 10.1159/000512333
    1. Brunstein J. C. (1993). Personal goals and subjective well-being: a longitudinal study. J. Pers. Soc. Psychol. 65, 1061–1070. 10.1037/0022-3514.65.5.1061
    1. Bryant E. F. (2015). The Yoga Sutras of Patañjali: A New Edition, Translation, and Commentary. New York, NY: Farrar, Straus and Giroux.
    1. Burns M. K. (2012). Meta-analysis of single-case design research: introduction to the special issue. J. Behav. Educ. 21, 175–184. 10.1007/s10864-012-9158-9
    1. Büssing A., Michalsen A., Khalsa S. B. S., Telles S., Sherman K. J. (2012). Effects of yoga on mental and physical health: a short summary of reviews. Evid. Based Complement. Alternat. Med. 2012:e165410. 10.1155/2012/165410
    1. Carmody J., Baer R. A. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. J. Clin. Psychol. 65, 627–638. 10.1002/jclp.20555
    1. Cebolla A., Demarzo M., Martins P., Soler J., Garcia-Campayo J. (2017). Unwanted effects: is there a negative side of meditation? A multicentre survey. PLoS ONE 12:e0183137. 10.1371/journal.pone.0183137
    1. Chen S., Jordan C. H. (2020). Incorporating ethics into brief mindfulness practice: effects on well-being and prosocial behavior. Mindfulness 11, 18–29. 10.1007/s12671-018-0915-2
    1. Cohen S., Williamson G. M. (1988). Perceived stress in a probability sample of the United States, in The Social Psychology of Health: Claremont Symposium on Applied Social Psychology, eds Spacapan S., Oskamp S. (Newbury Park, CA: Sage; ), 31–67.
    1. Cramer H., Lauche R., Dobos G. (2014). Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement. Altern. Med. 14:328. 10.1186/1472-6882-14-328
    1. Cramer H., Lauche R., Langhorst J., Dobos G. (2013). Yoga for depression: a systematic review and meta-analysis. Depress. Anxiety 30, 1068–1083. 10.1002/da.22166
    1. Cramer H., Lauche R., Langhorst J., Dobos G. (2016). Is one yoga style better than another? A systematic review of associations of yoga style and conclusions in randomized yoga trials. Complement. Ther. Med. 25, 178–187. 10.1016/j.ctim.2016.02.015
    1. Dedrick R. F., Ferron J. M., Hess M. R., Hogarty K. Y., Kromrey J. D., Lang T. R., et al. . (2009). Multilevel modeling: a review of methodological issues and applications. Rev. Educ. Res. 79, 69–102. 10.3102/0034654308325581
    1. Devananda S. V. (1999). Meditation and Mantras. New Delhi: Motilal Banarsidass.
    1. Diener E. D., Emmons R. A., Larsen R. J., Griffin S. (1985). The satisfaction with life scale. J. Pers. Assess. 49, 71–75. 10.1207/s15327752jpa4901_13
    1. Evans J. J., Gast D. L., Perdices M., Manolov R. (2014). Single case experimental designs: introduction to a special issue of neuropsychological rehabilitation. Neuropsychol. Rehabil. 24, 305–314. 10.1080/09602011.2014.903198
    1. Ferron J. M., Bell B. A., Hess M. R., Rendina-Gobioff G., Hibbard S. T. (2009). Making treatment effect inferences from multiple-baseline data: the utility of multilevel modeling approaches. Behav. Res. Methods 41, 372–384. 10.3758/BRM.41.2.372
    1. Ferron J. M., Moeyaert M., Van den Noortgate W., Beretvas S. N. (2014). Estimating causal effects from multiple-baseline studies: implications for design and analysis. Psychol. Methods 19, 493–510. 10.1037/a0037038
    1. Feuerstein G. (2012). The Yoga Tradition: Its History, Literature, Philosophy and Practice. Gardena, CA: SCB Distributors.
    1. Fox K. C. R., Dixon M. L., Nijeboer S., Girn M., Floman J. L., Lifshitz M., et al. . (2016). Functional neuroanatomy of meditation: a review and meta-analysis of 78 functional neuroimaging investigations. Neurosci. Biobehav. Rev. 65, 208–228. 10.1016/j.neubiorev.2016.03.021
    1. Franquesa A., Cebolla A., García-Campayo J., Demarzo M., Elices M., Pascual J. C., et al. . (2017). Meditation practice is associated with a values-oriented life: the mediating role of decentering and mindfulness. Mindfulness 8, 1259–1268. 10.1007/s12671-017-0702-5
    1. Fredrickson B. L., Boulton A. J., Firestine A. M., Van Cappellen P., Algoe S. B., Brantley M. M., et al. . (2017). Positive emotion correlates of meditation practice: a comparison of mindfulness meditation and loving-kindness meditation. Mindfulness 8, 1623–1633. 10.1007/s12671-017-0735-9
    1. Gage N. A., Lewis T. J. (2013). Analysis of effect for single-case design research. J. Appl. Sport Psychol. 25, 46–60. 10.1080/10413200.2012.660673
    1. Gard T., Brach N., Hölzel B. K., Noggle J. J., Conboy L. A., Lazar S. W. (2012). Effects of a yoga-based intervention for young adults on quality of life and perceived stress: the potential mediating roles of mindfulness and self-compassion. J. Posit. Psychol. 7, 165–175. 10.1080/17439760.2012.667144
    1. Gard T., Noggle J. J., Park C. L., Vago D. R., Wilson A. (2014). Potential self-regulatory mechanisms of yoga for psychological health. Front. Hum. Neurosci. 8:770. 10.3389/fnhum.2014.00770
    1. Gong H., Ni C., Shen X., Wu T., Jiang C. (2015). Yoga for prenatal depression: a systematic review and meta-analysis. BMC Psychiatry 15:14. 10.1186/s12888-015-0393-1
    1. Gorvine M. M., Zaller N. D., Hudson H. K., Demers D., Kennedy L. A. (2019). A naturalistic study of yoga, meditation, self-perceived stress, self-compassion, and mindfulness in college students. Health Psychol. Behav. Med. 7, 385–395. 10.1080/21642850.2019.1688154
    1. Gothe N. P., McAuley E. (2015). Yoga and cognition: a meta-analysis of chronic and acute effects. Psychosom. Med. 77, 784–797. 10.1097/PSY.0000000000000218
    1. Granath J., Ingvarsson S., von Thiele U., Lundberg U. (2006). Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn. Behav. Ther. 35, 3–10. 10.1080/16506070500401292
    1. Grossman P., Niemann L., Schmidt S., Walach H. (2004). Mindfulness-based stress reduction and health benefits: a meta-analysis. J. Psychosom. Res. 57, 35–43. 10.1016/S0022-3999(03)00573-7
    1. Hartfiel N., Havenhand J., Khalsa S. B., Clarke G., Krayer A. (2011). The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace. Scand. J. Work Environ. Health 37, 70–76. 10.5271/sjweh.2916
    1. Hayes S. C., Follette V. M., Linehan M. (eds.). (2004). Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition. New York, NY: Guilford Press.
    1. Hendriks T., de Jong J., Cramer H. (2017). The effects of yoga on positive mental health among healthy adults: a systematic review and meta-analysis. J. Altern. Complement. Med. 23, 505–517. 10.1089/acm.2016.0334
    1. Hölzel B. K., Lazar S. W., Gard T., Schuman-Olivier Z., Vago D. R., Ott U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect. Psychol. Sci. 6, 537–559. 10.1177/1745691611419671
    1. Hox J. J. (2010). Multilevel Analysis: Techniques and Applications, 2nd Edn. Abingdon-on-Thames: Routledge.
    1. Hunt M., Al-Braiki F., Dailey S., Russell R., Simon K. (2018). Mindfulness training, yoga, or both? Dismantling the active components of a mindfulness-based stress reduction intervention. Mindfulness 9, 512–520. 10.1007/s12671-017-0793-z
    1. Iyengar B. K. S. (2009). Light on Yoga: Yoga Dipika. New Delhi: Harper Collins.
    1. Jones R. N., Rosenberg A. L., Morris J. N., Allaire J. C., McCoy K. J., Marsiske M., et al. . (2005). A growth curve model of learning acquisition among cognitively normal older adults. Exp. Aging Res. 31, 291–312. 10.1080/03610730590948195
    1. Kabat-Zinn J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen. Hosp. Psychiatry 4, 33–47. 10.1016/0163-8343(82)90026-3
    1. Kassambara A. (2020). ggpubr: “ggplot2” Based Publication Ready Plots (R package version 0.4.0) [Computer software]. Available online at: (accessed February 21, 2011).
    1. Kinser P. A., Robins J. L. (2013). Control group design: enhancing rigor in research of mind-body therapies for depression. Evid. Based Complement. Altern. Med. 2013:e140467. 10.1155/2013/140467
    1. Kishida M., Mama S. K., Larkey L. K., Elavsky S. (2018). “Yoga resets my inner peace barometer”: a qualitative study illuminating the pathways of how yoga impacts one's relationship to oneself and to others. Complement. Ther. Med. 40, 215–221. 10.1016/j.ctim.2017.10.002
    1. Kocovski N. L., Segal Z. V., Battista S. R. (2009). Mindfulness and psychopathology: problem formulation, in Clinical Handbook of Mindfulness, ed Didonna F. (New York, NY: Springer; ), 85–98. 10.1007/978-0-387-09593-6_6
    1. Kratochwill T. R., Hitchcock J., Horner R. H., Levin J. R., Odom S. L., Rindskopf D. M., et al. . (2010). Single-case designs technical documentation, in What Works Clearinghouse. What Works Clearinghouse. Available online at: (accessed June 21, 2014).
    1. Kropp A., Sedlmeier P. (2019). What makes mindfulness-based interventions effective? An examination of common components. Mindfulness 10, 2060–2072. 10.1007/s12671-019-01167-x
    1. Lane J. D., Gast D. L. (2014). Visual analysis in single case experimental design studies: brief review and guidelines. Neuropsychol. Rehabil. 24, 445–463. 10.1080/09602011.2013.815636
    1. Lehrer P. M., Woolfolk R. L., Sime W. E. (2007). Principles and Practice of Stress Management, 3rd Edn. New York, NY: Guilford Press.
    1. Leiner D. J. (2019). SoSci Survey (Version 3.1.06) [Computer software]. Available online at: (accessed January 3, 2019).
    1. Lindahl J. R., Fisher N. E., Cooper D. J., Rosen R. K., Britton W. B. (2017). The varieties of contemplative experience: a mixed-methods study of meditation-related challenges in Western Buddhists. PLoS ONE 12:e0176239. 10.1371/journal.pone.0176239
    1. Lindsay E. K., Chin B., Greco C. M., Young S., Brown K. W., Wright A. G. C., et al. . (2018). How mindfulness training promotes positive emotions: dismantling acceptance skills training in two randomized controlled trials. J. Pers. Soc. Psychol. 115, 944–973. 10.1037/pspa0000134
    1. Lippelt D. P., Hommel B., Colzato L. S. (2014). Focused attention, open monitoring and loving kindness meditation: effects on attention, conflict monitoring, and creativity: a review. Front. Psychol. 5:1083. 10.3389/fpsyg.2014.01083
    1. Lundh L.-G. (2020). Experimental phenomenology in mindfulness research. Mindfulness 11, 493–506. 10.1007/s12671-019-01274-9
    1. Lynch J., Prihodova L., Dunne P. J., Carroll Á., Walsh C., McMahon G., et al. . (2018). Mantra meditation for mental health in the general population: a systematic review. Eur. J. Integr. Med. 23, 101–108. 10.1016/j.eujim.2018.09.010
    1. Machalicek W., Horner R. H. (2018). Special issue on advances in single-case research design and analysis. Dev. Neurorehabil. 21, 209–211. 10.1080/17518423.2018.1468600
    1. Manincor M., de Bensoussan A., Smith C. A., Barr K., Schweickle M., Donoghoe L.-L., et al. . (2016). Individualized yoga for reducing depression and anxiety, and improving well-being: a randomized controlled trial. Depress. Anxiety 33, 816–828. 10.1002/da.22502
    1. Matko K., Bringmann H. C., Sedlmeier P. (2021a). The effects of different components of yoga: a review of comparative studies and meta-analyses. PsyArXiv. 10.31234/
    1. Matko K., Ott U., Sedlmeier P. (2021b). What do meditators do when they meditate? proposing a novel basis for future meditation research. Mindfulness 12, 1791–1811. 10.1007/s12671-021-01641-5
    1. Matko K., Sedlmeier P. (2019). What is meditation? Proposing an empirically derived classification system. Front. Psychol. 10:2276. 10.3389/fpsyg.2019.02276
    1. Matsushita T., Oka T. (2015). A large-scale survey of adverse events experienced in yoga classes. Bio Psycho Soc. Med. 9:9. 10.1186/s13030-015-0037-1
    1. May C. J., Weyker J. R., Spengel S. K., Finkler L. J., Hendrix S. E. (2014). Tracking longitudinal changes in affect and mindfulness caused by concentration and loving-kindness meditation with hierarchical linear modeling. Mindfulness 5, 249–258. 10.1007/s12671-012-0172-8
    1. McCall M. C. (2013). How might yoga work? An overview of potential underlying mechanisms. J. Yoga Phys. Ther. 3:130. 10.4172/2157-7595.1000130
    1. McCrary M. (2013). Pick Your Yoga Practice: Exploring and Understanding Different Styles of Yoga. Novato, CA: New World Library.
    1. Moeyaert M., Rindskopf D., Onghena P., Van den Noortgate W. (2017). Multilevel modeling of single-case data: a comparison of maximum likelihood and Bayesian estimation. Psychol. Methods 22, 760–778. 10.1037/met0000136
    1. Nakagawa S., Schielzeth H. (2013). A general and simple method for obtaining R2 from generalized linear mixed-effects models. Methods Ecol. Evol. 4, 133–142. 10.1111/j.2041-210x.2012.00261.x
    1. Orme-Johnson D. W., Barnes V. A. (2013). Effects of the Transcendental Meditation technique on trait anxiety: a meta-analysis of randomized controlled trials. J. Altern. Complement. Med. 20, 330–341. 10.1089/acm.2013.0204
    1. Park C. L., Finkelstein-Fox L., Sacco S. J., Braun T. D., Lazar S. (2020). How does yoga reduce stress? A clinical trial testing psychological mechanisms. Stress Health 37, 116–126. 10.1002/smi.2977
    1. Parker R. I., Vannest K. J., Davis J. L. (2011a). Effect size in single-case research: a review of nine nonoverlap techniques. Behav. Modif. 35, 303–322. 10.1177/0145445511399147
    1. Parker R. I., Vannest K. J., Davis J. L., Sauber S. B. (2011b). Combining nonoverlap and trend for single-case research: Tau-U. Behav. Ther. 42, 284–299. 10.1016/j.beth.2010.08.006
    1. Pascoe M. C., Thompson D. R., Ski C. F. (2017). Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology 86, 152–168. 10.1016/j.psyneuen.2017.08.008
    1. Peng C.-K., Henry I. C., Mietus J. E., Hausdorff J. M., Khalsa G., Benson H., et al. . (2004). Heart rate dynamics during three forms of meditation. Int. J. Cardiol. 95, 19–27. 10.1016/j.ijcard.2003.02.006
    1. Peng C.-Y. J., Chen L.-T. (2021). Assessing intervention effects in the presence of missing scores. Educ. Sci. 11:76. 10.3390/educsci11020076
    1. Pinheiro J., Bates D., DebRoy S., Sarkar D., R Core Team (2020). nlme: Linear and Nonlinear Mixed Effects Models (R Package Version 3.1-144) [Computer software]. Available online at: (accessed February 21, 2011).
    1. Powers M. B., de Kleine R. A., Smits J. A. J. (2017). Core mechanisms of cognitive behavioral therapy for anxiety and depression: a review. Psychiatr. Clin. N Am. 40, 611–623. 10.1016/j.psc.2017.08.010
    1. Pustejovsky J. E. (2019). Procedural sensitivities of effect sizes for single-case designs with directly observed behavioral outcome measures. Psychol. Methods 24, 217–235. 10.1037/met0000179
    1. Quach D., Mano K. E. J., Alexander K. (2016). A randomized controlled trial examining the effect of mindfulness meditation on working memory capacity in adolescents. J. Adolesc. Health 58, 489–496. 10.1016/j.jadohealth.2015.09.024
    1. Quasten L. C. (2019). Die Untersuchung Psychologischer Maße in der Meditationsforschung im Rahmen Experimenteller Einzelfallanalysen. Unpublished master's thesis.
    1. R Core Team (2020). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Available online at: (accessed June 20, 2022).
    1. Raghuraj P., Ramakrishnan A. G., Nagendra H. R., Telles S. (1998). Effect of two selected yogic breathing techniques on heart rate variability. Indian J. Physiol. Pharmacol. 42, 467–472.
    1. Riley K. E., Park C. L. (2015). How does yoga reduce stress? A systematic review of mechanisms of change and guide to future inquiry. Health Psychol. Rev. 9, 379–396. 10.1080/17437199.2014.981778
    1. Ryan R. M., Deci E. L. (2001). On happiness and human potentials: a review of research on hedonic and eudaimonic well-being. Annu. Rev. Psychol. 52, 141–166. 10.1146/annurev.psych.52.1.141
    1. Sarkar D. (2008). lattice: Multivariate Data Visualization With R. Springer. Available online at: (accessed February 21, 2011).
    1. Schmalzl L., Powers C., Henje Blom E. (2015). Neurophysiological and neurocognitive mechanisms underlying the effects of yoga-based practices: towards a comprehensive theoretical framework. Front. Hum. Neurosci. 9:235. 10.3389/fnhum.2015.00235
    1. Sedlmeier P., Eberth J., Puta M. (2016). Meditation: future theory and research, in The Psychology of Meditation: Research and Practice, ed West M. A. (Oxford: Oxford University Press; ), 285–310.
    1. Sedlmeier P., Eberth J., Schwarz M., Zimmermann D., Haarig F., Jaeger S., et al. . (2012). The psychological effects of meditation: a meta-analysis. Psychol. Bull. 138, 1139–1171. 10.1037/a0028168
    1. Sedlmeier P., Srinivas K. (2019). Psychological theories of meditation based on early Buddhism and Samkhya/Yoga, in The Oxford Handbook of Meditation, eds Farias M., Brazier D., Lalljee M. (Oxford: Oxford University Press; ).
    1. Sedlmeier P., Theumer J. (2020). Why do people begin to meditate and why do they continue? Mindfulness 11, 1527–1545. 10.1007/s12671-020-01367-w
    1. Seligman M. E. P. (2004). Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment. New York, NY: Simon and Schuster.
    1. Shadish W. R. (2014). Analysis and meta-analysis of single-case designs: an introduction. J. Sch. Psychol. 52, 109–122. 10.1016/j.jsp.2013.11.009
    1. Shannahoff-Khalsa D. S., Fernandes R. Y., Pereira C. A., de B., March J. S., Leckman J. F., et al. . (2019). Kundalini Yoga meditation versus the Relaxation Response meditation for treating adults with obsessive-compulsive disorder: a randomized clinical trial. Front. Psychiatry 10:793. 10.3389/fpsyt.2019.00793
    1. Sherman K. J. (2012). Guidelines for developing yoga interventions for randomized trials. Evid. Based Complement. Altern. Med. 2012:e143271. 10.1155/2012/143271
    1. Shiffman S., Stone A. A., Hufford M. R. (2008). Ecological momentary assessment. Annu. Rev. Clin. Psychol. 4, 1–32. 10.1146/annurev.clinpsy.3.022806.091415
    1. Shoham A., Goldstein P., Oren R., Spivak D., Bernstein A. (2017). Decentering in the process of cultivating mindfulness: an experience-sampling study in time and context. J. Consult. Clin. Psychol. 85, 123–134. 10.1037/ccp0000154
    1. Singh N. N., Lancioni G. E., Medvedev O. N., Sreenivas S., Myers R. E., Hwang Y.-S. (2019). Meditation on the soles of the feet practice provides some control of aggression for individuals with Alzheimer's disease. Mindfulness 10, 1232–1242. 10.1007/s12671-018-1075-0
    1. Smith J. A., Greer T., Sheets T., Watson S. (2011). Is there more to yoga than exercise? Altern. Ther. Health Med. 17, 22–29.
    1. Solomon B. G., Howard T. K., Stein B. L. (2015). Critical assumptions and distribution features pertaining to contemporary single-case effect sizes. J. Behav. Educ. 24, 438–458. 10.1007/s10864-015-9221-4
    1. Stein E., Witkiewitz K. (2020). Dismantling mindfulness-based programs: a systematic review to identify active components of treatment. Mindfulness 11, 2470–2485. 10.1007/s12671-020-01444-0
    1. Stephens M. (2011). Teaching Yoga: Essential Foundations and Techniques. Berkeley, CA: North Atlantic Books.
    1. Sullivan M. B., Moonaz S., Weber K., Taylor J. N., Schmalzl L. (2017). Toward an explanatory framework for yoga therapy informed by philosophical and ethical perspectives. Altern. Ther. Health Med. 23, 38–47.
    1. Tarlow K. R. (2017). An improved rank correlation effect size statistic for single-case designs: baseline corrected Tau. Behav. Modif. 41, 427–467. 10.1177/0145445516676750
    1. Telles S., Singh N. (2013). Science of the mind: ancient yoga texts and modern studies. Psychiatr. Clin. 36, 93–108. 10.1016/j.psc.2013.01.010
    1. Titz J. (2020). mimosa: a modern graphical user interface for 2-level mixed models. J. Open Source Softw. 5:2116. 10.21105/joss.02116
    1. Trivedi G. Y., Patel V., Shah M. H., Dhok M. J., Bhoyania K. (2020). Comparative study of the impact of active meditation protocol and silence meditation on heart rate variability and mood in women. Int. J. Yoga 13, 255–260. 10.4103/ijoy.IJOY_18_20
    1. Varambally S., Gangadhar B. N. (2016). Current status of yoga in mental health services. Int. Rev. Psychiatry 28, 233–235. 10.3109/09540261.2016.1159950
    1. Wachholtz A. B., Pargament K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. J. Behav. Med. 28, 369–384. 10.1007/s10865-005-9008-5
    1. Wilbert J., Lueke T. (2019). scan: Single-Case Data Analyses for Single and Multiple Baseline Designs (R Package Version 0.40) [Computer Software]. Available online at: (accessed February 21, 2011).
    1. Wolf D. B., Abell N. (2003). Examining the effects of meditation techniques on psychosocial functioning. Res. Soc. Work Pract. 13, 27–42. 10.1177/104973102237471
    1. World Health Organization (1998). Info Package: Mastering Depression in Primary Care, Version 2.2. WHO, Regional Office for Europe, Psychiatric Research Unit. Available online at: (accessed February 21, 2011).
    1. Wu Y., Johnson B. T., Acabchuk R. L., Chen S., Lewis H. K., Livingston J., et al. . (2019). Yoga as antihypertensive lifestyle therapy: a systematic review and meta-analysis. Mayo Clin. Proc. 94, 432–446. 10.1016/j.mayocp.2018.09.023

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe