Yoga as a Complementary Treatment of Depression: Effects of Traits and Moods on Treatment Outcome

David Shapiro; Ian A. Cook; Dmitry M. Davydov; Cristina Ottaviani; Andrew F. Leuchter; Michelle Abrams


Evid Based Complement Alternat Med. 2007;4(4):493-502. 

In This Article


The 21 Ins and 16 Outs were compared by t-test and chi-square test on all measures at baseline. They differed only on one measure; Ins had higher scores on the Anger In scale (19.3 versus 15.8; P <0.02). Scores on the Anger In scale were negatively correlated with total Anger (r = -0.50, P <0.002) and positively correlated with Trait Anxiety (r = 0.53, P <0.001), Indirect Hostility (r = 0.59, P <0.001) and Months Medication (r = 0.45, P <0.01).

For the 17 completers, HAM-D at intake was 12.4 (7-18) and 6.2 (0-15) at post-intervention (P <0.001). All but two out of the 17 showed a decrease in HAM-D scores. For all 37 participants, using the last observation carried forward, thus no change for the 16 Outs and the four who did not complete the post-assessment, the mean reduction in HAM-D scores was still significant (P <0.001). For the 17 completers, significant pre-post reductions (P <0.05) were shown for STAI, ANGOUT, SCL, RESF36 and LF-HRV ( Table 1 ).

Eleven participants (65%) ended the study at remission levels (REMISS, <7 on HAM-D); for the remaining six participants, one showed a sizable reduction (14-9) and the other five small changes. With respect to intake (pre) measures, REMISS participants differed significantly (Ps <0.05) from NON-REMISS participants on intake data as follows: less education, more habitual exercise; lower HR, higher levels of HF-HRV, lower levels of LFHF-HRV, higher levels of HFTOT-HRV, lower levels of LFTOT-HRV and higher BRS ( Table 2 ). Given the activity-oriented intervention, we examined the relationship between the intake measure of habitual exercise and the physiological measures for all participants. The various high-frequency HRV measures (vagally mediated) were positively correlated with hours of exercise (rs 0.35 to 0.40), and the low-frequency HRV measures were negatively correlated with exercise (rs -0.25 to -0.35).

Differences between pre- and post-intervention assessment measures were examined as a function of whether participants achieved remission or not, using HAM-D <7 for stratification. REMISS participants showed greater reductions in their QIDS and SCL scores. In addition, they also showed several physiological effects: a reduction in HF-HRV and HFTOT-HRV compared with increases in the NON-REMISS group and a small increase in LFHF-HRV compared with a small decrease in the NON-REMISS participants ( Table 3 ).

We also examined each of the 17 items in the HAM-D to specify which symptom factors in the HAM-D were most responsive to treatment. The effects indicate greater improvement in depressed mood (P <0.005) and middle insomnia (P <0.005) for REMISS compared with NON-REMISS participants.

For the 17 completers, all 20 moods showed significant immediate changes from before to after each class (all P values <0.0001): negative moods decreased, positive moods increased, energy/arousal moods increased (less tired, more energetic, etc.) ( Table 4 ). Moods did not change significantly over the course of the sessions with one exception: average levels of 'happy' (pre- and post-class ratings) increased over the course of the sessions (P <0.03) and the increases in 'happy' from before to after each class became greater over the course of sessions (P <0.03).

The average level of mood ratings over all the classes differed between REMISS and NON-REMISS participants as follows: REMISS rated themselves higher on happy, relaxed, optimistic, confident, and content, and they rated themselves lower on frustrated, pessimistic, depressed, anxious and blue (Ps <0.025). The differences between REMISS and NON-REMISS participants for energy/arousal related moods were not significant.

Comparing the REMISS and NON-REMISS groups, in five moods, the change in rating from beginning to the end of class differed significantly. For three negative moods (frustrated, pessimistic, anxious), the decrease was greater for the NON-REMISS group, reflecting higher initial values for this group (Ps <0.05). In fact, at the end of class, the REMISS participants remained lower. For two energy-related moods (tired, energetic), the same pattern was shown, less tired and more energetic for NON-REMISS participants (Ps <0.05). In these cases, the two groups had similar levels at the end of classes.


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