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Jaime Umpleby
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
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
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
Conclusion: The evidence shows that yoga can decrease prenatal anxiety and depression in
interventions for prenatal anxiety and depression, therefore more studies are needed to
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
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
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
REDUCING ANXIETY AND DEPRESSION USING YOGA 4
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
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
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
(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
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
The American Psychiatric Association and the American College of Obstetricians and
Gynecologists created guidelines on prenatal depression that suggests that treatment should be
REDUCING ANXIETY AND DEPRESSION USING YOGA 6
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
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
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
REDUCING ANXIETY AND DEPRESSION USING YOGA 7
subject to decipher whether it is the poses, breathing exercises, or the meditation that causes the
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
yoga; therefore more studies are needed to evaluate the effectiveness of such treatment.
REDUCING ANXIETY AND DEPRESSION USING YOGA 8
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.
doi:10.1016/j.ctcp.2015.06.005
Field, T., Diego, M., Delgado, J., & Medina, L. (2013). Tai chi/yoga reduces prenatal depression,
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
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