The relationship between yoga involvement, mindfulness and psychological well-being

Complementary Therapies in Medicine 26 (2016) 123–127

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The relationship between yoga involvement, mindfulness and psychological well-being L. Gaiswinkler a , H.F Unterrainer a,b,∗,1 a b

University clinic of Psychiatry, Medical University of Graz, Austria Center for Integrative Addiction Research (Grüner Kreis Society), Vienna, Austria

a r t i c l e

i n f o

Article history: Received 16 December 2015 Received in revised form 26 February 2016 Accepted 16 March 2016 Available online 17 March 2016 Keywords: Mindfulness Meditation Psychological well-being Spirituality Yoga involvement

a b s t r a c t Objectives: The aim of this study was to examine how different levels of yoga involvement are related to different parameters of mental health and illness. Design and setting: A total sample of 455 participants (410 females) were investigated by means of an internet survey. 362 yoga practitioners (327 females) rated their degree of yoga involvement on the Yoga Immersion Scale. A control group was comprised of 93 gymnastics practitioners (83 females). Main outcome measures: All participants completed the Multidimensional Inventory for Religious/Spiritual Well-Being, the Freiburger Mindfulness Inventory and the Brief Symptom Inventory for psychiatric symptoms. Results: Highly involved yoga practitioners exhibited a significantly increased amount of mindfulness and religious/spiritual well-being (both p < 0.01) and lower psychiatric symptoms such as depression (p < 0.01) compared to those who were only marginally/moderately yoga-involved or who were in the gymnastics control group. Conclusions: In accordance with the literature, yoga practice might have its biggest impact on mental health when it is part of a practitioner’s worldview. Further research focusing on the impact of yoga involvement in clinical groups is encouraged. © 2016 Elsevier Ltd. All rights reserved.

1. Introduction A holistic view of human beings is becoming more and more central to the practice of medicine these days. At the same time, there is a growing need to develop efficient treatments for psychiatric diseases. According to the World Health Organization 37% of the “healthy working years” are lost due to mental disorders.18 Therefore, it is a matter of concern for psychosomatic research to find out more about the specific functional mechanisms which cause the positive effects of Complementary and Alternative Methods (CAM), such as yoga, for psychological well-being.2 According to2 yoga is an ancient practice rooted in India, which unites movement, respiration, concentration and meditation. Although there is a vast amount of different schools of yoga these days, it can be concluded that the most common yoga styles include physical postures (asanas), control of breath (pranayama) and the use of meditation

∗ Corresponding author at: Center for Integrative Addiction Research (Grüner Kreis Society), Vienna Widerhofergasse 5/8, 1090 Vienna, Austria. E-mail address: [email protected] (H.F Unterrainer). 1 web: http://www.a-research.info/. http://dx.doi.org/10.1016/j.ctim.2016.03.011 0965-2299/© 2016 Elsevier Ltd. All rights reserved.

(dyana) to increase strength, flexibility and mindfulness.4 Furthermore there are several yoga styles that include only one or two of these components (e.g. Iyengar Yoga includes solely asanas or Kriya Yoga includes only meditation). The main focus of yoga is essentially to arrive in the “here and now” − by focusing on the present moment, similar to mindful mediation techniques.10 As a result, mindfulness is trained on one’s own feelings, thoughts, body and environment. Evidently, the practice of yoga offers a perspective for the prevention, as well as for the treatment, of mental and physical disorders.1,8,10 Most prominently, yoga was observed to be positively associated with more adequate stress coping by influencing various physiological parameters (such as breathing and heartbeat) positively 5,13 as well as psychometric parameters; for instance, practicing yoga in clinical and non-clinical settings showed a positive effect for the treatment of anxious/depressive symptoms.1,8,4 Correspondingly, there is also growing evidence for the positive influence of yoga on subjective well-being as confirmed by neuronal correlates in the brain.1

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1.1. The impact of yoga involvement for psychosomatic health Yoga, practitioners, represents a way of living which can affect all aspects of life, depending on how deep the practitioner is immersed into it.9 Therefore the impact of yoga on the practitioners’ subjective well-being might depend on the degree of involvement into the practice itself.3,4 Being “intrinsically motivated” for something can be equated with something being in a central position of a hierarchical personal construct system.9,12 Consequently, a centrally mounted construct should influence the experience and behaviour of an individual in a significant way.12 As suggested by Huber,11 a multidimensional (religiosity) trait can be assumed as comprising five different core dimensions: the intellectual, the ideological, the experiential, the private practice and the public practice dimension. Now the probability that religion moves to the central (“autonomous”) position in one‘s personality rises with frequency and intensity of activation of the religious construct system.11 In line with this model, we propose the idea of a “yogic construct system”. In order to assess the centrality of yoga in the self-concept of a person, a short scale (Yoga Immersion Scale, YI-S) was constructed and validated in a previous study.9 Here Yoga Immersion was defined as “the extent of personal involvement into the teachings of yoga running on a continuum”.9, p. 32 1.2. Research aims In this study we explore the idea that the practice of yoga might show its most powerful effects on Mindfulness and several parameters of psychological well-being when linked to a higher level of yoga involvement. Therefore the level of Yoga Immersion is correlated to several parameters of mindfulness, subjective well-being and psychiatric symptoms in a non-clinical group of yoga practitioners who were then compared to a control group of gymnasts. 2. Methods 2.1. Participants and procedure The test subjects were recruited via announcements in yoga and fitness studios, yoga forums, as well as through the support of the professional association for yoga teachers in Austria (BYO) and Germany (BDY). The entire study was conducted via an online survey and took place from January–March 2014. The inclusion criteria for this study were the practice of yoga or gymnastics as well as fluency in the German language. In order to lay some groundwork regarding the relevance of yoga involvement as being related to psychological well-being we did not set any exclusion criteria. The study protocol was approved by the ethics board of the University of Graz, Austria. Informed consent was obtained from all participants. There was no financial remuneration, however all the participants were entered into a contest with small material prizes (e.g. yoga mat). 2.2. Socio-demographic and psychometric assessment Socio-demographic data such as for instance gender, age and education status were assessed via an anamnestic datasheet. Furthermore, the frequency and duration of practice were assessed to determine the intensity of yoga/gymnastics practice. The Yoga Immersion Scale (YI-S) 9 is used in order to assess the amount of yoga involvement (Yoga Immersion). The YI-S consists of 10 items, which are answered on a six-point likert scale (1—totally disagree to 6—totally agree). Some item examples can be given as follows: “The wisdom of yoga affects my way of seeing things in everyday life” or “By practicing yoga I can concentrate better”.

The Freiburg Mindfulness Inventory (FMI) is a 30-item instrument that assesses mindfulness, which can be best understood as the attentive, unprejudiced perception of all mental content, such as thoughts, feelings, emotions and bodily sensations.17 The questions are answered via a four-point likert scale (1—hardly ever to 4—almost always). The Brief Symptom Inventory (BSI-18) 6 measures the amount of three categories of psychiatric symptoms, namely Somatization, Anxiety and Depression, which can be summarized to a total amount of general symptom burden: the Global Severity Index (GSI). The instrument consists of 18 items which are answered via a four-point likert scale (0—not at all to 4—very strong). The Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB) 15 is a multidimensional measure to assess six different dimensions of religious and spiritual well-being, namely General Religiosity, Forgiveness, Connectedness, Hope immanent, Hope Transcendent and Experiences of Sense and Meaning, which can be collated into a total amount of RSWB (Religious/Spiritual WellBeing). The instrument consists of 48 items, which are answered via a six-point likert scale (1—totally disagree to 6—totally agree). 2.3. Statistical methods To compare the participants with regards to their level of Yoga Immersion (YI), three groups (total: 362 participants), were formed and compared to 93 gymnasts. The total sample of yoga practitioners was divided into three groups by means of a tertile split based on their YI-S total score, where the participants could reach a minimum score of 10 points and a maximum score of 60 points. 10–33 points = Y1 : Yoga Immersion marginal : 111 participants; 34–46 points = Y2 : Yoga Immersion moderate : 120 participants; 47–60 points = Y3 : Yoga Immersion high : 131 participants. These three Yoga Immersion sub-groups (marginal, moderate, high) were further compared with the respondents who exclusively practiced gymnastics (93 participants). Differences in sociodemographic data as well as frequency of yoga/gymnastics practice were investigated by means of ␹2 test. Univariate (ANOVA) and multivariate Analysis of Variance (MANOVA) were conducted to investigate the differences between the amount of YI and how it compares to gymnastics practitioners due to FMI, BSI-18 and RSWB dimensions. Gender, age and level of education, frequency and duration of practice were considered as important covariates. By conducting Analysis of Covariance we observed only the covariate “Age” to have a significant influence on the GSI and BSI-18 subscales “Anxiety” and “Depression”. All other covariates had no influences on the observed parameters and were thus excluded from further analysis. Tukey-HSD was used for post-hoc comparisons. The relationships between YI and socio-demographic, yoga/gymnastics related variables, FMI, BSI-18 and RSWB dimensions were investigated by means of Pearson correlation statistics. The ␣-level was set to 0.05. Bonferroni correction was applied in order to control for ␣-inflation. 3. Results The total study sample was comprised of 455 participants (410 females). We examined a group of 362 yoga practitioners; in this group, 327 subjects (90.3%) were female and the age ranged from 18 to 68 years. Furthermore, we investigated a comparison group of 93 gymnasts, where 83 of them were female (89.2%). This group was aged between 16 and 71 years. Depending on the yoga style practiced, multiple answers were possible. Within the sample of

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Table 1 Differences in age, gender, education status, duration and frequency of yoga/gymnastics practice.

Gender Female Male Age M(SD)

Yoga marginal (Y1) n = 111

Yoga moderate (Y2) n = 120

Yoga high (Y3) n = 131

Control-group (CG) n = 93

102 (91.9%) 9 (8.1%) 27.83 (8.57)

114 (86.7%) 6 (13.3%) 36.96 (12.79)

121 (92.4%) 10 (7.6%) 43.77 (13.10)

83 (89.2%) 10 (10.8%) 25.58 (9.52)

Education 1 2 3 4 5 6

2 (1.8%) 5 (4.5%) 3 (2.7%) 53 (47.7%) 1 (0.9%) 47 (42.4%)

2 (1.7%) 5 (4.2%) 9 (7.5%) 40 (33.3%) 13 (10.8%) 51 (42.5%)

7 (5.4%) 15 (11.4%) 17 (13.0%) 31 (23.7%) 22 (16.8%) 39 (29.7%)

1 (1.1%) 5 (5.4%) 9 (9.7%) 56 (60.2%) 7 (7.5%) 15 (16.1%)

Time 1 2 3 4 5 6 7 8 9

12 (10.8%) 9 (8.1%) 9 (8.1%) 27 (24.3%) 26 (23.4%) 9 (8.1%) 7 (6.3%) 2 (1.8%) 10 (9.1%)

5 (4.1%) 2 (1.7%) 4 (3.3%) 8 (6.7%) 18 (15.0%) 8 (6.7%) 8 (6.7%) 8 (6.7%) 59 (49.1%)

1 (0.8%) 2 (1.5%) 0 8 (6.1%) 2 (1.5%) 6 (4.6%) 4 (3.1%) 4 (3.1%) 104 (79.4%)

15 (16.1%) 16 (17.2%) 11 (11.8%) 12 (12.9%) 10 (10.8%) 5 (5.4%) 4 (4.3%) 13 (14.0%) 7 (7.5%)

Frequency 1 2 3 4 5 6 7

7 (6.3%) 8 (7.2%) 10 (9.5%) 13 (11.4%) 47 (42.2%) 20 (18.0%) 6 (5.4%)

0 2 (1.7%) 1 (0.8%) 6 (5.0%) 25 (20.8%) 65 (54.2%) 21 (17.5%)

0 0 0 4 (3.1%) 9 (6.8%) 47 (35.9%) 71 (54.2%)

1 (1.1%) 13 (14.0%) 7 (7.5%) 4 (4.3%) 32 (34.4%) 19 (20.4%) 17 (18.3%)

F/Chi2 (df)

p

2

Post Hoc

2.82 (3/451)

ns

62.20 (3/451) 6.15 (3/451)

<0.01**

0.29

CG = Y1 < Y2 < Y3

<0.01**

0.04

Y3 < CG < Y2 < Y1

97.99 (3/451)

<0.01**

0.40

CG < Y1 < Y2 < Y3

63.94 (3/451)

<0.01**

0.30

CG < Y1 < Y2 < Y3

Note: M = mean difference; SD = standard deviation; **p < 0.01 after Bonferroni correction; ␩2 = partial eta squared; Education = education level (1 = compulsory education, 2 = completed apprenticeship, 3 = vocational high school, 4 = high school, 5 = college degree, 6 = university degree); Time: duration of practice (1 = <1 month, 2 = 3 months, 3 = 6 months, 4 = 1 year, 5 = 2 years, 6 = 3 years, 7 = 4 years, 8 = 5 years, 9 = > 5 years); Frequency: Frequency of yoga/gymnastics practice (1 = once/week, 7 = daily).

Table 2 Sociodemographic and anamnestic characteristics of different yoga immersive sub-groups and gymnastics practitioners. Yoga marginal (Y1) n = 111

Yoga moderate (Y2) n = 120

Yoga high (Y3) n = 131

Controlgroup (CG) n = 93

Occupation Retired Unemployed In education Working

0 6 (5.4%) 62 (55.9%) 43 (38.7%)

4 (3.3%) 7 (5.8%) 44 (36.7%) 65 (54.2%)

9 (6.9%) 7 (5.3%) 20 (15.3%) 95 (72.5%)

2 (2.2%) 3 (3.2%) 67 (72.0%) 21 (22.6%)

Religious affiliation None Buddhist Christian Hindu

40 (36.0%) 0 71 (64.0%) 0

46 (38.3%) 5 (4.2%) 68 (56.7%) 1 (0.8%)

63 (48.1%) 7 (5.3%) 58 (44.3%) 3 (2.3%)

24 (25.8%) 2 (2.2%) 67 (72.0%) 0

Marital Status Married Relationship Single Widowed/divorced

39 (35.1%) 62 (55.9%) 10 (9.0%) 0

36 (30.0%) 53 (44.2%) 30 (25.0%) 1 (0.8%)

41 (31.3%) 38 (29.0%) 50 (38.2%) 2 (1.5%)

44 (47.3%) 44 (47.3%) 4 (4.3%) 1 (1.1%)

Psychiatric diagnosis Yes No

7 (6.3%) 104 (93.7%)

10 (8.3%) 110 (91.7%)

7 (5.3%) 124 (94.7%)

10 (10.8%) 83 (89.2%)

Psychotropics Yes No

5 (4.5%) 106 (95.5%)

7 (5.8%) 113 (94.2%)

1 (0.8%) 130 (99.2%)

6 (6.5%) 87 (93.5%)

yoga practitioners, 247 (68.2%) stated the practice of Hatha Yoga, 32 (8.8%) stated Bikram Yoga practice, 51 (14.4%) practiced Ashtanga Yoga, 20 (5.5%) practiced Iyengar Yoga, 26 (7.2%) practiced Karma Yoga and 9 (2.5%) stated the practice of Hormone Yoga. Regarding

the practiced gymnastics style, participants could also give multiple answers: Here 27 (29%) practiced Aerobics, 7 (7.5%) practiced Pelvic floor exercises, 20 (21.5%) practiced gymnastics especially for the spinal column and 25 (26.9%) stated the practice of Pilates.

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Table 3 Correlations between Yoga Immersion, Mindfulness, Religious/Spiritual Well-Being and psychiatric symptom burden. YI-S YI-S FMI GSI SOMA ANX DEPR RSWB GR FO HI CO HT

FMI

GSI

SOMA

ANX

DEPR

RSWB

GR

FO

HI

CO

HT

SM

0.59**

−0.30** −0.42**

−0.18** −0.26** 0.82**

−0.28** −0.35** 0.86** 0.59**

−0.30** −0.43** 0.87** 0.56** 0.62**

0.89** 0.63** −0.15** −0.25** −0.31** −0.45**

0.58** 0.43** −0.20** −0.09 −0.18** −0.22** 0.79**

0.47** 0.48** −0.37** −0.23** −0.33** −0.36** 0.65** 0.37**

0.32** 0.38** −0.43** −0.30** −0.25** −0.52** 0.62** 0.30** 0.28**

0.58** 0.42** −0.17** −0.07 −0.11* −0.22** 0.77** 0.62** 0.25** 0.39**

0.41** 0.43** −0.34** −0.24** −0.32** −0.31** 0.51** 0.21** 0.49** 0.16** 0.19**

0.24** 0.34** −0.15** −0.11* −0.01 −0.25** 0.54** 0.30** 0.16** 0.47** 0.45** −0.01

Note: * = p < .05; ** = p < .01; YI-S = Yoga Immersion Scale total score; FMI = Freiburg Mindfulness Inventory; GSI = Global Severity Index; Soma = Somatization; Anx = Anxiety; Depr = Depression; RSWB = Religious/spiritual Well-Being total score; GR = General Religiosity; FO = Forgiveness; HI = Hope Immanent; CO = Connectedness; HT = Hope Transcendent; SM = Experiences of Sense and Meaning.

Table 1 displays group differences between the yoga-immersive sub-groups and the gymnastics practitioners in socio-demographic variables. Additional sociodemographic variables concerning the yogaimmersive sub-groups and gymnastics practitioners are shown in Table 2. 3.1. Correlations between Yoga Immersion and parameters of psychological well-being and psychiatric symptom burden In general Yoga Immersion was found to be highly positively interconnected with duration (r = 0.59; p < 0.01) and frequency (r = 0.58; p < 0.01) of yoga practice. Table 3 now exhibits all intercorrelations between YI, FMI, MI-RSWB and BSI-18. 3.2. Group differences in mindfulness and religious/spiritual well-being As shown in Table 4, we observed several relevant differences between the three yoga immersive sub-groups and the gymnastics control group in Mindfulness and religious/spiritual well-being. 3.3. Differences in psychiatric symptoms between yoga immersive sub-groups and the gymnastics group Within our results concerning psychiatric symptoms we observed significant differences as shown in Table 5. Furthermore, as shown in Table 5, we observed significant group differences in the amount of mood pathology. 4. Discussion In this study we sought to investigate the relationship between the practice of yoga and various parameters of subjective wellbeing and mental health, which has been found to be well documented in the literature.3–5,14 By employing a community sample of yoga practitioners, together with a group of gymnastics practitioners, the assumed positive relationship between yoga practice and psychological well-being was confirmed. Furthermore, we found empirical support for the positive impact of Yoga Immersion (YI). Therefore, our initial results tentatively point to the conclusion that yoga may only develop its full beneficial effect on the human psyche when the individual is highly involved in this practice. A division into three different YI levels (Y1–Y3) highlighted the strongest health-related effects for the high yogaimmersive Y3 group. Substantial differences for all parameters of psychological well-being (FMI, RSWB) were found, especially with regards to the Y1 group, which in turn exhibited similar results

compared to group of gymnastics practitioners. Therefore, there is some limited evidence that practicing yoga on a marginal level of personal involvement (Y1) might lead to similar results as any other body-oriented technique such as gymnastics. Consequently, the Y3 group exhibited the lowest amount of mood pathology in comparison to all the other groups, especially for the Anxiety and the Depression sub-scales (p < 0.01 for both). This confirms previous research, where yoga was reported as being especially effective for the treatment of anxious/depressive disorders.3–5 However, there is still a lack of research addressing the spiritual dimension of yoga practice,4 as most research these days focuses on its potential psycho-physiological and therapeutic benefits.1,5,8 Among the RSWB dimensions, Y3 subjects scored excessively high for General Religiosity as well as Connectedness compared to all the other groups. Accordingly, the spiritual dimension of yoga might especially facilitate an increased amount of psychological wellbeing. Therefore, connecting with a spiritual realm of perception might be especially important for mental health issues. More generally, this assumption fits nicely with the fact that spirituality has been widely described as being one of the major ingredients for a holistic view in patients’ treatment.16,19,20 4.1. Limitations and future perspectives Regarding the limitations of this study, it has to be mentioned that a further differentiation of our control group in three different levels of gymnastics involvement probably might have led to more convincing results. Furthermore, enhanced information about the quantitative (e.g. more accurate data about frequency and duration) and qualitative aspects of the actual yoga-practice (e.g. which yoga style or tradition) is warranted. Due to the cross-sectional design of the study we cannot rule out at this point that differences between the three yoga groups do not simply reflect the effects of longer and more intensive practice. Perhaps mentally stable yoga practitioners are simply more able to fully immerse themselves into yoga practice rather than mentally unstable ones. Therefore, further research on any causal inferences of yoga involvement has to be done. Moreover, some additional potential confounders might be considered in further research, such as ethnicity or differences between urban and rural areas. As our sample consisted of 90% female participants, enhanced data from male subjects are needed in order to say something more definitively about potential gender specific effects of YI. These might be anticipated based upon previous research.3 Additionally, most research on yoga as being related to mental health benefits has been conducted in community samples.5,8 Therefore, further research might also investigate the health benefits of YI in clinical surroundings. Based on these preliminary findings, we assume that an in-depth amount of yoga

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Table 4 Differences in Mindfulness and Religious/Spiritual Well-Being in different yoga immersive sub-groups and the gymnastics group.

FMI RSWB General Religiosity Forgiveness Hope Immanent Connectedness Hope Transcendent Experiences of Sense and Meaning

Cronbach´ıs ␣ Yoga marginal (Y1) M (SD) n = 111

Yoga moderate (Y2) M (SD) n = 120

Yoga high (Y3) M (SD) n = 131

Control-group (CG) M (SD) n = 93

F (df)

p

2

Post Hoc

0.83 0.84 0.93 0.75 0.70 0.82 0.77 0.66

84.33 (9.40) 208.23 (25.82) 25.84 (10.67) 38.74 (6.98) 36.95 (6.62) 30.74 (8.44) 37.45 (6.28) 38.51 (6.04)

92.31 (9.46) 233.08 (23.07) 33.18(9.26) 42.17(5.25) 40.53(5.08) 36.93 (7.72) 39.22 (6.56) 41.04 (4.79)

78.59 (8.54) 189.90 (28.14) 21.71 (10.84) 32.95 (8.53) 36.13 (7.45) 28.77 (7.92) 31.44 (7.49) 38.90 (5.07)

64.14 (3/451) 84.40 (3/451) 50.62 (3/451) 40.05 (3/451) 12.51 (3/451) 43.13 (3/451) 34.63 (3/451) 6.47 (3/451)

<0.01** <0.01** <0.01** <0.01** <0.01** <0.01** <0.01** <0.01**

0.29 0.36 0.25 0.21 0.08 0.22 0.19 0.04

CG = Y1 < Y2 < Y3 CG = Y1 < Y2 < Y3 Y1 < CG < Y2 < Y3 CG = Y1 < Y2 < Y3 CG = Y1 = Y2 < Y3 Y1 < CG < Y2 < Y3 CG = Y1 < Y2 < Y3 CG = Y1 = Y2 < Y3

77.61 (9.20) 184.48 (28.85) 17.86 (9.75) 34.23 (7.99) 36.17 (7.15) 25.40 (8.42) 32.40 (7.19) 38.42 (5.72)

Note: M = mean difference; SD = standard deviation; ** = p < 0.01 after Bonferroni correction; ␩2 = partial eta squared; FMI = Freiburg Mindfulness Inventory, RSWB = Religious/Spiritual Well-Being total score.

Table 5 Differences in mood pathology in different yoga-immersive sub-groups and the gymnastics group. Cronbach´ıs ␣ Global Severity Index Somatization Anxiety Depression

0.89 0.74 0.77 0.85

Yoga marginal (Y1) M (SD) n = 111 13.61 (11.27) 3.48 (3.74) 5.42 (3.97) 4.71 (4.96)

Yoga moderate (Y2) M (SD) n = 120 10.70 (8.29) 2.91 (2.78) 4.42 (3.46) 3.37 (3.61)

Yoga high (Y3) M (SD) n = 131 6.71 (6.93) 2.12 (2.76) 2.82 (2.76) 1.76 (2.40)

Control-group (CG) M (SD) n = 93 14.15 (8.56) 3.89 (3.55) 4.99 (3.29) 5.27 (4.51)

F (df) 1

3.58 (3/451) 6.55 (3/451) 3.471 (3/451) 4.57 1 (3/451)

p

2

Post Hoc

<0.01** <0.01** <0.01** <0.01**

0.02 0.04 0.02 0.03

CG = Y1 = Y2Y3 < Y1&Y2 CG = Y1 = Y2 = Y3 < CG&Y1 CG = Y1 = Y2 > Y3 CG = Y1 > Y2 > Y3

Note: M = mean difference; SD = standard deviation; **p < 0.01 after Bonferroni correction; 1 controlled for age; ␩2 = partial eta squared.

involvement might significantly improve the patients’ conditions in clinical treatment. At this point further randomized controlled trials are highly recommended. Furthermore, it should be mentioned that there has been substantial criticism concerning mindfulness meditation techniques (MMT) as a form of intervention in patient treatment.7 Here the authors strongly criticise the supposed health enhancing effects of MMT as mostly over-interpreted and sometimes ideologically driven. Additionally, they point to the possibility that MMT can be related to mental illness by fostering feelings of anxiety and depression and even triggering psychotic symptoms. However, in this study we did not find anything in our data pointing to these alleged pathological aspects of yoga practice. In conclusion, this study provides an initial look at the development of a stage model of Yoga involvement in order to characterize the effect of yoga on the human psyche by means of psychometric measures. Our initial findings add some evidential support that yoga-practicing might engender major therapeutic benefits.2 In line with the idea of YI, ancient yogic teachings might be nowadays considered as invaluable resources for health and clinical practice. 5. Conflicts of interest None. Acknowledgements We are grateful to Shanti Yoga Store Vienna for sponsoring the yoga mats for the contest, as well as the Professional Association for Yoga Teachers in Austria (BYO) and Germany (BDY) for their help in recruiting the participants. We would also like to thank Nikolas Bonatos for making critical and helpful comments in order to improve this manuscript. References 1. Balasubramaniam M, Telles S, Doraiswamy PM. Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Front. Psychiatry. 2013;3:117, http://dx.doi.org/10.3389/fpsyt.2012.00117. 2. Barnett JE, Shale AJ. The integration of complementary and alternative medicine (CAM) into the practice of psychology: a vision for the future. Prof. Psychol. Res. Pr. 2012;43:576–585;, http://dx.doi.org/10.1037/a0028919. 3. Büssing A, Edelhäuser F, Weisskircher A, Fouladbakhsh JM, Heusser P. Inner correspondence and peacefulness with practices among participants in eurythmy therapy and yoga: a validation study. Evid. Based Compl. Alt. 2011, http://dx.doi.org/10.1155/2011/329023, 329023.

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