Complementary Therapies in Medicine 40 (2018) 89–94

Contents lists available at ScienceDirect

Complementary Therapies in Medicine

journal homepage: www.elsevier.com/locate/ctim

Mindfulness and avoidance mediate the relationship between yoga practice T

and anxiety
⁎
Marina Bonia, Robert Schützea,b, , Robert T. Kanea, Katherine L. Morgan-Lowesa, Jean Byrnec,
Sarah J. Egana
a
School of Psychology, Curtin University, Perth, Australia
b
School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
c
School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia

A R T I C LE I N FO A B S T R A C T

Keywords: Objectives: There is accumulating evidence that yoga and mindfulness meditation can alleviate symptoms of
Yoga anxiety, although the mechanisms by which this occurs remain unclear. The purpose of this study was to ex-
Mindfulness amine the relationship between yoga practice and self-reported anxiety as well as the potential mediating roles
Anxiety of mindfulness and emotional avoidance.
Transdiagnostic
Methods: Using a cross-sectional design, 367 participants were recruited online and completed measures of
Avoidance
anxiety, avoidance, and mindfulness.
Mediation
Results: Results showed that length of yoga practice was significantly correlated with lower anxiety in yoga
practitioners. Avoidance and mindfulness mediated the relationship between length of yoga practice and an-
xiety, shedding light on possible mechanisms by which these practices reduce anxiety.
Conclusions: Future experimental and longitudinal research is needed to examine the causal role of mindfulness
and avoidance in the relationship between yoga practice and anxiety, and whether yoga is a useful adjunct to
cognitive behaviour therapy for anxiety disorders.

1. Introduction healthy women and found a significant reduction in anxiety compared

Yoga is a heterogenous group of mind-body practices that have been
used to reduce human suffering for millennia, with origins in Indian
philosophy and culture.1 Historically, the goal of yoga was to ‘yoke’ or
unify mind, body and spirit through various mental, physical and
ethical practices.2 However, in contemporary settings, particularly in
developed countries, yoga is a largely secular practice mainly com-
prised of physical postures (asana), breathing exercises (pranayama)
and meditation techniques (dyana) aimed at fostering physical and
mental health.3,4 Similarly, contemporary mindfulness meditation in-
terventions such as Mindfulness-Based Stress Reduction (MBSR; 5) are
secularised adaptations of Buddhist teachings,6,7 which themselves
emerged within a yogic context.2
In modern health research settings, there is accumulating evidence
supporting the benefits of yoga and mindfulness meditation for im-
proving psychological functioning.8–10 For yoga, the strongest evidence
exists for its use in treating depression11,12; however there is increasing
evidence of its efficacy in reducing anxiety. 13,14 For example, re-
searchers studied the effects of a two-month yoga intervention in 34
to wait-list control.15 Similarly, a 6-week yoga intervention resulted in
significant decreases in anxiety compared to a relaxation control
group.16 The anxiolytic effect of yoga has been observed in various
groups including college students,17 musicians,18 and breast cancer
patients.19 However, despite evidence for the efficacy of yoga in re-
ducing anxiety, systematic reviews suggest there are several methodo-
logical limitations in this area, including a paucity of evidence about
mechanisms of change in these typically heterogeneous interven-
tions.20–23
One potential explanation for how yoga and mindfulness meditation
reduce anxiety is that these interventions reduce avoidance of negative
affect.22,24 Avoidance of negative affect has been proposed as a central
‘transdiagnostic’ maintaining mechanism across anxiety and mood
disorders.25,26 Treatments that are applicable across all anxiety dis-
orders – known as ‘transdiagnostic’ approaches – aim to combat emo-
tional and behavioural avoidance, in part with a sustained present-fo-
cused awareness and acceptance of negative emotions.25,27,28 The
concept of acceptance is central to third-wave cognitive behavioural
therapies, such as Acceptance and Commitment Therapy (ACT29;) and

⁎
Corresponding author at: School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6847, Australia.
E-mail address: r.schutze@curtin.edu.au (R. Schütze).

https://doi.org/10.1016/j.ctim.2018.08.002
Received 24 June 2018; Received in revised form 7 August 2018; Accepted 7 August 2018
Available online 08 August 2018
0965-2299/ © 2018 Elsevier Ltd. All rights reserved.
M. Boni et al. Complementary Therapies in Medicine 40 (2018) 89–94

Mindfulness-Based Cognitive Therapy (MBCT30;), amongst others. 31
Similarly, mindfulness is a key feature of these third-wave interven-
tions,32 which aim to reduce anxiety by attenuating ruminative cogni-
tive processes and avoidant behaviours, while increasing acceptance of
internal emotional experiences.33
Despite the historical and philosophical commonalities between
yoga and mindfulness practices, few studies have examined their re-
lationship empirically, particularly in the context of explaining me-
chanisms of change in yoga interventions. The present study therefore
aimed to explore these relationships, given there is some evidence that
yoga practice increases self-reported levels of mindfulness.34 It also
aimed to explore factors which might mediate the relationship between
yoga and anxiety (e.g. avoidance, mindfulness), in order to elucidate
potential mechanisms of change in yoga for anxiety. It was hypothe-
sised that yoga practice would be associated with decreased avoidance
of negative affect, given its focus on experiential acceptance and
awareness of present-focused experience, including negative emotions.
Given the previously indicated positive association between avoidance
and anxiety,27 and the negative association between mindfulness and
anxiety,35 we also expected that after controlling for age and gender,
yoga practitioner status (yoga practice versus non-yoga practice) would
be negatively associated with anxiety. Finally, it was expected that
length of yoga practice would be negatively associated with anxiety in
yoga practitioners and that avoidance and mindfulness would mediate
this relationship.
2. Method
2.1. Research design
mindfulness, including observing (MO; attending to internal or external
environments), describing (MD; ability to label the internal environ-
ment), acting with awareness (MAW; attending entirely to the present
moment), non-judging of experience (MNJ; ability to not evaluate the
internal environment), and non-reactivity to experience (MNR; ability
to attend to the internal environment without negative rumination).
These subscales had adequate internal consistency (α = .85, 0.91, 0.91,
.89, and .85, respectively).
2.3.4. Yoga Practice
Participants were asked whether they practiced yoga. If they re-
sponded yes, they were asked about the type of yoga, frequency of
practice in weeks, and length of time practicing yoga in months or
years. Participants responding yes to this question were subsequently
identified as yoga practitioners.
2.4. Procedure
The study was granted ethics approval by the Curtin University
Human Research Ethics Committee. Participants were recruited
through convenience sampling. Students from a yoga school in Perth,
Australia as well as personal contacts of the researchers were invited to
participate. Links to the online questionnaire were posted on social
media and sent via emails. The questionnaire was constructed using the
Qualtrics platform and demographic information was asked first, fol-
lowed by the DASS, CBAS, and FFMQ. Consent was given once parti-
cipants read the information sheet and clicked on the link to start the
survey.

A cross-sectional, correlational design was used, with self-reported 3. Results

measures of anxiety as the criterion variable. Predictor variables were
yoga practice (length in years x practice frequency within a week), non-
yoga practice, avoidance, and mindfulness.
2.2. Participants
The sample consisted of 367 participants (308 females, 59 males).
Of these, 301 were yoga practitioners and 66 non-yoga practitioners,
with ages ranging from 19 to 66 (M = 35.27, SD = 8.83). Types of yoga
practiced included Ashtanga 47.2%, Yin 3%, Vinyasa 27.9%, Iyengar
1.7%, and Other 20.3%.
A priori power analysis determined that a sample size of 300 par-
ticipants would be required for an 80% chance of detecting a relatively
small population regression coefficient (f2 = .05) for the most complex
nine-predictor regression model. The same number of participants
would be required for an 80% chance of detecting a relatively small
Inspection of normality revealed that the continuous yoga practice
variable, anxiety and avoidance were positively skewed.
Transformations were conducted on avoidance and the continuous
(length of) yoga practice variables. Due to the violations of normality
for anxiety, Spearman’s Rho correlations and Non-Parametric
Simultaneous Multiple Regression Analysis (NPSMRA) were used. For
consistency, the same analytical process using NPSMRA was used in the
entire mediation model. Descriptive statistics are presented in Table 1.
As shown in Table 2, age was significantly correlated with gender
and anxiety; however the correlation between yoga practitioner status
Table 1
Descriptive Statistics for Scale Variables.
Yoga Practitioners Total Sample
(N = 301) (N = 367)

indirect effect (κ2 = .05) using mediation analysis.

Variable M [95% CI] SD Range M [95% CI] SD Range

2.3. Measures Anxiety 10.01 [9.58, 3.757 7 - 25 10.07 [9.68, 3.765 7–28
10.43]ª 10.46] ª
Avoidance 52.45 [50.54, 16.811 31 - 113 53.68 [51.82, 18.079 31–119
2.3.1. Anxiety
54.36] 55.53]
Anxiety (criterion variable) was measured using the 7-item anxiety MO 29.63 [29.01, 5.436 9 - 40 28.62 [28.01, 5.978 9–40
subscale of the Depression Anxiety Stress Scale-21 (DASS36). This scale 30.25] 29.24]
consists of 21 items that measure depression, anxiety, and stress over MD 29.26 [28.56, 6.165 11 – 40 28.97 [28.34, 6.135 11–40
the past week. Internal consistency of the anxiety subscale was ex- 29.96] 29.60]
MAW 26.84 [26.25, 5.255 10 - 39 26.75 [26.20, 5.391 8–40
cellent (α = .83). 27.44] 27.30]
MNJ 26.81 [26.02, 7.056 8 - 40 26.66 [25.94, 7.016 8–40
2.3.2. Avoidance 27.61] 27.38]
Avoidance was measured using the 31-item Cognitive Behavioural MNR 22.30 [21.75, 4.824 6 - 34 21.83 [21.32, 4.996 6–34
22.85] 22.35]
Avoidance Scale (CBAS37). The scale had excellent internal consistency
(α = .94). Note: CI = confidence interval; MO = mindfulness observe; MD = mindfulness
describe; MAW = mindfulness act with awareness; MNJ = mindfulness non-
2.3.3. Mindfulness judging of experience; MNR = mindfulness non-reacting to experience.
Mindfulness was measured using the 39-item Five Facet Mindfulness ª
Mean anxiety levels classified as moderate according to the DASS severity
Questionnaire (FFMQ38). This scale was used to measure five aspects of ratings36.

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M. Boni et al. Complementary Therapies in Medicine 40 (2018) 89–94

Table 2
Spearman’s Rho Correlation Matrix for Total Sample (N = 367).
1. 2. 3.
1. Age 1 B [95 % CI]
2. Gender −.133* 1
3. Anxiety −.161** .089 1 Age
4. YPS −.048 −.049 .059
Note: Gender: 0 = female, 1 = male; YPS = yoga practitioner status: 1 = yoga
practitioners, 2 = non-yoga practitioners.
* p < .05.
** p < .01.
and anxiety was non-significant r(365) = 0.059, p = .259.
As shown in Table 3, yoga practitioners’ age was significantly cor-
related with gender, anxiety, avoidance, and mindfulness describe, non-
judging, and non-reacting. Gender was significantly correlated with
anxiety and mindfulness non-reacting. Age and gender were therefore
controlled for in subsequent analyses. Length of yoga practice was
significantly associated with avoidance as well as anxiety and all
mindfulness subscales. Self-reported anxiety was significantly asso-
ciated with avoidance as well as the mindfulness subscales of describe,
act with awareness, non-judging of experience, and non-reacting to
experience.
To examine whether length of yoga practice negatively correlates
with anxiety, a NPSMRA was conducted, as shown in Table 4. The
predictor variables explained 7.2% of the variance in anxiety,
R2 = .072, adjusted R2 = .063, F (3, 297) = 7.70, p < .001. Age and
length of yoga practice accounted for a significant 2% and 2.1% of the
variance in anxiety, respectively.
To examine whether avoidance and mindfulness mediated the re-
lationship between length of yoga practice and anxiety a series of
NPSMRA was conducted, as seen in Table 5. In the first regression, the
combination of the predictor variables (age, gender, length of yoga
practice, avoidance, mindfulness describe, acting with awareness, non-
judging, and non-reacting to experience) explained 30.3% of the var-
iance in anxiety, R2 = .303, adjusted R2 = .284, F (8, 292) = 15.89,
p < .001. Age, avoidance, and mindfulness non-judging of experience
accounted for a significant 1.5%, 9.6%, and 3.8% of the variance in
anxiety, respectively.
In Regressions 2–6 the combination of the predictor variables (age,
gender, and length of yoga practice) explained 4.0% of the variance in
avoidance, R2 = .040, adjusted R2 = .030, F (3, 297) = 4.08, p = .007;
6.5% in mindfulness describe, R2 = .065, adjusted R2 = .056, F (3,
297) = 6.91, p < .001; 11.1% in mindfulness act with awareness,
R2 = .111, adjusted R2 = .102, F (3, 297) = 12.35, p < .001; 11.5% in
mindfulness non-judging of experience, R2 = .115, adjusted R2 = .106,
Table 4
Un-Standardised (B), Standardised (ß) Regression coefficients, and Squared
Semi-Partial Correlations (sr2) for each predictor variable and step of a
4.
NPSMRA Predicting Levels of Self-Reported Anxiety (N = 301).
ß sr2
−.065 [−.115, −.015]* −.149 .020
1 Gender 1.071 [−.086, 2.229] .103 .011
YP −.330 [−.580, −.079]* −.150 .021
f2 .077
Note. CI = confidence interval, YP = yoga practice (length of yoga practice in
weeks).
* p < .05.
F (3, 297) = 12.83, p < .001 and 11.3% in mindfulness non-reacting
to experience, R2 = .113, adjusted R2 = .104, F (3, 297) = 12.59, p <
.001. Length of yoga practice accounted for a significant 2.8% of the
variance in avoidance, 4.5% in mindfulness describe, 9.2% in mind-
fulness act with awareness, 9.1% in mindfulness non-judging of ex-
perience and 8.9% in mindfulness non-reacting to experience.
The Sobel Test indicated that the indirect effect in the model was
significant when using avoidance and mindfulness non-judging of ex-
perience as mediators, z = 2.39, p = .017 and z = 2.89, p = .003,
respectively. These mediation pathways are depicted in Fig. 1.
4. Discussion
This correlational, cross-sectional study sought to explore the re-
lationships between yoga practice, mindfulness, emotional avoidance,
and anxiety. We found that a longer time practising yoga was associated
with lower anxiety, suggesting that the more sustained and frequent a
person’s yoga practice is, the less anxious they are. These results are
similar to previous findings in experimental research measuring levels
of perceived anxiety13,15 and biological markers such as salivary cor-
tisol,17 which indicate that yoga practice is associated with lower an-
xiety. Alternatively, this correlation could also suggest that only in-
dividuals with lower anxiety continue to practice yoga. Thus further
experimental research is necessary to explore these relationships.
However, contrary to expectations we found that yoga practitioner
status was not significantly associated with anxiety. Yoga practitioners
were not significantly less anxious than people who did not practice
yoga. This may be partly explained by sampling confounds in that in-
stead of being comprised of a different subgroup of the population, non-
yoga practitioners were personal contacts of yoga practitioners, thus
introducing the potential for bias. Moreover, there is evidence to sug-
gest that many people are drawn to yoga as a way of reducing their
anxiety.39 Hence, yoga practitioners may have had elevated pre-morbid

Table 3
Spearman’s Rho Correlations Matrix for Yoga Practitioners (N = 301).
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

1. Age 1
2. Gender −.128* 1
3. Anxiety −202*** .127* 1
4. Avoidance −.126* −.018 .448*** 1
5. MO .015 .048 −.039 −.185** 1
6. MD .137* .013 −.203*** −.330*** .441*** 1
7. MAW 108 −.095 −.329*** −.409*** .322*** .391*** 1
8. MNJ .140* .095 −.420*** −.398*** .198** .274*** .548*** 1
9. MNR .125* −.118* −.344*** −.333*** .509*** .418** .493*** .476*** 1
10. YP .264*** −.035 −.193** −.178*** .316*** .242*** .322*** .325*** .317*** 1

Note: Gender: 0 = female, 1 = male; MO = mindfulness observe; MD = mindfulness describe; MAW = mindfulness act with awareness; MNJ = mindfulness non-
judging of experience; MNR = mindfulness non-reacting to experience; YP = yoga practice (length of yoga practice in weeks).
* p < .05.
** p < .01.
*** p < .001.

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M. Boni et al. Complementary Therapies in Medicine 40 (2018) 89–94

Table 5
Un-Standardised (B), Standardised (ß) Regression coefficients, and Squared Semi-Partial Correlations (sr2) for each predictor variable and step of a NPSMRA
Predicting Levels of Criterion Variables (N = 301).
Regression 1 (Criterion: Anxiety) Regression 2 (Criterion: Avoidance) Regression 3 (Criterion: Mind Describe)

B [95 % CI] ß sr2 B [95 % CI] ß sr2 B [95 % CI] ß sr2

Age −.048[−.092, −.004]* −.109 .015 .003 [−.007, .001] −.089 .007 .059 [−.023, .142] .083 .006
Gender .860 [−.166, 1.886] .082 .001 −.029 [−.122, .064] .035 .001 .536 [−1.370, 2.443] .031 .001
YP .000 [−.236, .237] .000 .000 −.027 [−.047, −.007]** −.156 .028 .798 [.385, 1.211]*** .221 .045
Avoid 3.980 [2.572, 5.387]*** .314 .096
MD .018 [−.050, .086] .029 .000
MAW −.012 [−.103, .079] −.017 .000
MNJ −.114 [−.180, −.049]** −.215 .038
MNR −.092 [−.186, .003] −.118 .012
f2 .435 .042 .070

Regression 4 (Criterion: Mind Act) Regression 5 (Criterion: Mind Non-Judge) Regression 6 (Criterion: Mind Non React)

B [95 % CI] ß sr2 B [95 % CI] ß sr2 B [95 % CI] ß sr2

Age −.009 [-.060, .077] −.014 .000 .040 [-.052, .131] .048 .002 .017 [−.045, .080] .032 .001
Gender −1.199 [-2.784, .386] −.082 .007 −1.562 [−3.652, .595] −.078 .007 −1.385 [−2.838, .069] −.103 .014
YP .970 [.626, 1.313]*** .315 .092 1.278 [.818, 1.738]*** .310 .091 .861 [.547, 1.176]*** .305 .089
f2 .125 .130 .127

Note. CI = confidence interval; MD = mindfulness describe; MAW = mindfulness act with awareness; MNJ = mindfulness non-judging; MNR = mindfulness non-
reacting; YP = yoga practice (length of yoga practice in weeks).
* p < .05.
** p < .01.
*** p < .001.

anxiety compared to the general population, which may explain the
non-significant findings.
As expected, we found a positive association between avoidance and
anxiety. This is consistent with research showing that avoidance is a
common maintaining factor in anxiety disorders.40 According to
transdiagnostic models of emotional disorder, people who judge their
emotional responses as inappropriate and therefore try to suppress
emotion-eliciting thoughts are more likely to develop a negative emo-
tional expression.41 In contrast, those who acknowledge and accept the
full range of internal experiences, without trying to change them, may
observe a decrease in levels of avoidance.33 Consistent with this, we
found that length of yoga practice was negatively associated with
avoidance, suggesting that the practice of yoga may be related to the
acceptance of negative emotions rather than the use of suppression and
avoidance strategies.
The present study also found positive associations between facets of
mindfulness –including observe, describe, act with awareness, non-judging
of experience, non-reacting to experience – and length of yoga practice.

Fig. 1. Mediation pathway of avoidance and mindfulness between yoga practice and anxiety. Values are standardised coefficients (ß) of the direct effects. Value
between brackets is the direct effect of yoga practice on anxiety. Broken lines represent a non-significant correlation at p < .05.
*p < .05, **p < .01, ***p < .001.

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M. Boni et al.
Similar associations have been found previously with meditation
practice.8,42 Importantly, we found that the relationship between yoga
practice and anxiety was mediated by a key facet of mindfulness – non-
judging of experience. This suggests that cultivation of non-elaborative
awareness of present-moment experience may be a mechanism by
which yoga is associated with lower anxiety. Of course, further dis-
mantling research using prospective and experimental designs would be
required to test this. However, this cross-sectional data provides pre-
liminary data to pursue such research.
Although the relationship between yoga practice,13,15 mind-
fulness,42 avoidance,25,43 and their effects on anxiety have been re-
ported in previous experimental research, until now the potential
mediating role of mindfulness and avoidance has not been investigated
in the context of yoga. Our study found that avoidance also mediated
the relationship between yoga and anxiety. This is the first evidence to
our knowledge of such mediation. However, these mediation effects are
consistent with the principles of Mindfulness-Based Cognitive
Therapy,30 which targets decreased experiential avoidance and an in-
creased ability to be in the present moment without judgment or ela-
borative cognition.32,40
Despite these novel findings, the present study has several limita-
tions. First, our cross-sectional design precludes any conclusions about
causal relationships between yoga, mindfulness, avoidance, and an-
xiety. Further, the sample may not be considered representative of the
general yoga community,44 as the majority of participants were Ash-
tanga yoga practitioners and recruited via convenience sampling. In
addition, yoga respondents who are very committed to yoga practice
may have been more inclined to participate in the study. Sampling bias
may have also been introduced, as non-yoga practitioners were per-
sonal contacts of yoga practitioners and researchers. Additionally, data
was not collected on pre-existing psychiatric history of participants.
Despite these limitations, the present findings warrant further ex-
ploration of the possible role for yoga practice as a complementary
therapy within the evidence-based treatment of anxiety. Recognition by
systematic review authors of several methodological issues in yoga
treatment research suggest that high quality, adequately powered
randomised controlled trials are needed to better investigate the effi-
cacy of yoga for anxiety. In addition, dismantling studies are needed to
examine the active components of yoga interventions, optimal dosage,
and mechanisms of change. The present study paves the way for such
research by suggesting that increased mindfulness and decreased
avoidance should be investigated as mechanisms of change in the re-
duction of anxiety through yoga.
Funding
This research was supported by a grant from the School of
Psychology, Curtin University.
Conflict of interest
The authors have no conflicts of interest to disclose.
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