Psychology, Health & Medicine

ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage: http://www.tandfonline.com/loi/cphm20

The physical postures of yoga practices may

protect against depressive symptoms, even as life
stressors increase: a moderation analysis

Rebecca A. Franklin, Michael P. Butler & Jacob A. Bentley

To cite this article: Rebecca A. Franklin, Michael P. Butler & Jacob A. Bentley (2018):
The physical postures of yoga practices may protect against depressive symptoms, even
as life stressors increase: a moderation analysis, Psychology, Health & Medicine, DOI:
10.1080/13548506.2017.1420206

To link to this article: https://doi.org/10.1080/13548506.2017.1420206

Published online: 08 Jan 2018.

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 Psychology, Health & Medicine, 2018
https://doi.org/10.1080/13548506.2017.1420206

The physical postures of yoga practices may protect against

depressive symptoms, even as life stressors increase: a
moderation analysis
Rebecca A. Franklina, Michael P. Butlerb and Jacob A. Bentleya
a
Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA; bDepartment of Psychology,
Saint Martin’s University, Lacey, WA, USA
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ABSTRACT ARTICLE HISTORY

Yoga contains sub-components related to its physical postures Received 9 May 2017
(asana), breathing methods (pranayama), and meditation (dhyana). Accepted 24 November 2017
To test the hypothesis that specific yoga practices are associated with KEYWORDS
reduced psychological distress, 186 adults completed questionnaires Depression; yoga; stress;
assessing life stressors, symptom severity, and experience with each moderation; psychological
of these aspects of yoga. Each yoga sub-component was found to be distress
negatively correlated with psychological distress indices. However,
differing patterns of relationship to psychological distress symptoms
were found for each yoga sub-component. Experience with asana
was negatively correlated with global psychological distress (r = −.21,
p < .01), and symptoms of anxiety (r = −.18, p = .01) and depression
(r = −.17, p = .02). These relationships remained statistically significant
after accounting for variance attributable to Social Readjustment
Rating Scale scores (GSI: r = −.19, p = .01; BSI Anxiety: r = −.16, p = .04;
BSI Depression: r = −.14, p = .05). By contrast, the correlations between
other yoga sub-components and symptom subscales became non-
significant after accounting for exposure to life stressors. Moreover,
stressful life events moderated the predictive relationship between
amount of asana experience and depressive symptoms. Asana was
not related to depressive symptoms at low levels of life stressors,
but became associated at mean (t[182] = −2.73, p < .01) and high
levels (t[182] = −3.56, p < .001). Findings suggest asana may possess
depressive symptom reduction benefits, particularly as life stressors
increase. Additional research is needed to differentiate whether asana
has an effect on psychological distress, and to better understand
potential psychophysiological mechanisms of action.

Yoga includes several components: physical postures (asanas), breathing methods (pra-
nayama), chanting, and meditation (dhyana). A growing body of literature has identified
potential benefits of yoga in reducing psychological distress (Cramer, Lauche, Langhorst,
& Dobos, 2013; Uebelacker et al., 2010; Woolery, Myers, Sternlieb, & Zeltzer, 2004). For
example, Woolery et al. (2004) found that participants who engaged in two 60-min yoga
sessions per week for five weeks displayed significant decreases in depressive symptoms

CONTACT Rebecca A. Franklin franklinr2@spu.edu

© 2018 Informa UK Limited, trading as Taylor & Francis Group
 2  R. A. FRANKLIN ET AL.

in comparison to a control group. Moreover, a meta-analysis of 12 randomized controlled

trials found moderate evidence for short-term effects of yoga on symptoms of depression
as compared to care as usual (Cramer et al., 2013). Despite methodological limitations of
existing studies (e.g. small number of studies; heterogeneous methodologies and operational
definitions of ‘yoga’), practice of various yoga forms appears related to reduced psychological
distress in general and perhaps depressive symptomology in particular.
Indeed, operationalizing yoga in its various forms remains a challenge in the overall
empirical research and few studies have evaluated the relative influence of the sub-com-
ponents of yoga on symptom presentations. Research on meditation and yoga-inspired
stress reduction strategies has yielded promising results (Bishop, 2002; Kerr, 2000), but
there has been comparatively little research focused on specific outcomes associated with
asana experience. Asanas are physical positions that exercise the joints and muscles as well
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as the internal organs through stretching and pressure (Goodman, Kashdan, Mallard, &
Schumann, 2014). They are adaptable to people of all ages and a wide range of physical abil-
ities (Dubey, 2011; Yadav, Magan, Mehta, Sharma, & Mahapatra, 2012). Additional research
into asana appears warranted, as the physical postures of yoga qualitatively distinguish it
from other disciplines that also contain meditation or breath-focused relaxation techniques.
Initial evidence suggests that the asanas of yoga are associated with both physiologic and
self-perceived stress reduction (Bhavanani & Ramanathan, 2018; Cowen & Adams, 2005;
Streeter et al., 2007). Physiologically, preliminary findings indicate asana may have effects
on immune system and specific neurotransmitter functions. Streeter et al. (2007) compared
brain gamma-Aminobutyric acid (GABA) levels between experienced yoga practitioners fol-
lowing an asana-concentrated session and a comparison group completing a reading session.
Participants in the yoga group were instructed to modify their usual practice by engaging in
a 60-min, asana-focused session. As part of the study protocol, participants were instructed
to spend at least 55 min of the hour doing asanas and to only use pranayama or meditation in
conjunction with an asana or a brief quiet period (no more than 5 min of the overall hour).
Results indicated a 27% increase in GABA levels in the yoga practitioner group following
the session, and no change in the comparison group. This finding is noteworthy because
(a) low GABA has been associated with depression and anxiety symptoms and (b) it raises
questions about potential physiological and psychological benefits of asana-focused yoga.
If asana-focused yoga can be preliminarily linked to increased GABA, does asana have a
differential effect on perceived stress and the secondary psychological symptoms associated
with low GABA? Cowen and Adams (2005) compared six-week outcomes between partici-
pants in an asana-intensive form of ashtanga yoga and those engaged in a less asana-focused
yoga (e.g. hatha). They found that all participants demonstrated a variety of physiologic and
self-report improvements from baseline to post-test regardless of yoga type. Participants
in the asana-intensive ashtanga group showed improvements in diastolic blood pressure,
perceived stress, health perception, flexibility, and upper body and trunk dynamic muscular
strength and endurance. By contrast, participants in the hatha group only had significant
improvements in flexibility and trunk dynamic muscular strength and endurance. This study
by Cowen and Adams suggests that various forms of yoga may be associated with different
benefits, and leaves questions about asana’s relationship with psychological distress open.
The present study examined the influence of asana on psychological distress in the con-
text of stressful life events. Although complimentary analyses of pranayama and dhyana
 PSYCHOLOGY, HEALTH & MEDICINE  3

were also conducted in order to better understand the potential differential effects of yoga’s
sub-components, the following hypotheses focused on asana:
(1) Number of months’ experience with the daily (or near daily) practice of asana will
be negatively correlated with psychological distress indices (e.g. depression, anxiety,
global distress), even after accounting for the presence of life stressors.
(2) Experience with asana will predict a reduction in symptoms of depression, anxiety,
and global psychological distress.
(3) Exposure to life stressors will moderate the relationship between asana experience
and symptoms of emotional distress such that the symptom reduction benefits of
asana will become apparent as stressful life events increase.
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Method
Participants
A prospective, cross-sectional sample was recruited from the world-renowned Himalayan
International Institute of Yoga Science and Philosophy. The Himalayan Institute is highly
regarded within the yoga community for formal and systematic approaches to the practice
of yoga. Participants were included based on three criteria. First, participants were required
to be learning, teaching, or practicing asana at the Himalayan Institute. Second, they were
required to have been practicing yoga for a minimum of one month to ensure familiarity
with the practices on which they would report. Third, participants were required to be
age 18 years or older. All study procedures were approved by the university Institutional
Review Board.
Two hundred and fifty questionnaires were mailed to the Himalayan Institute. Of these,
235 were completed and returned. Thirty-six participants were excluded due to being under
the age of 18. Responses from four participants were excluded based on the results of outlier
analyses. Another nine participants were not included due to missing data on the varia-
bles of interest. As a result, the final sample consisted of 186 participants (female n = 150,
80.6%) with a mean age of 44.2 years (SD = 14.53). With respect to lifestyle, 179 identified
themselves as ‘laypersons’ (97.8%), two as ‘pandits’ or Hindu scholars (1.1%), and two
as ‘clergy’ (1.1%). The sample included participants from diverse religious and spiritual
backgrounds. The most common religions represented in the sample were ‘miscellaneous’
(31.2%), Christian (29.6%), atheist (13.4%), Hindu (5.9%), and Jewish (4.8%).

Instruments
Yoga Disciplines Questionnaire
The Yoga Disciplines Questionnaire (YDQ) is a brief questionnaire created for use in this
study. The YDQ gauges their participation in the practice of yoga across three subscales:
(a) asana, (b) pranayama, and (c) dhyana. Although no pilot data was gathered on the YDQ
prior to conducting this study, the individual items were constructed with an attention to
face and content validity. Each item simply provides respondents with a clear definition and
asks them to report how much time they have spent engaging in the practice. For example,
the practice of asana was operationalized using the following definition: ‘The Hatha Yoga
 4  R. A. FRANKLIN ET AL.

Pradipika and other scriptures describe postures and stretches (asanas) that can be used
to strengthen and cleanse the body, boost the immune system, and balance the energies
of the body’. The section then asked participants to indicate how many months and years
they had engaged in the daily (or near daily) practice of each yoga component. The YDQ’s
subscales are scored separately, and are not summed or combined in any other way to create
a total score.

Brief Symptom Inventory

The Brief Symptom Inventory (BSI) (Derogatis, 1993; Derogatis & Spencer, 1982) is a
53-item version of the longer Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1975).
The BSI was designed to measure levels of psychological distress over the last seven days
using specific symptom dimensions (e.g. depression, anxiety) and several indices, including
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the Global Severity Index (GSI), which measures overall psychological distress.
The BSI and GSI have demonstrated reliability and validity in American samples (Boulet
& Boss, 1991; Broday & Mason, 1991; Croog et al., 1986; Derogatis, 1993; Endermann, 2005).
Psychometric evaluations of BSI scales and indices have reported internal consistency
coefficients (alphas) ranging from .71 to .89. Test–retest reliability coefficients (2 weeks)
range from .68 to .91 for the nine dimension scales and the three global indices (Derogatis,
1993). The BSI has also demonstrated predictive utility, predicting depression in at-risk
populations (Buckner & Mandell, 1990).

Social Readjustment Rating Scale

The Social Readjustment Rating Scale (SRRS) (Holmes & Rahe, 1967) is a 53-item stimu-
lus-event measure of environmental/situational stress, experienced by an individual over
a 12-month period. The SRRS does not quantify emotional or psychological distress but
rather the degree to which an individual’s environment has exerted a demand for change and
adjustment. Respondents indicate the number of times they have experienced an identified
positive, negative, or neutral event over a 12-month period. The number of times an event
has been experienced is then multiplied by the event’s standardized intensity weight and
the item products are summed to produce a total score. Both item weights and total scores
are coded in terms of ‘life change units’ (LCUs), which represent the amount of demand
for adjustment exerted by an event and for the twelve-month period.
Event intensity weights have been derived via extensive research with a variety of nor-
mative samples which rated the intensity of the specified events (Holmes & Rahe, 1967;
Masuda & Holmes, 1967). Examples of SRRS positive life events include ‘vacation’ (13 LCUs)
and ‘marriage’ (50 LCUs). Negative events on the SRRS include ‘trouble with in-laws’ (29
LCUs) and ‘death of a spouse’ (100 LCUs). SRRS scores have been found to predict gen-
eral psychological distress (Allen, 1981; Roca, 2013; Scully, Tosi, & Banning, 2000). With
regard to scoring and interpretation, total scores of 150 or less are considered indicative of
a low level of exposure of stressful life events in the last 12 months and a low probability
of developing a stress-related disorder (Holmes & Rahe, 1967). A total score of 150 to 299
suggests moderate exposure to stressful life events, whereas a total score of 300 or more
suggests a high level of stressors experienced in the past year.
 PSYCHOLOGY, HEALTH & MEDICINE  5

Statistical analysis
All data analyses were performed in SPSS 24. A Spearman’s rho correlation was calculated
between number of months’ experience with each of the three yoga components and the
GSI. A partial correlation accounting for the influence of SRRS scores on the GSI was also
calculated to account for variance in GSI scores attributable to stress levels. The potential
moderating effect of life stressors on the predictive relationship between months of experi-
ence with each component of yoga and psychological distress symptoms was evaluated using
the PROCESS macro for SPSS (Hayes, 2013). The moderating influence of life stressors on
distress symptoms was tested using 5,000 bootstrap resamples in separate analyses. Simple
slopes of significant interactions were evaluated at one standard deviation below the mean of
the moderator variable, at the mean of the moderator variable, and one standard deviation
above the mean of the moderator. The Johnson-Neyman procedure was used to identify
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trends in the statistical significance of the hypothesized moderation effect.

Results
Table 1 displays the correlations coefficients for the study variables. The three components
of yoga were positively correlated, with r coefficients ranging from .71 to .82 (p < .01).
A statistically significant negative correlation was found between experience with pra-
nayama and life stressors (r = −.19, p = .01), but not the symptom subscales. Experience
with dhyana was negatively correlated with anxiety symptoms (r = −.15, p = .05), overall
psychological distress (r = −.16, p = .03), and life stressors (r = −.18, p = .02), but not
depressive symptoms (r = −.13, p = .08). However, the correlations between dhyana and
the symptom subscales became non-significant after accounting for the variance associated
with life stressors (GSI: r = −.13, p = .09; BSI Anxiety: r = −.12, p = .12; BSI Depression:
r = −.10, p = .17). Experience with asana was negatively correlated with overall psycho-
logical distress (r = −.21, p < .01) as well as the anxiety (r = −.18, p = .01) and depression
(r = −.17, p = .02) subscales. Results remained statistically significant after partialling out
variance attributable to SRRS scores (GSI: r = −.19, p = .01; BSI Anxiety: r = −.16, p = .04;
BSI Depression: r = −.14, p = .05).
Regression analyses revealed main effects of asana predicting reduced anxiety
(t[182] = −2.86, p < .01) and overall psychological distress (t[182] = −3.71, p < .01).
However, no interaction effect was found in the moderation analyses for anxiety symptoms
(t[182] = −1.18, p = .24) or overall psychological distress (t[182] = −1.90, p = .06). Asana

Table 1. Correlations among stressful life events, BSI scales and asana experience in a sample of yoga
practitioners (N = 186).
M SD 1. 2. 3. 4. 5. 6. 7.
1. BSI – Global Severity Index 20.35 17.95 –
2. BSI – Depression 2.38 3.18 .81** –
3. BSI – Anxiety 2.65 2.66 .82** .53** –
4. SRSS 273.35 200.67 .21** .18* .21** –
5. Yoga – Asana (months) 74.44 83.33 −.21** −.17* −.18* −.15* –
6. Yoga – Pranayama (months) 58.80 83.71 −.13 −.06 −.10 −.19** .82** –
7. Yoga – Dhyana (months) 67.06 89.17 −.16* −.13 −.15* −.18* .71** .78** –
Notes: BSI = Brief Symptoms Inventory; SRRS = Social Readjustment Rating Scale.
*p < .05; **p < .01.
 6  R. A. FRANKLIN ET AL.

Table 2. Depressive symptoms predicted from asana practice and life stress.
Predictor β R2/ΔR2 p 95% CI
Asana** −.17 .03 <.001 −.012, −.002
Life stress .15 .02 .07 −.0001, .004
Asana × life stress* −.24 .02 .02 −.0002, −.0001
*p < .05; **p < .01.

predicted a reduction in symptoms of depression (t[182] = −2.73, p < .01). Moderation anal-
yses revealed a significant interaction term of asana and stressful life events that explained
an additional 2% of the variance in depressive symptoms (Table 2). The moderating effect
was not statistically significant at one standard deviation below the mean of life stressors
(t[182] = −.24, p = .81), but became significant at the mean (t[182] = −2.73, p < .01) and
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remained so at one standard deviation above the mean (t[182] = −3.56, p < .001). Figure
1 shows the effect of asana practice on depressive symptoms across levels of life stressors.
Full results of the Johnson-Neyman analysis are conveyed in Table 3. As asana experience
increased, the relationship between life stressors and depressive symptoms became more
negative before levelling off slightly as values in the sample approached the highest number

Figure 1. Simple slopes of the moderator, life stressors, at levels of the predictive relationship between
months of asana yoga practice and depressive symptoms.
 PSYCHOLOGY, HEALTH & MEDICINE  7

Table 3. Conditional effect of asana on depressive symptoms at values of life stressors.

Value Effect SE t p LLCI ULCI
−273.3495 .0014 .0042 .3256 .7451 −.0069 .0096
−229.6995 .0000 .0037 .0086 .9932 −.0074 .0074
−186.0495 −.0013 .0034 −.3843 .7012 −.0079 .0053
−142.3995 −.0026 .0030 −.8634 .3890 −.0086 .0034
−98.7495 −.0039 .0028 −1.4238 .1562 −.0094 .0015
−59.0723 −.0051 .0026 −1.9731 .0500 −.0103 .0000
−55.0995 −.0053 .0026 −2.0281 .0440 −.0104 −.0001
−11.4495 −.0066 .0025 −2.6009 .0101 −.0116 −.0016
32.2005 −.0079 .0026 −3.0577 .0026 −.0130 −.0028
75.8505 −.0092 .0028 −3.3557 .0010 −.0147 −.0038
119.5005 −.0106 .0030 −3.5091 .0006 −.0165 −.0046
163.1505 −.0119 .0033 −3.5611 .0005 −.0185 −.0053
206.8005 −.0132 .0037 −3.5532 .0005 −.0206 −.0059
250.4505 −.0145 .0041 −3.5142 .0006 −.0227 −.0064
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294.1005 −.0159 .0046 −3.4616 .0007 −.0249 −.0068

337.7505 −.0172 .0050 −3.4045 .0008 −.0272 −.0072
381.4005 −.0185 .0055 −3.3480 .0010 −.0294 −.0076
425.0505 −.0198 .0060 −3.2941 .0012 −.0317 −.0080
468.7005 −.0212 .0065 −3.2440 .0014 −.0340 −.0083
512.3505 −.0225 .0070 −3.1979 .0016 −.0364 −.0086
556.0005 −.0238 .0075 −3.1556 .0019 −.0387 −.0089
599.6505 −.0251 .0081 −3.1170 .0021 −.0411 −.0092

of stressors reported in the sample (t[182] = −3.12, p = .002). Post-hoc analyses found no
conditional effect of either pranayama (t[182] = .38, p = .70) or dhyana (t[179] = −.70,
p = .49) on depressive symptoms.

Discussion
Asanas are theorized to reduce physical tension produced by stress, and emerging psycho-
physiological indicators suggest that they may hold promise for the reduction of depression
and anxiety symptoms (Bhavanani & Ramanathan, 2018; Streeter et al., 2007). The present
study suggests potential symptom reduction benefits specifically associated with increased
asana experience. Experience with asana was negatively correlated with symptoms of psy-
chological distress after accounting for the variance attributable to self-reported life stress-
ors. Moreover, asana experience predicted decreased symptomatology. Moderation analyses
indicated that having more asana experience buffered against depressive symptoms, even
in the presence of greater exposure to life stressors.
These findings constitute an important contribution to the empirical literature on yoga,
as few previous asana studies have controlled for subjective life stressors or evaluated incre-
mental variance accounted for by interaction effects. In addition, this study highlights
ongoing questions about the differential benefits of yoga’s various sub-components (Cowen
& Adams, 2005), and their varied effect on type of psychological symptoms. All aspects
of yoga were negatively correlated with psychological distress in our sample. However, we
also found differing symptom patterns associated with asana, pranayama, and dhyana even
though each of those aspects of yoga were highly correlated with one another. Moreover,
asana was the only sub-component of yoga that remained significantly correlated with
symptoms of psychological distress after accounting for the influence of life stressors.
 8  R. A. FRANKLIN ET AL.

The potential effect of asana experience on stress-related symptoms of psychological

distress becomes intuitive when considering purported psychophysiological models of
yoga’s therapeutic effects. In aggregate, the practices of yoga have been shown to act on the
functions of the hypothalamic–pituitary–adrenal axis and the sympathetic nervous system
thereby reducing salivary cortisol and contributing to adaptive mood outcomes (Kinser,
Goehler, & Taylor, 2012; Louie, 2014). Streeter et al. (2007), Streeter, Gerbarg, Saper, Ciraulo,
and Brown (2012) have theorized a physiologic model positing that yoga-based practices
promote autonomic nervous system balance and reduce allostatic load. The Streeter and
colleagues’ model draws on previous psychophysiological yoga research as well as their own
finding that asana-focused yoga increased brain GABA levels among practitioners relative to
a control group. Taken together, current conceptual modeling and the emerging empirical
evidence suggest potential underlying mechanisms for asanas’ purported buffering effect
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on psychological symptoms experienced under stressful conditions.

Considering the previously demonstrated physiological (e.g. increased GABA; decreased
diastolic blood pressure; improved muscular strength, endurance, and flexibility) and per-
ceptual effects (e.g. increased health perception and decreased perceived stress) of asana
through the lens of the aforementioned conceptual model, the results of our study contribute
to an important area of future inquiry. Additional research will be needed in order to under-
stand underlying psychophysiologic mechanisms of action for yoga in general and asana
in particular. Future research should specifically examine mechanisms for the potentially
differential benefit of yoga asanas on reducing depressive symptoms. Cross-referencing
self-report of stress and symptoms with physiological data would be helpful in discerning
potential therapeutic effects of experience with asana and other properties of yoga. Such
studies would also be useful in determining the dose-response effects of specific yoga prac-
tices. In addition, studies comparing yoga practices to other forms of physical activity are
needed in order to better understand asana’s potentially unique benefits.
There are several limitations to this study that must be noted. First, the study sample
was collected from practitioners at a yoga institute and therefore may not be generalizable
to the broader population. Second, being correlation-based, this study was only able to
quantify the direction and degree of association between asana and psychological dis-
tress. Experimental investigations will need to be conducted to determine whether asana
improves mental health or if it is simply associated with better mental health. Third, there
are inherent limitations in attempting to parse the relative influence of the fundamentally
inter-related mechanisms and practices of yoga. Asana, pranayama, and dhyana occur in
conjunction and complementarity with one another. Attempting to isolate their effects arti-
ficially categorizes non-categorical processes in some respects. Although it would likely be
inaccurate to conceptualize yoga’s sub-components as categorical or orthogonal, there are
clear implications for intervention development if the core elements of yoga are associated
with different symptom management benefits across populations (Cowen & Adams, 2005).
Fourth, from a measurement perspective, interpretation of overall SRRS scores is difficult
because of large variations in peoples’ reactions to stressors and coping strategies.

Conclusion
The literature on the psychological and physiological benefits of yoga continues to grow
rapidly. Experience with the asanas of yoga may have stress-reduction benefits that decrease
 PSYCHOLOGY, HEALTH & MEDICINE  9

psychological distress even in conditions of increased life stressors. However, more research
is needed to better understand the relative contributions of asana and other yoga sub-com-
ponents in order to tailor programs and practices for maximum benefit.

Disclosure statement
No potential conflict of interest was reported by the authors.

ORCID
Jacob A. Bentley http://orcid.org/0000-0001-6240-8122
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