?Adaptation and pilot study of yoga to reduce depression in adolescents? Recent reports have shown an alarming increase in prevalence of depression in adolescents, particularly girls, as well as increased numbers of untreated depression in adolescents. This is true despite improved access to health care from 2000 to 2014 across all socioeconomic groups and data supporting more efficacious treatment of depression in adolescents. Thus, testing alternative approaches to treating depression in adolescents, including approaches that do not rely on the limited pool of child and adolescent mental health providers, is an urgent public health priority. A meta-analysis of 12 randomized controlled trials (RCTs) of yoga for depressive symptoms in adults reported yoga was significantly better than usual care, relaxation, or aerobic exercise in decreasing depressive symptoms. We recently conducted a 10-week RCT of adjunctive hatha yoga (vs. a health education control) for adults with current or recent major depression, on antidepressant treatment, yet continued to have depressive symptoms (n=122). Between-group differences in depression symptom severity, while not statistically significant at 10 weeks, were significantly different at the 6-month follow-up period, favoring yoga. Thus, even in this difficult-to-treat group of adults, hatha yoga had an enduring effect on depressive symptoms. There are various plausible mechanisms by which yoga may have an impact on depression, including self- regulatory mechanisms. Yoga may increase self-compassion and one?s ability to observe one?s thoughts and feelings as subjective and transient internal experiences rather than objective and permanent reality (i.e., meta-cognitive awareness). It may also lead to increased heart rate variability, reflecting an improved ability to regulate one?s biological and other responses to stress. To our knowledge, there have not been any studies that rigorously examined yoga in adolescents with clinically significant depression symptoms. Given yoga?s promising results in adults, we believe that hatha yoga may be a useful and safe intervention for depression in adolescents. Using the Participatory Action Research framework, we propose to adapt yoga for adolescents using step-wise guidelines for adapting manualized interventions which include conducting separate focus groups with adolescents (n=24) and parents; soliciting feedback from experts; making iterative revisions of an instructor manual, and conducting pilot open (n=12) and randomized controlled trials (n=40). We will compare yoga to group CBT, to assess feasibility, acceptability, safety, and within-group changes on depression symptom severity (primary outcome) and functional impairment and anxiety (secondary outcomes), as well as changes in potential mechanisms of action, including self-compassion, meta-cognitive awareness, and heart rate variability. This pilot project will provide us with procedures, manuals, and supportive data on feasibility and acceptability that will prepare us to conduct a fully-powered noninferiority design trial of hatha yoga vs. group CBT for depression in adolescents.

Public Health Relevance

?Adaptation and pilot study of yoga to reduce depression in adolescents? The rate of depression in adolescents and the numbers of untreated depression in adolescents has increased in recent years, making this a significant public health concern. Recent studies have shown that hatha yoga may be a promising treatment for depression in adults; however, it has not been rigorously studied as a treatment for depression in adolescents. Taking into account feedback from adolescents with depression, parents, and experts, we propose to adapt yoga for adolescent, to examine its feasibility, acceptability, safety in two pilot clinical trials, and to prepare for an adequately powered RCT comparing yoga to group cognitive- behavioral therapy for reducing depression, functional impairment and anxiety.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Planning Grant (R34)
Project #
5R34AT009886-02
Application #
9703900
Study Section
Special Emphasis Panel (ZAT1)
Program Officer
Mudd, Lanay Marie
Project Start
2018-06-01
Project End
2021-05-31
Budget Start
2019-06-01
Budget End
2020-05-31
Support Year
2
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Brown University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912