Brigham & Women’s Hospital Harvard Medical School Yoga in Schools Yoga Alliance Webinar May 7, 2020 Sat Bir S. Khalsa, Ph.D. Assistant Professor of Medicine, Harvard Medical School Director of Yoga Research, Yoga Alliance Director of Research, Kundalini Research Institute Editor in Chief, International Journal of Yoga Therapy Research Associate, Benson Henry Institute for Mind Body Medicine Research Affiliate, Osher Center for Integrative Medicine
U.S. Adult Yoga Demographics From: Clarke TC, Barnes PM, Black LI, Stussman BJ, Nahin RL.Use of yoga, meditation, and chiropractors among U.S. adults aged 18 and older. NCHS Data Brief, no 325. Hyattsville, MD: National Center for Health Statistics. 2018. From: Yoga in America Market Study, Yoga Journal, 2008
Youth Challenges
National Youth Risk Behavior Survey, 2017 Percentage of High School Students Who Were Bullied on School Property 22.7 22.3 21.5 20.3 19.0 20 18.3 16.3 Percent 15.6 14.0 13.2 0 Total Male Female 9th 10th 11th 12th Black Hispanic White
National Youth Risk Behavior Survey, 2017 Percentage of High School Students Who Ever Drank Alcohol 71.7 66.4 64.7 62.6 61.7 60.4 58.1 58.0 60 51.3 47.7 Percent 40 20 0 Total Male Female 9th 10th 11th 12th Black Hispanic White
National Youth Risk Behavior Survey, 2017 Percentage of High School Students Who Ate Vegetables One or More Times Per Day 62.8 60.8 60.8 60.4 59.4 59.4 59.3 60 56.1 56.1 49.4 40 Percent 20 0 Total Male Female 9th 10th 11th 12th Black Hispanic White
National Youth Risk Behavior Survey, 2017 Percentage of High School Students Who Were Physically Active at Least 60 Minutes Per Day on 5 or More Days 60 56.9 54.1 48.7 46.5 45.1 45.0 44.9 42.0 41.4 40 36.8 Percent 20 0 Total Male Female 9th 10th 11th 12th Black Hispanic White
National Youth Risk Behavior Survey, 2017 Percentage of High School Students Who Described Themselves As Slightly or Very Overweight 40 37.5 37.1 33.8 32.3 31.5 30.5 29.9 29.7 28.1 25.3 Percent 20 0 Total Male Female 9th 10th 11th 12th Black Hispanic White
Stress is Taking a Physical and Emotional Health Toll on Children …parents are underestimating how much stress their children experience and the impact their own stress has on their children. …children as young as eight years old are reporting that they experience physical and emotional health consequences often associated with stress.
Majority of seriously impairing and persistent conditions have child- adolescent onsets and high comorbidity Need for treatment of largely untreated child-adolescent disorders
Child-Adolescent Psychiatric Disorders “…10.06% of youths experience [serious emotional disturbance] with substantial impairment in one or more functional domains…” “…large numbers of youth and families affected… underscore the need for comprehensive and effective prevention and treatment services.” From: Prevalence of Serious Emotional Disturbance Among U.S. Children: A Meta-Analysis. Williams NJ, Scott L, Aarons GA, Psychiatric Services, 69:32-40, 2018. “…overall prevalence for at least one [subthreshold] disorder in the past year of…almost 16%...” “One in four adolescents had either…disorder with impairment.” From: Estimating the burden of psychiatric disorders in adolescence: the impact of subthreshold disorders. Roberts RE, Fisher PW, Turner JB, Tang M. Social Psychiatry and Psychiatric Epidemiology, 50:397-406, 2015. “The most consistent factors involve indicators of stress…” “Personal resources (e.g. mastery) enhance resilience to onset” From: One-year incidence of psychiatric disorders and associated risk factors among adolescents in the community. Roberts RE, Roberts CR, Chan W., Journal of Child Psychology and Psychiatry. 50:405-15, 2009.
…the striking feature of the present data is...how high the rates of early psychiatric disorders are. Most likely, the lifetime prevalence of psychiatric problems by age 21 well exceeds 80%, suggesting that the From: Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort experience of analysis from the Great Smoky Mountains Study, psychiatric illness is Copeland W, Shanahan L, Costello EJ, Angold A, Journal of the American Academy of Child and nearly universal. Adolescent Psychiatry, 50:252-61, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049293/pdf/nihms261148.pdf
National Youth Risk Behavior Survey, 2017 Percentage of High School Students Who Seriously Considered Attempting Suicide 22.1 20 17.5 17.3 17.4 17.3 17.2 16.4 16.3 14.7 Percent 11.9 0 Total Male Female 9th 10th 11th 12th Black Hispanic White
Adolescent / School Challenges l Stress (developmental, family, social, academic, societal) l Mental Health (depression, anxiety, substance abuse, trauma) l Behavior (apathy, violence, social skills, bullying, absenteeism) l Academics (grades, dropouts) l Physical Health (obesity, diabetes) l Attention (ADD, ADHD)
Yoga Practices Postures, Breathing, Relaxation, Meditation Self-Regulation Awareness Spirituality Fitness ↑ Flexibility ↑ Attention ↑ Unitive State ↑ Stress Regulation ↑ Strength ↑ Emotion Regulation ↑ Mindfulness ↑ Transcendence ↑ Coordination/Balance ↑ Resilience ↑ Concentration ↑ Flow ↑ Respiratory Function ↑ Equanimity ↑ Cognition ↑ Transformation ↑ Self-Efficacy ↑ Self-Efficacy ↑ Meta-cognition ↑ Life Meaning/Purpose Global Human Functionality ↑ Physical & Mental Health, ↑ Physical Performance ↑ Stress & Emotion Regulation, ↑ Awareness/Mindfulness, ↑ Meta-cognition ↑ Positive Behavior, ↑ Wellbeing, ↑ Values, ↑ Life Purpose & Meaning, ↑ Spirituality
Yoga for Children/Adolescents
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945853/pdf/PE_7_8_20.pdf
https://pediatrics.aappublications.org/content/pediatrics/138/3/e20161896.full-text.pdf
https://www.frontiersin.org/articles/10.3389/fped.2020.00078/pdf
Research Outcomes l Physiological - Physical Functioning l Psychological - Behavioral Functioning l Cognitive Performance
Yoga in Schools
… the health and welfare of a child will … be regarded as one of as much importance as arithmetic and geography… From: The Hygiene of the School Child, LM Terman, 1914.
Center for Disease Control Collaborative for Whole School, Academic, Whole Community, Social and Emotional Whole Child Model Learning (CASEL)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831047/pdf/nihms-749696.pdf
Yoga in Schools Research
https://www.frontiersin.org/articles/10.3389/fpsyt.2014.00035/pdf
http://downloads.hindawi.com/journals/ecam/2015/345835.pdf
Systematic Review of Yoga in Schools RCT’s From: Are There Benefits from Teaching Yoga at Schools? A Systematic Review of Randomized Control Trials of Yoga-Based Interventions, Ferreira-Vorkapic C Feitoza, Marchioro M, Simões J, Kozasa E, Telles S, Evidence-Based Complementary and Alternative Medicine, Article ID 345835, 2015.
Research Outcomes l Physiological - Physical Functioning l Psychological - Behavioral Functioning l Cognitive Performance
Adolescent / School Challenges l Stress (developmental, family, social, academic, societal) l Mental Health (depression, anxiety, substance abuse, trauma) l Behavior (apathy, violence, social skills, bullying, absenteeism) l Academics (grades, dropouts) l Physical Health (obesity, diabetes) l Attention (ADD, ADHD)
Single Session - Yoga vs. PE * * * From: Yoga in public school improves adolescent mood and affect, Felver JC, Butzer B, Olson KJ, Smith IM, Khalsa SBS, Contemporary School Psychology, 19:184-192, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605219/pdf/nihms679030.pdf
Yoga for Youth in a Charter School Perceived Stress Resilience 19 140 Average PSS Score p < 0.05 p < 0.001 Average RS Score 18 135 17 130 16 125 15 120 14 13 115 Baseline End Program Baseline End Program Negative Affect Positive Affect Average PANAS-C PA Score Average PANAS-C NA Score 52 34 p < 0.05 p = NS 32 50 30 48 28 46 26 44 24 Baseline End Program Baseline End Program From: Effects of a Kundalini Yoga Program on Elementary and Middle School Students’ Stress, Affect, and Resilience, Sarkissian M, Trent N, Huchting K, Khalsa SBS, Journal of Developmental and Behavioral Pediatrics, 39:210-216, 2018.
Mental Health Outcomes Worsening Improvement Social Stress Attitude to School Anger Resilience Negative Affect Anxiety Anger Expression
Yoga for Stress and Emotion From: School-based yoga intervention increases adolescent resilience: a pilot trial. Felver JC, Razza R, Morton ML, Clawson AJ, Mannion RS, Journal of Child and Adolescent Mental Health, 17:1-10, 2020 (preprint).
Yoga and Emotion Regulation Difficulties with Emotion Regulation Condition 40.00 Yoga Group Control Group 38.00 Average score on the DERS 36.00 * 34.00 32.00 30.00 28.00 Pre (Before program) Post (After program) Time point From: Khalsa K, Berger M, Khalsa S, unpublished data.
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