Running head: REDUCING ANXIETY AND DEPRESSION USING YOGA 1

Using Yoga Among Prenatal Women to Reduce Anxiety and Depression

Jaime Umpleby

University of South Florida

REDUCING ANXIETY AND DEPRESSION USING YOGA 2

Abstract

Background: Anxiety and depression during pregnancy is becoming a major public health issue

that can lead to negative effects such as preeclampsia, preterm labor, low birth weight, and

psychological symptoms for the mother. Therefore, an evidence-based intervention is needed to

reduce the levels of anxiety and depression associated with pregnancy. Yoga is a combination of

breathing, meditation, and posturing that is shown to have positive effects on decreasing anxiety

and depression levels in prenatal women.

Search for evidence: Three search engines were used to search for randomized controlled trials

(RCTs) and a clinical review related to this clinical problem: CINAHL, Psychinfo, and PubMed.

The key search terms used were prenatal anxiety, yoga, and randomized controlled trials.

Results: The results of the three RCTs all found significant findings that yoga decreased the

anxiety and depression levels experienced by prenatal women when compared to treatment as

usual (TAU). However, it is unclear which specific aspect(s) of yoga caused the reduction in

anxiety and depression: posturing, breathing, and/or meditation.

Conclusion: The evidence shows that yoga can decrease prenatal anxiety and depression in

women. However, there is no clinical guideline that specifically addresses non-pharmacological

interventions for prenatal anxiety and depression, therefore more studies are needed to

investigate the effectiveness of this intervention.

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Using Yoga Among Prenatal Women to Reduce Anxiety and Depression

Each year, about half a million women in the United States experience prenatal anxiety

and depression (Kim, O’Reardon, & Epperson, 2014). Yoga is a non-pharmacological method to

reduce symptoms of anxiety and depression that incorporates breathing, relaxation, and

movement techniques to assist women through their anxiety from pregnancy (Newham,

Wittkowski, Hurley, Aplin, & Westwood, 2014). Therefore, having prenatal women practice

yoga may reduce the stress that leads to anxiety and depression during pregnancy. The clinical

question addressed in this paper is: In prenatal women, how does yoga, compared to standard

care, affect anxiety and depression within two months?

Literature Search

CINAHL, Psychinfo, and PubMed were used to access the clinical guideline and RCTs

pertaining to the use of yoga for the reduction of anxiety. Key search terms included prenatal

anxiety, yoga, and randomized controlled trials. The publication years searched were 2013-2018.

Literature Review

Three RCTs and one clinical guideline were used to research the effects of yoga on

reducing anxiety and depression on prenatal women. Davis, Goodman, Leifman, Taylor, &

Dimidjian (2015) examined the effect of yoga on 64 prenatal women experiencing anxiety and

depression. The anxiety and depression levels were measured using the mental health history

(SCID-RV), international physical activity questionnaire (IPAQ), client satisfaction

questionnaire (CSQ-8), the Edinburgh perinatal depression scale (EPDS), the state-trait anxiety

inventory (STAI), and the positive and negative affect schedule-negative subscale (PANAS-N).

Participants were 18-45 years old, less than or equal to 28 weeks gestation, and were randomized

into a control group (n=23) and an intervention group (n=23). The intervention group
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participated in an eight week yoga program, while those in the control group continued with

TAU. The participants in the intervention group experienced a significant reduction in negative

affect compared to the control group after completing the yoga program (β = -0.53, SE = 0.20, p

= 0.011). These results suggest that participating in yoga reduces the symptoms associated with

anxiety and depression during pregnancy. Strengths of the RCT were that the participants were

randomly assigned to groups, assignments were concealed from individuals enrolling

participants, rationale was provided to explain why some participants did not complete the study,

participants were analyzed in the group they were assigned, the measurements were valid and

reliable, the participants had similar demographics and baseline clinical variables, and the groups

were appropriate. Some weaknesses of the RCT were that the participants and providers were not

blind to the assignments and there were no follow-up assessments.

On the other hand, Field, Diege, Delgado, & Medina (2013) examined if tai chi and yoga

reduces prenatal anxiety, depression, and sleep disturbances. Anxiety levels were measured using

the STAI, depression levels were measured through the structure clinical interview for

depression (SCID) and the center for epidemiological studies-depression scale (CES-D), and

sleep disturbances were also measured. This RCT included a total of 92 women, who were

randomized into an intervention group (n=46) and a control group (n=46). The intervention

group participated in a 12-week yoga program while the control group participated in TAU. The

intervention group experienced a significant decrease in depression scores on the CES-D

(p=0.001), anxiety scores on the STAI scale (p=0.01), and sleep disturbances (p=0.05). Strengths

of the RCT were that the participants were randomly assigned to groups, random assignments

were concealed from the individuals enrolling participants into the study, the control group was

appropriate, some forms of measurement were reliable and valid, the participants had similar
REDUCING ANXIETY AND DEPRESSION USING YOGA 5

demographics and baseline clinical variables, the participants were analyzed in the groups they

were assigned, and follow-up assessments were conducted long enough. Weaknesses of the RCT

were that no rationale was provided to explain why any participants did not complete the study,

some measurements were not valid and reliable, and the participants and providers were not

blind to the group assignments.

Similarly, Newham et al. (2014) examined the efficacy of yoga as a significant

intervention for reducing anxiety and depression during pregnancy. The anxiety and depression

levels were measured using the STAI, Wiima delivery expectancy questionnaire (WDEQ), and

the EPDS. This RCT randomized 59 pregnant women into an intervention group (n=31) and a

control group (n=28). The intervention group participated in an eight-week yoga course while the

control group participated in TAU. The intervention group experienced a significant reduction in

pregnancy-specific anxiety after completing the course, compared to the control group measured

by the WDEQ (β =-9.59, P=0.014) and EPDS (β=-3.06, P=0.042). Strengths of the study were

that the participants were randomly assigned to groups, assignments were concealed from the

individuals enrolling participants into the study, rationale was provided to explain why any

participants did not complete the study, the control group was appropriate, some of the

measurements were reliable and valid, participants had similar demographics and baseline

clinical variables, the participants were analyzed in the groups they were assigned, and follow-up

assessments were conducted long enough. Weaknesses of the RCT were that the individuals

completing the study were not blind to the study group and some forms of measurement were not

reliable and valid.

The American Psychiatric Association and the American College of Obstetricians and

Gynecologists created guidelines on prenatal depression that suggests that treatment should be
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initiated as soon as pregnant women are diagnosed with depression (Kim et al., 2014). The

preferred treatment method is psychotherapy, but medication may also be needed, depending on

the severity of depression (Kim et al., 2014). The guidelines also suggest that pregnant women

should be routinely screened for depression, and the risks and benefits should be measured

whether to start, continue, or discontinue antidepressants (Kim et al., 2014). There is no specific

recommendation for the use of non-pharmacological intervention such as yoga or tai chi to

decrease anxiety and depression in women during pregnancy (Kim et al., 2014).

Synthesis

The three RCTs all showed significant findings that yoga among prenatal women reduces

anxiety and depression associated with pregnancy. While anxiety and depression levels were

measured in two RCTs, sleep disturbances were only measured in the tai chi and yoga study

conducted by Field et al. (2013).

All three of the RCTs shared a common weakness of the participants and providers

completing the study not being blind to the group assignments. Also, the studies did not all have

reliable and valid forms of measurement to measure the depression and anxiety levels of the

participants, which could have possibly affected the results.

Clinical Recommendations

Research suggests that yoga is a safe, feasible, and credible intervention for prenatal

depression and anxiety (Davis et al., 2015). Yoga has shown to be beneficial for pregnant

women, causing less stress and anxiety, decreased pain and discomfort, and a decrease in labor

pain and time (Field et al., 2013). It is not clear which aspect of yoga causes the decrease of

anxiety and depression in pregnant women, so more evidence-based research is needed on the
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subject to decipher whether it is the poses, breathing exercises, or the meditation that causes the

reduction in anxiety and depression in participants (Field et al., 2013).

The currently available guideline recommends recognition of depression during

pregnancy, and when possible, a referral to a psychiatrist should be considered to decide the

possible risks and benefits of starting or continuing antidepressants (Kim et al., 2014). The

clinical guideline had a lack of recommendations for non-pharmacological treatment such as

yoga; therefore more studies are needed to evaluate the effectiveness of such treatment.
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References

Davis, K., Goodman, S.H., Leiferman, J., Taylor, M., & Dimidjian, S. (2015). A randomized

controlled trial of yoga for pregnant women with symptoms of depression and anxiety.

Complementary Therapies In Clinical Practice, 21(3), 166-172.

doi:10.1016/j.ctcp.2015.06.005

Field, T., Diego, M., Delgado, J., & Medina, L. (2013). Tai chi/yoga reduces prenatal depression,

anxiety, and sleep disturbances. Complementary Therapies In Clinical Practice, 19(1), 6-

10. doi:10.1016/j.ctcp.2012.10.001

Kim, D.R., O’Reardon, J.P., & Epperson, C.N. (2014). Guidelines for the management of

depression during pregnancy. Curr Psychiatry Rep, 12(4), 279-281. doi:

10.1007/s11920.010.0114x

Newham, J., Wittkowski, A., Hurley, J., Aplin, J., & Westwood, M. (2014). Effects of antenatal

yoga on maternal anxiety and depression: A randomized controlled trial. Depression And

Anxiety, 31(8), 631-640. doi:10.1002/da.22268