THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume X, Number X, 2017, pp. 1–13

ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2016.0334

REVIEW ARTICLE

The Effects of Yoga on Positive Mental Health

Among Healthy Adults:
A Systematic Review and Meta-analysis
Tom Hendriks, MSc,1 Joop de Jong, PhD,2 and Holger Cramer, PhD3

Abstract
Objectives: The aim of this study was to present an overview of the research on the effects of yoga on positive
mental health (PMH) among non-clinical adult populations.
Methods: This was a systematic literature review and meta-analysis, including a risk of bias assessment. The
electronic databases PubMed/Medline, Scopus, IndMED, and the Cochrane Library were searched from 1975 to
2015. Randomized controlled trials (RCTs) on the effects of yoga interventions on PMH among a healthy adult
population were selected.
Results: A total of 17 RCTs were included in the meta-analysis. Four indicators of PMH were found:
psychological well-being, life satisfaction, social relationships, and mindfulness. A significant increase in
psychological well-being in favor of yoga over no active control was found. Overall risk of bias was unclear due
to incomplete reporting.
Conclusions: The current body of research offers weak evidence that the practice of yoga contributes to an
increase in PMH among adults from non-clinical populations in general. Yoga was found to contribute to a
significant increase in psychological well-being when compared to no intervention but not compared to physical
activity. For life satisfaction (emotional well-being), social relationships (social well-being), and mindfulness
no significant effects for yoga were found over active or non-active controls. Due to the limited amount of
studies, the heterogeneity of the intervention, and perhaps the way PMH is being measured, any definite
conclusions on the effects of yoga on PMH cannot be drawn.

Keywords: yoga, meditation, complementary therapies, well-being, positive mental health, meta-analysis

Introduction spiritual practice rooted in Indian philosophy. In modern

practice, its main techniques consist of postural exercises

T he rising popularity of yoga has been a worldwide

trend in the new millennium. During the period 2002–
2012, the use of yoga in the United States alone increased
from 5.1% to 9.5%.1 Yoga has become a focal point of sci-
entific attention, with a sharply increasing number of publi-
cations on its beneficial effects.2,3 That the growing interest
in yoga is more than a fleeing trend was underlined when the
United Nations in December 2014 declared 21 June as ‘‘In-
ternational Day of Yoga,’’ which aims at raising awareness
worldwide of the benefits of yoga.4 Yoga is originally a
(asanas), breathing exercises ( pranayama), and meditation
(dnyana).5,6 People practice yoga for a variety of reasons.
They expect relief from pain, stress, depression, and other
physical health issues. In addition, people practice yoga for
spiritual reasons and to increase feelings of happiness.7,8
Some have pointed out that in the West, the focus is on the
physical benefits of yoga (such as relaxation and stress re-
lief), while in the East the focus is on the integration of body
and the mind.9 Although the primary reasons for people in
Western countries to start practicing yoga may be physical

1
Department of Psychology, Anton de Kom University of Suriname, Paramaribo, Suriname.
2
Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, the Netherlands.
3
Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

1
2 HENDRIKS ET AL.
ones, with continued practice there seems to be a shift toward
spiritual reasons, suggesting a holistic mind–body–spirit
experience.7
Positive mental health
Positive psychology is a movement that focuses on the
scientific study of the conditions and processes contributing
to the flourishing or optimal functioning of people, groups,
and institutions.10,11 With the emergence of the positive
psychology movement, there has been a shift in the view of
the concept of mental health. The traditional approach to
mental health regards mental illness and mental well-being
as two opposite poles of a continuum.12 The notion that
mental health does not equal the absence of mental illness is
gaining territory. Positive mental health (PMH) is defined as
a health state characterized by the presence of psychologi-
cal well-being (positive individual functioning and self-
realization), emotional well-being (feelings of happiness and
satisfaction), and social well-being (positive social func-
tioning).13,14 The Dual Factor Model of Mental Health15–17
and the Two Continua Model13,14,18–20 are two similar models
that suggest mental illness and mental well-being are two
separate dimensions that correlate.
Positive psychology and yoga
In order to understand and treat mental illnesses, clinical
psychology historically has focused on classifying psycho-
logical dysfunctions.11,21 Positive psychology aims at
changing this approach and has developed various inter-
ventions in the past two decades. These positive psychology
interventions consist of techniques and exercises aimed at
developing personal strengths and enhancing positive emo-
tions, life satisfaction, personal growth, and meaning.22
Examples of evidence-based positive psychology exercises
are remembering three good things,23–25 identifying and
using character strengths,26–28 performing acts of kind-
ness,29 counting one’s blessings,30 gratitude exercises,31–34
appreciation of beauty exercises,35 and savoring the moment
exercises.36 Positive psychology has contributed to a shift
from a focus on the negative indicators of mental health to-
ward more research on positive indicators of mental health. A
wide variety of recently published meta-analyses report on
indicators of PMH such as compassion,37,38 forgiveness,39,40
gratitude,41 goal setting,42 hope,43 and resilience.44,45 Many
positive psychology interventions have also integrated
mindfulness meditation.46–50 Positive psychology in general
promotes mind–body interventions, but its focus appears to
be limited to interventions based on Buddhist principles such
as mindfulness-based interventions51–54 and acceptance and
commitment therapy.55,56 Besides ongoing research of the
effect of mindfulness-based meditation on negative indicators
of mental health, such as anxiety, depression, and stress,
there is a growing number of studies that investigate the link
between mindfulness and specific positive constructs, such
as compassion,57,58 forgiveness,59 gratitude,60 happiness,61
optimism,62 self-awareness/self-control,63 and character
strengths and virtues.64 However, while the positive psy-
chology movement seems to have fully embraced mindful-
ness and the Buddhist philosophy, it appears that it is
neglecting the benefits of yoga and ignores the psycholog-
ical and philosophical knowledge that can be found in yoga
philosophy and Hinduism. During the systematic database
search that was performed in this study, only a handful of
publications were encountered discussing the relation be-
tween yoga and positive psychology65–67 or indicators of
PMH, for example passion.68 This is odd when positive
psychology and yoga share much common ground when it
comes to their specific goals; both focus on achieving well-
being, increasing meaning in life, and personal growth.
Aim of the study
Although most people believe and expect that yoga will
increase their well-being, to the best of the authors’ knowl-
edge, no studies have examined the relationship between
yoga and (positive) mental well-being among healthy adults.
The aim of this meta-analysis was to investigate the effects of
yoga on PMH among adults from non-clinical populations in
order to establish if there is a possible causal relation. A
national survey on the mental and physical benefits of yoga
among 4307 practitioners reported that only 1.1% of the
practitioners of yoga indicated that they were languishing,
that is, experiencing severe mental and/or physical prob-
lems,69 while a bibliometric analyses reported that 73.9%
of published randomized controlled trials (RCTs) on yoga
focus on non-healthy participants.2 This study was interested
in whether yoga can improve PMH in healthy individuals
rather than serving as a therapeutic intervention. Physical
conditions clearly influence PMH indicators, mental condi-
tions even more so. So in order to reduce heterogeneity, only
trials on healthy individuals (or those from the general pop-
ulation) were included. Only outcomes of RCTs were in-
cluded because the RCT is widely taken as the golden
standard for doing scientific research in the field of medicine
and psychology.70–72
Methods
The PRISMA guidelines for systematic reviews and
meta-analyses73 and the recommendations of the Cochrane
Back Review group74 were followed in the planning and the
implementation of the review.
Inclusion criteria
The inclusion and criteria for this review were: (1) adults
belonging to a non-clinical population; (2) studies with
outcomes that could be identified as positive indicators of
mental health; (3) all structured forms of yoga that offer a
postural-based (asanas), breathing-based ( pranayama), or
meditation-based (dnyana) program or a combination of
these three elements; and (4) RCTs. Research indicates that
the various yoga styles do not differ in their odds of reaching
positive conclusions,75 so there will be no differentiation of
the effects per style.
Literature search
Data were gathered in the following ways. First, for
studies prior to 2014, all RCTs were included that were
found in a bibliometric analysis that was conducted in 2014
by one of the authors.2 In this analysis, the electronic data-
bases Medline/PubMed, Scopus, the Cochrane Library,
and IndMED were searched, and the tables of content of
yoga-specialty journals not listed in the medical databases
A SYSTEMATIC REVIEW AND META-ANALYSIS
Table 1. Search Strategy
PubMed/Medline
#1 Yoga [MeSH Terms]
#2 Yoga* [Title/Abstract] OR Yogic [Title/Abstract]
OR Pranayam* [Title/Abstract] OR Asana*
[Title/Abstract]
#3 #1 OR #2
#4 Randomized Controlled Trial [Publication Type]
OR controlled clinical trial [Publication Type] OR
randomized [Title/Abstract] OR placebo
[Title/Abstract] OR random [Title/Abstract] OR
randomly [Title/Abstract] OR trial [Title/Abstract]
OR group [Title/Abstract]
#5 #3 AND #4
Asterisks (*) represent truncations (PubMed finds all terms that
begin with a given text string).
were also checked. Search terms around the keyword
‘‘yoga’’ were used for the literature search; the complete
search strategy for Pubmed/Medline is shown in Table 1,
and the search strategy was adapted for the other databases.
Second, for studies from 2014 to 2015, the databases
PubMed/Medline, Scopus, InMED, and the Cochrane Li-
brary were also searched using the aforementioned strategy.
In addition, references of several meta-analysis, reviews,
and trials were checked. Only studies that were published in
articles in peer-reviewed journals were included, and re-
search from grey literature, dissertations, or conference
proceedings was not included.
Data extraction
The data extraction was performed by one reviewer
(T.H.) and independently checked by a second reviewer
(H.C.). The following data were extracted: authors, year of
publication, country origin, population, intervention, num-
ber of participants who completed the trial, primary and
secondary outcomes, and post measurements of mean and
standard deviation. Consensus was achieved by discussion.
Risk of bias assessment
Two authors (T.H. and H.C.) independently assessed the
risk of bias using the Cochrane risk of bias tool74 on the
following domains: selection bias (random sequence gen-
eration and allocation concealment), performance bias
(blinding of participants and personnel), detection bias
(adequate outcome assessor blinding), attrition bias (in-
complete outcome data), reporting bias (selective outcome
reporting), and free of other bias (such as extreme baseline
imbalance, author alliance, and population bias).76 Con-
sensus was achieved by discussion.
Data analysis
Assessment of overall effect size. Separate meta-
analyses were conducted for comparisons of yoga to dif-
ferent control interventions using Review Manager 5 soft-
ware v5.1 (The Nordic Cochrane Centre, Copenhagen).
Meta-analyses were conducted by random effects models if
at least two studies assessing this specific outcome were
3
available. Standardized mean differences (SMD) with 95%
confidence intervals (CI) were calculated as the difference in
means between groups divided by the pooled standard de-
viation using Hodges’s correction for small study samples.55
Where no standard deviations were available, they were
calculated from standard errors, confidence intervals, or
t-values,77 or attempts were made to obtain the missing data
from the trial authors by e-mail. A positive SMD (i.e.,
higher values in the yoga group) was defined as indicating
beneficial effects of yoga compared with the control inter-
vention. If necessary, values were inverted.74 Cohen’s ca-
tegories were used to evaluate the magnitude of the overall
effect size with (1) SMD = 0.2–0.5: small; (2) SMD = 0.5–
0.8: medium; and (3) SMD >0.8: large effect sizes.78
Assessment of heterogeneity. Statistical heterogeneity
between studies was analyzed using the I2 statistics, a
measure of how much variance between studies can be at-
tributed to differences between studies rather than chance.
The magnitude of heterogeneity was categorized as (1)
I2 = 0–24%: low heterogeneity; (2) I2 = 25–49%: moderate;
(3) I2 = 50–74%: substantial; and (4) I2 = 75–100%: consid-
erable.77,79 The chi-square test was used to assess whether
differences in results were compatible with chance alone.
Given the low power of this test when only few studies or
studies with low sample size are included in a meta-analysis,
a p-value of £0.10 was regarded as indicating significant
heterogeneity.54
Sensitivity analyses. To test the robustness of significant
results, sensitivity analyses were conducted for studies with
a high versus low risk of selection bias (adequate random
sequence generation and allocation concealment). If het-
erogeneity was present in the respective meta-analysis,
sensitivity analyses were also used to explore possible rea-
sons for statistical heterogeneity.
Publication bias across studies. Assessment of publica-
tion bias was originally planned by using funnel plots gen-
erated using Review Manager software.80 As fewer than 10
studies were included in each meta-analysis, funnel plots
could not be analyzed.
Results
Study selection
A total of 1901 records were identified. A flow chart is
presented in Figure 1. After the removal of duplicates, 495
records remained for screening. Of these, 297 articles were
excluded because they were related to the clinical population,
leaving 202 full-text articles to be assessed for eligibility. Of
these, 182 were excluded: 170 studies did not have any out-
come that could be classified as a positive outcome, eight
studies did have a positive outcome but the population was
<18 years of age, one was not a yoga intervention, four used a
program where yoga was combined with other invention
types, and in one study had its results published in an earlier
study, which was already included. In total, 20 studies were
included in the systematic review: 17 studies were included in
the quantitative meta-analysis; three studies were included in
the qualitative analysis due to insufficient raw data (incom-
plete means and/or standard deviation).
4 HENDRIKS ET AL.
FIG. 1. Flowchart of the
inclusion of studies.
Study characteristics
Table 2 show the characteristics of the 20 included RCTs.
Seven studies originated from India,81–87 six from the Uni-
ted States,88–92 four from the United Kingdom,93–96 one
from Australia,97 one from Japan,98 and one from Turkey.99
The studies were published between 1983 and 2015. The
total number of participants was 1901, of which 769 re-
ceived an exclusive yoga intervention. In eight studies, the
yoga intervention consisted of a combination of physical
postures (asanas), breathing exercises ( pranayama), and
meditation (dnyana). In eight studies, it consisted of a
combination of physical postures and breathing exercises.
One study consisted of physical postures and meditation.
Three studies consisted of only physical postures. The av-
erage intervention period was 9 weeks, with an average of
12 sessions that lasted around 53 min on average. In 10/20
studies, daily practice between 10 and 60 min, with an av-
erage of 30 min, was advised. The control conditions used
were yoga + physical exercises (100), physical exercises
(319), mindfulness (94), progressive muscle relaxation (65),
brain wave vibration (29), and non-active control groups
(536 participants). The age of the participants ranged from
18 to 77 years, with some studies not reporting (mean) age.
The female ratio in total was 61%. (The study by Haber90
reported the female ratio of two groups at baseline, which
was 66% and 60%, but did not report the number of females
who completed the trial.)
 Table 2. Characteristics of Included Studies
Author, year,
country Intervention N Age Yoga type Sessions, weeks, duration Results/Instrument
Bhat et al., 2012, 1. Y 100 25–30 A + P Y: 60, 12w, 45 min  Psychological well-being (PWS): Significant effects for Y (4w
India 2. PE 100 PE: 60, 12w and 12w), PE (12w), and Y + PE (4w,12w)
3. Y + PE 100 Y + PE: 60, 12w
4. Non-active control 100
Bonura et al., 2007, 1. Y 33 77 A+P+D Y + PE: 6, 6w, 45 min  Psychological well-being (STAI/STAXI/GDS/GSES/CDSES/
United States 2. PE 33 LGMS): Significant effects for Y ( p < 0.001)
3. Wait-list control 32  General self-efficacy(GSEC) and self-efficacy daily living
(CDSECS): Significant effect for Y ( p < 0.001)
Bowden et al., 2012, 1. BWV 12 A+P BWV + Y + M: 10, 5w,  Mindfulness (MAAS): No significant effects for BWV ( p = 0.062),
United Kingdom 2. Y 9 75 min + 10 min daily significant effects for Y ( p = 0.028), and M ( p = 0.028)
3. M 12 practice
Bowden et al., 2014, 1. BWV 17 18–32 A BWV + Y: 8–12, 8–12w,  Psychological well-being (WEMWBS): Significant effects for BWV
United Kingdom 2. Y 14 75 min + 10 min daily ( p = 0.014); no significant effects for Y ( p = 0.32)
practice  Mindfulness (MAAS): Significant effects for BWV ( p = 0.005)
and Y ( p = 0.012)
Cusumano et al., 1. Y 45 A+P 9, 3w, 80 min  Self-esteem (RSS): No significant effects
1992, Japan 2. Progressive relaxation 45
Elavsky and 1. Y 51 49.9 A + P 12, 4m, 60 min + 15–45 min  Self-esteem (RSS, PSPP): No significant effects

5
McAuley, 2007, 2. Walking 60 daily practice
United States 3. Non-active control 39
Ghoncheh et al., 1. Y 20 34 A 5, 5w, 30 min  Disengagement, joy, mental quiet (SRSI): Significant effects for
2003, 2. PMR 20 PMR disengagement ( p < 0.005) and joy ( p < 0.01) at week 5,
United States mental quiet ( p < 0.04) at week 5; no significant effects for Y
Godse et al., 2015, 1. Y 40 A+P 2w, 14 days, 20 min  Mental quiet, ease/peace, rested/refreshed, strength and
India 2. Non-active control 40 awareness, joy (SRDI): Significant effects for Y ( p < 0.01)
 Love, thankfulness, prayerfulness, childlike innocence, awe,
mystery, timeless/boundless (SRDI)s: No significant effects
Haber, 1983, India 1. Y 43 69.4 A + P Y + PE: 10, 10w + daily  Psychological well-being (BS): Significant effects for Y and PE
2. PE 43 practice ( p < 0.05)
Harinath et al., 2004, 1. Y 15 29.6 A + P + D Y + PE: 3m + 60 min daily  Psychological well-being: Significant effects for Y ( p < 0.001)
India 2. PE 15 practice
Hartfiel et al., 2011, 1. Y 20 39.3 A + P + D 6–18, 6w, 60 min + 35 min  Life purpose and satisfaction (IPPA): Significant effects for Y
United Kingdom 2. Wait-list control 20 daily practice ( p < 0.009)
 Self-confidence (IPPA): Significant effects for Y ( p < 0.001)
 Agreeableness (IPPA): Small but no significant increase
Hartfiel et al., 2012, 1. Y 33 44.8 A + P + D 8, 8w, 60 min + 20 min  Psychological well-being (PANAS X): Significant effects for Y
United Kingdom 2. Wait-list control 26 daily practice ( p < 0.001): serenity ( p < 0.001), self-assured ( p < 0.01), and
attentiveness ( p < 0.01)
Joviality: No significant effect for Y
(continued)
 Table 2. (Continued)
Author, year,
country Intervention N Age Yoga type Sessions, weeks, duration Results/Instrument
Jayabharathi, 2014, 1. Y 128 49.1 A + P + D 41, 18w, 35–40 min daily  Psychological well-being, social relations and environment
India 2. Non-active control 126 practice (WHOQoL-BREF): Significant effects for Y ( p < 0.001)
Kanojia et al., 2013, 1. Y 25 18.3 A + P + D 78, 13w, 40 min  Psychological well-being: Significant effects at postmenstrual
India 2. Non-active control 25 phase ( p < 0.01) and premenstrual phase ( p < 0.001)
Rakhshani et al., 1. Y 51 28.5 A + P + D 48–54, 16–18w + daily  Psychological well-being (WHOQOL-100): Significant effects
2010, India 2. PE 51 practice for Y ( p < 0.001)
 Social relationships (WHOQOL-100): Significant effects for Y
( p < 0.001)
 Independence, spirituality, environment (WHOQOL-100):
Nonsignificant effects
Shelov et al., 2009, 1. Y 23 34.4 A + P 8, 8w, 60 min + daily practice  Mindfulness (FMI): Significant effects for Y ( p < 0.05) and control
United States 2. Non-active control 23 group ( p < 0.01)
Taspinar et al., 2014, 1. Y 17 25.6 A + P 21, 7w, 50 min  Self-esteem (RSS): Significant effects for Y and resistance exercise

6
Turkey 2. Resistance exercise 17 (no p-values reported)
3. Non-active control 17
Varambally et al., 1. Y 7 28.6 A + D 12, 4w + 2 min daily practice  Psychological well-being (WHOQOL-BREF): Significant effects
2012, India 2. Wait-list control 11 for Y ( p < 0.05)
 Social relationships, environment (WHOQOL-BREF):
Nonsignificant effects
Vogler et al., 2011, 1. Y 19 73.2 A 16, 8w, 90 min + 3w 15–  Emotional well-being (MCS/LOQ): Small but nonsignificant
Australia 2. Non-active control 19 20 min daily practice effects in emotional well-being ( p = 0.04)
 Self-care (MCS/LOQ): Small but non-significant improvement
for Y ( p = 0.04) and self-care ( p = .001)
 Social connectedness, purpose and meaning (MCS/LOQ):
 No significant effects
Wolever et al., 2012, 1. Y 76 42.8 A + P + D 12, 12w, 60 min  Mindfulness (CAMS-R): Significant effect on mindfulness
United States 2. Mindfulness 82 ( p < 0.10)
3. Non-active control 47
Y, yoga; PE, physical exercise; BWV, brain wave vibration; M, mindfulness; PMR, progressive muscle relaxation; w, weeks.
Yoga types: A, asanas; P, pranayama; D, dnyana.
Instruments: BS, Bradburn Scale; CAMS-R, Cognitive and Affective Mindfulness Scale-Revised; CDSES, Chronic Disease Self-Efficacy Scales; FMI, Freiburg Mindfulness Inventory; GDS,
Geriatric Depression Scale; GSES, General Self-Efficacy Scale; IPPA, Inventory of Positive Psychological Attitudes; LGMS, Lawton’s PGC Morale Scale; LOQ, Life’s Odyssey Questionnaire;
MAAS, Mindfulness Attention Awareness Scale; MCS, Mental Component Summary; PANAS-X, Positive and Negative Affect Scale; PSPP, Physical Self-Perception Profile; PWS, Psychological
Well-Being Scale; RSS, Rosenberg Self-Esteem Scale; SRDI, Smith Relaxation Disposition Inventory; SRSI, Smith Relaxation States Inventory; STAI, State–Trait Anxiety Inventory; STAXI, State–
Trait Anger Expression Inventory; WEMWBS, Warwick–Edinburgh Mental Well-Being Scale; WHOQOL-100,World Health Organization Quality of Life; WHOQoL-BREF, World Health
Organization Quality of Life Scale.
A SYSTEMATIC REVIEW AND META-ANALYSIS 7

Table 3. Risk of Bias Assessment of the Included Studies Using the Cochrane Risk of Bias Tool
Bias
Detection
Selection bias Performance bias: Attribution Reporting
bias: adequate bias: bias:
Random blinding of outcome incomplete selective
sequence Allocation participants, assessor outcome outcome
Author, year generation concealment personnel blinding data reporting Other bias
Bhat et al., 2012 Unclear Unclear Unclear Unclear Unclear Low risk Unclear
Bonura et al., 2014 Unclear Unclear Unclear Unclear Unclear Unclear Low risk
Bowden et al., 2012 Low risk Low risk Unclear Unclear Unclear Low risk High risk
Bowden et al., 2014 Low risk Unclear Unclear Unclear Unclear Low risk High risk
Cusumano et al., 1992 Unclear Unclear Unclear Unclear Unclear Low risk Unclear
Elavsky et al., 2007 Unclear Unclear Unclear Low risk Low risk Low risk Low risk
Ghoncheh et al., 2003 Unclear Unclear Unclear Unclear Unclear Low risk Unclear
Godse et al., 2015 Low risk Unclear Unclear Unclear High risk Low risk Unclear
Haber, 1983 Unclear Unclear Unclear Unclear Unclear Unclear Unclear
Harinath et al., 2004 Low risk Unclear Unclear Unclear Unclear Low risk Unclear
Hartfiel et al., 2011 Low risk Unclear High risk Unclear Unclear Low risk High risk
Hartfiel et al., 2012 Unclear Unclear Unclear Unclear High risk Low risk Low risk
Jayabharathi, 2014 Low risk Unclear Unclear Unclear Low risk Low risk Low risk
Kanojia et al., 2012 Unclear Unclear High risk Unclear Unclear Low risk Low risk
Rakhshani et al., 2010 Low risk Unclear High risk Unclear Unclear Low risk Low risk
Shelov et al., 2009 Unclear Unclear Unclear Unclear Unclear Low risk Unclear
Taspinar et al., 2015 Unclear Low risk Unclear Unclear High risk Low risk Low risk
Varambally et al., 2012 Low risk Low risk Unclear Unclear High risk Low risk Low risk
Vogler et al., 2011 Unclear Unclear Unclear Unclear Low risk Low risk Unclear
Wolever et al., 2012 Unclear Unclear Unclear Unclear Unclear Low risk Unclear

Study measures
In total, 32 types of measures were found that could be
classed as indicators of PMH (at ease/peacefulness, atten-
tiveness, aware, awe and wonder, childlike innocence, disen-
gagement, independence, joviality, joy, emotional well-being,
environment, life and health attitude, life purpose satisfaction,
love and thankfulness, mental quiet, mindfulness, mystery,
peacefulness, prayerfulness, quality of life, rested/refreshed,
positive affect, psychological well-being, purpose and meaning,
self-assured/self-confidence, self-efficacy, self-esteem, seren-
ity, spiritual, social relationships, strengths and awareness, and
timeless/boundless). However, a meta-analysis requires a
comparison of a similar outcome in a minimum of two
studies with a comparable control group (either active or
non-active control group). In total, only sufficient data on
four indicators of PMH was available to do the meta-
analysis. These four indicators were psychological well-being,
life satisfaction, social relationships, and mindfulness. The first
indicator corresponds with the construct of psychological well-
being in the framework of PMH. The second indicator corre-
sponds with emotional well-being, and the third indicator
corresponds with social well-being. Mindfulness is a state of
focused nonjudgmental attention, with the awareness being in
the present moment,100,101 and it is associated with increased
well-being.102–104 It could be regarded as a proxy measure of
PMH in general.
Risk of bias in individual studies
The risk of bias assessment for each study is shown in
Table 3. Selection bias was low in 8/20 studies. In the other
studies, the risk could not be determined because the ran-
domization process was not described. Allocation conceal-
ment was only described properly in three studies and was
therefore classified as having a low risk of bias. Blinding of
participants and personnel was described in three studies,
leading to the classification of a high risk of bias. Only one
study properly described outcome assessor blinding, scoring
a low risk of bias. The other studies did not report any
information. Risk of attribution bias was low in three
studies, high in four studies, and unclear in 13 studies. In 18
studies, all analyzed outcomes were reported, so these
studies appear to be free from selective reporting. Finally,
three studies were classified as having a general high risk of
bias due to author affiliation, not specifying funding, or
having high unaccounted dropout rates. Eight studies that
clearly addressed funding and absence of conflict of interest
were rated as having a low risk of bias. In conclusion, the
overall risk of bias could not be determined due to unclear
reporting.
Data analysis
Meta-analyses of psychological well-being revealed sig-
nificant group differences favoring yoga over no intervention
(n = 768; SMD = 0.69, 95% CI 0.16, 1.22; p = 0.01; I2 90%).
No such group differences occurred compared to physical
activity (n = 552; SMD = 0.00, 95% CI -0.34, 0.35; p = 0.99;
I2 72%; Fig. 2). No effects of yoga compared to no inter-
vention occurred for life satisfaction (n = 140; SMD = 0.39,
95% CI -0.47, 1.25; p = 0.38; I2 80%; Fig. 3); and social re-
lationships (n = 310; SMD = 0.30, 95% CI -1.21, 1.81; p =
0.69; I2 95%; Fig. 4). Further meta-analyses on mindfulness
8 HENDRIKS ET AL.

FIG. 2. Effects of yoga on psychological well-being.

revealed no group differences between yoga and no in- Discussion

tervention (n = 169; SMD = -0.09, 95% CI -0.47, 0.29;
p = 0.65; I2 27%); and yoga and physical activity (n = 52;
SMD = -0.17, 95% CI -0.72, 0.38; p = 0.54; I2 0%); while
group differences favoring mental activity over yoga were
found (n = 179; SMD = -0.30, 95% CI -0.60, -0.01; p = 0.05;
I2 0%; Fig. 5).
Sensitivity analyses
When only studies with a low risk of selection bias were
included, only the effects of yoga compared to no interven-
tion on psychological well-being remained significant, al-
though only one RCT could be included in this analysis
(n = 18; SMD = 1.02; 95% CI 0.00–2.04; p = 0.05). The effect
on mindfulness favoring mental activity over yoga no longer
was significant, although only one RCT could be included in
this analysis (n = 18; SMD = -0.60; 95% CI -1.48 to 0.29;
p = 0.19).
Following a systematic literature search, 17 studies were
included in the meta-analysis. Although 32 different indi-
cators of PMH were found, only four of these indicators
were present in two or more studies: psychological well-
being, social relationships, life satisfaction, and mindful-
ness. For psychological well-being, yoga was found to have
favorable effects over no intervention, but it did not have a
favorable effect over mental activity or physical activity. In
relation to life satisfaction and social relationships, no
significant effects were found for yoga versus no inter-
vention. For mindfulness, yoga interventions had no
significant effects on mindfulness in comparison to no in-
tervention, and no significant effect compared to control
groups that featured mental and psychical activity. So it
appears that yoga is not effective in the development of
PMH in general, except maybe for the dimension psycho-
logical well-being.

FIG. 3. Effects of yoga on life satisfaction.

A SYSTEMATIC REVIEW AND META-ANALYSIS
FIG. 4. Effects of yoga on social relations.
Limitations
There are several limitations in this meta-analysis. First, a
very limited number of studies focused on positive out-
comes in healthy adults. From almost 500 RCTs, only 20
(4%) studies reported positive outcomes for yoga among
healthy adults—a very disproportionate ratio. While 32
different indicators of PMH were identified, only measures
for four indicators could be included: psychological well-
being, life satisfaction, social relationships, and mindful-
ness. For psychological well-being, eight studies were found
that measured the effect of yoga versus no intervention, and
six studies for yoga versus physical activity. For life satis-
faction and mindfulness, only two studies were found that
measured the effect of yoga versus an active or no inter-
vention. For social relationships, only three studies were
found. Based on only two or three studies, definite claims on
the presence or absence of certain effects cannot be made. In
sum, a firm conclusion can only be drawn on the effects of
yoga on psychological well-being—that yoga only improves
FIG. 5. Effects of yoga on mindfulness.
9
psychological well-being compared to no intervention. It
could be argued that with so such a small number of studies,
a meta-analyses is not warranted. However, Davey et al.
performed an analysis of 22,453 meta-analyses and found
the median number of included studies was three; less than
three quarters contained five or fewer studies.105 Thus, the
limited amount of studies in the present meta-analysis is not
regarded as an exception.
Second, the findings of this study must be interpreted with
caution due to the clinical heterogeneity of the intervention
in regard to the various yoga traditions and the differences
in duration and frequency of the intervention. In addition to
the heterogeneity, most studies displayed poor methodo-
logical reporting, making a clear risk of bias assessment
practically impossible. Third, there are limitations in the
way psychological well-being is being measured. In the
majority of the studies, psychological well-being was mea-
sured using quality-of-life questionnaires, and these reflect
the traditional view of mental health—that mental health is
the absence of mental illness. The presence of positive
10
outcomes is more likely to be found when measured by an
instrument that reflects the dual factor/two continua model
approach to mental health by using questionnaires such as
the Mental Health Short Form,106 the Positive Mental
Health instrument,107 or even the Positive and Negative
Affect Scale.108
Suggestions for future research
First, as only 5% of the current research focuses on
positive outcomes, future research in the field of yoga
should make a shift from the focus on negative outcomes
toward positive outcomes, so there is more of a balance
between the two. Second, positive constructs should not be
measured by scales that define PMH merely as the absence
of mental illness. It is also suggested that PMH is not only
measured in a general sense (psychological well-being and
quality of life) but more specifically, just as mindfulness
research focuses on the relation with specific positive con-
structs. Third, studies are needed on the effects of yoga
intervention that focus primarily on physical postures
(asanas). Whereas as relationship between PMH and med-
itation has been found, there are simply no studies that focus
on the sole effects of yoga meditation (dnyana). Future
studies should therefore focus more on the effects of yogic
meditation. Fourth, since the overall risk of bias could not
be assessed due to unclear reporting, future researchers
should pay more attention to the quality of methodological
reporting, for example by following the CONSORT guide-
lines for reporting parallel group randomized trials.109 Fifth,
it is questioned whether modern researchers in the field of
psychology and yoga are actually measuring what practi-
tioners intend to achieve through yoga. In the present meta-
analysis, only one study was found that measured spiritu-
ality. A survey among 604 U.S. students reported that 73%
considered yoga to be a spiritual activity,8 and many practi-
tioners expect that yoga will lead to an increased sense of
spirituality.7 However, the spiritual aspects of yoga are rarely
addressed in research.110 In light of this, the field is reminded
that the original goal of yoga, as described in the Yoga Su-
tras,111 was the removal of fluctuations of the mind. What
Patañjali addresses as ‘‘fluctuations of the mind’’ could be
associated with modern psychological constructs such as
worrying, rumination, or mental activity. However, not a
single study was found that measures mental activity in yoga
studies. Many studies in the field of mindfulness focus on
outcomes that play an important role in Buddhism, such as
compassion112–114 and non-attachment.102,115,116 Future re-
search in the field of yoga should focus more not only on
positive outcomes, but also on positive psychological con-
structs that are linked to those that are rooted in yoga phi-
losophy and Hinduism such as moksha (meaning), ananda
(bliss, happiness), buddhi (wisdom), or kaivalya (detachment).
Using the theoretical frame work of the yoga philosophy could
also shed new light on the psychological mechanisms behind
yoga interventions and meditation in general.
Conclusions
PMH consists of three dimensions: psychological well-being,
emotional well-being, and social well-being. This meta-analysis
is the first address the efficacy of yoga in the development of
PMH in a non-clinical adult population. The current body of
HENDRIKS ET AL.
research suggests that yoga is only associated with an increase
in psychological well-being in comparison to no treatment. This
finding may be counterintuitive; people who practice yoga
expect that it will contribute to an increase in their mental
health. This study addressed several possible explanations
for the findings, including the small number of studies, the
heterogeneity of the interventions, and the way mental health
is being measured. More rigorous research is needed to draw
definite conclusions on the effects of yoga on PMH.
Author Disclosure Statement
The authors declare that they have no competing interests.
References
1. Clarke TC, Black LI, Stussman BJ, et al. Trends in the use
of complementary health approaches among adults: Uni-
ted States, 2002–2012. Natl Health Stat Report 2015;79:
1–16.
2. Cramer H, Lauche R, Dobos G. Characteristics of ran-
domized controlled trials of yoga: A bibliometric analysis.
BMC Complement Altern Med 2014;14:328.
3. Jeter PE, Singh N, Slutsky J, et al. Yoga as a therapeutic
intervention: A bibliometric analysis of published research
studies from 1967 to 2013. J Altern Complement Med
2015;21:586–592.
4. Abraham B. Yoga: A gift to the world. Indian Streams Res
J 2015;5:1–3.
5. Boehm K, Ostermann T, Milazzo S, et al. Effects of yoga
interventions on fatigue: A meta-analysis. Evid Based
Complement Alternat Med 2012;2012:124703.
6. Cramer H, Krucoff C, Dobos G. Adverse events associ-
ated with yoga: A systematic review of published case
reports and case series. PloS One 2013;8:e75515.
7. Park CL, Riley KF, Bedesin E, et al. Why practice yoga?
Practitioners’ motivations for adopting and maintaining
yoga practice. J Health Psychol 2016;21:887–895.
8. Quilty MT, Saper RB, Goldstein R, et al. Yoga in the real
world: Perceptions, motivators, barriers and patters of use.
Glob Adv Health Med 2013;2:44–49.
9. de Michelis E. A History of Modern Yoga: Patañjali and
Western Esotericism. New York: Continuum, 2004.
10. Gable SL, Haidt J. What (and why) is positive psychol-
ogy? Rev Gen Psychol 2005;9:103–110.
11. Sheldon KM, King L. Why positive psychology is nec-
essary. Am Psychol 2001;56:216–217.
12. Greenspoon PJ, Saklofske DH. Toward an integration of
subjective well-being and psychopathology. Soc Indic Res
2001;54:81–108.
13. Keyes CLM. The mental health continuum: From lan-
guishing to flourishing in life. J Health Soc Behav 2002;
43:207–222.
14. Westerhof GJ, Keyes CLM. Mental illness and mental
health: The two continua model across the life span. J
Adult Dev 2010;17:110–119.
15. Antamarian SP, Scott Huebner E, Hills KJ, et al. A dual-
factor model of mental health: Toward a more compre-
hensive understanding of youth functioning. Am J Or-
thopsychiatry 2010;80:462–472.
16. Doll B. The dual-factor model of mental health in youth.
School Psychol Rev 2008;37:69–73.
17. Wang X, Zhang D, Wang J. Dual-factor model of mental
health: Surpass the traditional mental health model. Psy-
chology 2011;2:767–772.
A SYSTEMATIC REVIEW AND META-ANALYSIS
18. Keyes CLM. Mental illness and/or mental health? In-
vestigating axioms of the complete state model of health.
Jo Consult Clin Psychol 2005;73:539–554.
19. Keyes CLM. Promoting and protecting mental health as
flourishing: A complementary strategy for improving na-
tional mental health. Am Psychol 2007;62:95–108.
20. Lamers SM, Westerhof GJ, Cees AW, et al. The bidirec-
tional relation between positive mental health and psycho-
pathology in a longitudinal representative panel study. J Pos
Psychol 2015;10:553–560.
21. Lyons MD, Scott Huebner E, Hill KJ, et al. The dual-
factor model of mental health: Further study of the de-
terminants of group differences. Can J Sch Psychol 2012;
27:183–196.
22. Casellas-Grau A, Font A, Vives J. Positive psychology
interventions in breast cancer. A systematic review. Psy-
chooncology 2014;23:9–19.
23. Gander F, Proyer RT, Ruch W. Positive psychology
interventions addressing pleasure, engagement, mean-
ing, positive relationships, and accomplishment. In-
crease well-being and ameliorate depressive symptoms:
A randomized, placebo-controlled online study. Front
Psychol 2016;7:686.
24. Odou N, Vella-Brodrick DA. The efficacy of positive
psychology interventions to increase well-being and the
role of mental imagery ability. Soc Indic Res 2013;110:
111–129.
25. Pietrowsky R, Mikutta J. Effects of positive psychology
interventions in depressive patients—A randomized con-
trol study. Psychology 2012;3:1067–1073.
26. Andrewes HE, Walker V, O’Neill B. Exploring the use
of positive psychology interventions in brain injury
survivors with challenging behaviour. Brain Injury 2014;
28:965–971.
27. Mitchell J, Stanimirovic R, Klein B, et al. A randomised
controlled trial of a self-guided internet intervention pro-
moting wellbeing. Comput Hum Behav 2009;25:749–760.
28. Proyer RT, Gander F, Wellenzohn S, et al. Strengths-
based positive psychology interventions: A randomized
placebo-controlled online trial on long-term effects for a
signaturestrengths-vs.a lesser strengths-intervention. Front
Psychol 2015;6:456.
29. Buchanan KE, Bardi A. Acts of kindness and acts of
novelty affect life satisfaction. J Soc Psychol 2010;150:
235–237.
30. Emmons RA, McCollough M. Counting blessings versus
burdens: An experimental investigation of gratitude and
subjective well-being in daily life. J Pers Soc Psychol
2003;84:377–389.
31. Boehm JK, Lyubomirsky S, Sheldon KM. A longitudinal
experimental study comparing the effectiveness of
happiness-enhancing strategies in Anglo Americans and
Asian Americans. Cogn Emot 2011;25:1263–1272.
32. Chan DW. Counting blessings versus misfortunes: Positive
interventions and subjective well-being of Chinese school
teachers in Hong Kong. Educ Psychol 2013;33:504–519.
33. Ghandeharioun A, Azaria A, Taylor S, et al. ‘‘Kind and
grateful’’: A context-sensitive smartphone app utilizing
inspirational content to promote gratitude. Psych Well
Being 2016;6.
34. Ouweneel E, Le Blanc PM, Schaufeli WB. On being
grateful and kind: Results of two randomized controlled
trials on study-related emotions and academic engage-
ment. J Psychol 2014;148:37–60.
11
35. Proyer RT, Gander F, Wellenzohn S, et al. Nine beautiful
things: A self-administered online positive psychology
intervention on the beauty in nature, arts, and behaviors
increases happiness and ameliorates depressive symptoms.
Pers Individ Diff 2016;94:189–193.
36. Hurley DB, Kwon P. Results of a study to increase sa-
voring the moment: Differential impact on positive and
negative outcome. J Happiness Stud 2012;13:579–588.
37. MacBeth A, Gumley A. Exploring compassion: A meta-
analysis of the association between self-compassion and
psychopathology. Clin Psychol Rev 2012;32:545–552.
38. Zessin U, Dickhäuser O, Garbade S. The relationship be-
tween self-compassion and well-being: A meta-analysis.
Appl Psychol Health Well Being 2015;7:340–364.
39. Davis DE, Griffin BJ, Hook JN, et al. Forgiving the self
and physical and mental health correlates: A meta-analytic
review. J Couns Psychol 2015;62:329–335.
40. Wade NG, Hoyt WT, Kidwell JEM, et al. Efficacy of
psychotherapeutic interventions to promote forgiveness: A
meta-analysis. J Consult Clin Psychol 2014;82:154–170.
41. Davis DE, Choe E, Meyers J, et al. Thankful for the little
things: A meta-analysis of gratitude interventions. J Couns
Psychol 2015;63:20–31.
42. Kleingeld A, van Mierlo A, Arends A. The effect of goal
setting on group performance: A meta-analysis. J Appl
Psychol 2010;96:1289–1304.
43. Alarcon GM, Bowling NA, Khazon S. Great expectations:
A meta-analytic examination of optimism and hope. Pers
Individ Diff 2013;54:821–827.
44. Hu T, Zhang D, Wang J. A meta-analysis of the trait resi-
lience and mental health. Pers Indiv Diff 2015;76:18–27.
45. Lee JH, Nam SK, Kim A, et al. Resilience: A meta-
analytic approach. J Couns Devel 2013;91:269–279.
46. Bolier L, Haverman M, Westerhof GJ, et al. Positive
psychology interventions: A meta-analysis of randomized
controlled studies. BMC Public Health 2013;13:119.
47. Burckhardt R, Manicavasagar V, Batterham PJ, et al. A
randomized controlled trial of strong minds: A school-
based mental health program combining acceptance and
commitment therapy and positive psychology. J School
Psychol 2016;57:41–52.
48. Cohn MA, Pietrucha ME, Saslow LR, et al. An online
positive affect skills intervention reduces depression in
adults with type 2 diabetes. J Pos Psychol 2014;9:523–534.
49. Feicht T, Wittmann M, Jose G, et al. Evaluation of a
seven-week web-based happiness training to improve
psychological well-being, reduce stress, and enhance
mindfulness and flourishing: A randomized controlled
occupational health study. Evid Based Complement Al-
ternat Med 2013;676953.
50. Nikrahan GR, Suarez L, Asgari K, et al. Positive psy-
chology interventions for patients with heart disease: A
preliminary randomized trial. Psychosomatics 2016;57:
348–358.
51. Bohlmeijer E, Prenger R, Taal E, et al. The effects of
mindfulness-based stress reduction therapy on mental
health of adults with a chronic medical disease: A meta-
analysis. J Psychosom Res 2010;68:539–544.
52. Ivtzan I, Young T, Martman J, et al. Integrating mind-
fulness into positive psychology: A randomised controlled
trial of an online positive mindfulness program. Mind-
fulness 2016. Published online July 23, 2016.
53. Hamilton NA, Kitzman H, Guyotte S. Enhancing health
and emotion: Mindfulness as a missing link between
12
cognitive therapy and positive psychology. J Cogn Psy-
chother 2006;20:123–134.
54. Niemiec RM. Mindful living: Character strengths inter-
ventions as pathways for the five mindfulness trainings.
Int J Well Being 2012;2.
55. Bohlmeijer ET, Lamers SMA, Fledderus M. Flourishing
in people with depressive symptomatology increases with
acceptance and commitment therapy. Post-hoc analyses of
a randomized controlled trial. Behav Res Ther 2015;65:
101–106.
56. Fledderus M, Bohlmeijer ET, Pieterse ME, et al. Ac-
ceptance and commitment therapy as guided self-help for
psychological distress and positive mental health: A
randomized controlled trial. Psychol Med 2012;42:485–
495.
57. Blunt K, Blanton P. Mindfulness and self-compassion:
Exploring pathways to adolescent emotional well-being. J
Child Fam Stud 2014;23:1298–1309.
58. Roeser RW, Eccles JS. Mindfulness and compassion in
human development: Introduction to the special section.
Devel Psychol 2014;51:1–6.
59. Webb JR, Dustin Phillips T, Bumgardner D, et al. For-
giveness, mindfulness, and health. Mindfulness 2013;4:
235–245.
60. Loo JMY, Tsai J, Raylu N, et al. Gratitude, hope, mind-
fulness and personal growth initiative: Buffers or risk
factors for problem gambling? PLoS One 2014;9:e83889.
61. Hollis-Walker L, Colosimo K. Mindfulness, self-
compassion, and happiness in non-meditators: A theo-
retical and empirical examination. Pers Individ Diff
2010;20:222–227.
62. Malinowski P, Lim HJ. Mindfulness at work: Positive
affect, hope, and optimism mediate the relationship be-
tween dispositional mindfulness, work engagement, and
wellbeing. Mindfulness 2015;6:1250–1262.
63. Vago DR, Silbersweig DA. Self-awareness, self-regulation,
and selftranscendence(S-ART): A framework for under-
standing the neuro biological mechanisms of mindfulness.
Front Hum Neurosci 2012;6:296.
64. Niemiec RM, Tayyab R, Spinella M. Strong mindfulness:
Integrating mindfulness and character strengths. J Mental
Health Couns 2012;34:240–253.
65. Ivtzan I, Papantoniou A. Yoga meets positive psychol-
ogy: Examining the integration of hedonic (gratitude)
and eudaimonic (meaning) wellbeing in relation to the
extent of yoga practice. J Bodywork Move Ther 2014;18:
183–189.
66. Kumar A, Kumar S. Karma yoga: A path towards work in
positive psychology. Ind Psychiatry J 2013;55:150–152.
67. Levine M. The Positive Psychology of Buddhism and
Yoga: Paths to a Mature Happiness. New York: Taylor
and Francis, 2011.
68. Carbonneau N, Vallerand RJ. Is the practice of yoga as-
sociated with positive outcomes? The role of passion. J
Pos Psychol 2010;5:452–465.
69. Ross A, Friedmann E, Bevans M, et al. National survey of
yoga practitioners: Mental and physical health benefits.
Complement Ther Med 2013;21:313–323.
70. Cuijpers P. Meta-Analyses in Nental Health Research. A
Practical Guide. Amsterdam, Netherlands: Vrije Universiteit
Amsterdam, 2016.
71. Kaptchuk TJ. The double-blind, randomized, placebo-
controlled trial: Gold standard or golden calf? J Clin
Epidemiol 2001;54:541–549.
HENDRIKS ET AL.
72. West SG, Duan N, Pequignat W, et al. Alternatives to the
randomized controlled trial. Am J Public Health 2008;98:
1359–1366.
73. Moher D, Liberati A, Teztlaff J, et al. The PRISMA
Group. Preferred Reporting Items for Systematic Reviews
and Meta-Analyses: The PRISMA statement. Ann Intern
Med 2009;51:1–7.
74. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Co-
chrane Collaboration’s tool for assessing risk of bias in
randomized trials. BMJ 2011;343:d5928.
75. Cramer H, Lauche R, Langhorst J, et al. Is one yoga style
better than another? A systematic review of associations
of yoga style and conclusions in randomized yoga trials.
Complement Ther Med 2016;25:178–187.
76. Jadad AR, Enkin M. Randomized Controlled Trials:
Questions, Answers, and Musings. Malden, MA: Black-
well, 2007.
77. Higgins JPT, Green S. Cochrane Handbook for Systematic
Reviews of Interventions. Vol. 5. Chichester, United
Kingdom: John Wiley (Wiley Online Library), 2008.
78. Cohen J. Statistical Power Analysis for the Behavioral
Sciences. Hillsdale, NJ: Lawrence Erlbaum, 1988.
79. Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring
inconsistency in meta-analyses. BMJ 2003;27:557–560.
80. Higgins JPT, Green S. Cochrane Handbook for Systematic
Reviews of Interventions. Version 5.1. 0. The Cochrane
Collaboration, 2011.
81. Bhat PS, Chopra V, Mehta SG, et al. Psychological ben-
efits of yoga in industrial workers. Ind Psychiatry J
2012;21:98–103.
82. Godse AS, Shejwal BR, Godse AA. Effects of sur-
yanamaskar on relaxation among college students with
high stress in Pune, India. Int J Yoga 2015;8:15–21.
83. Harinath K, Malhotra AS, Pal K, et al. Effects of Hatha
yoga and Omkar meditation on cardiorespiratory perfor-
mance, psychologic profile, and melatonin secretion. J
Altern Complement Med 2004;10:261–268.
84. Jayabharathi B, Judie A. Complementary health approach
to quality of life in menopausal women: A community-
based interventional study. Clin Interv Aging 2014;9:
1913–1921.
85. Kanojia S, Kumar Sharma V, Gandhi A, et al. Effect of
yoga on autonomic functions and psychological status
during both phases of menstrual cycle in young healthy
females. J Clin Diagn Res 2013;7:2133–2139.
86. Rakhshani A, Maharana S, Raghuram N, et al. Effects of
integrated yoga on quality of life and interpersonal rela-
tionship of pregnant women. Qual Life Res 2010;19:
1447–1455.
87. Varambally S, Gangadhar BN, Thirthalli J, et al. Ther-
apeutic efficacy of add-on yogasana intervention in sta-
bilized outpatient schizophrenia: Randomized controlled
comparison with exercise and waitlist. Ind J Psychiatry
Res 2013;54:227–232.
88. Bonura KB, Tenenbaum G. Effects of yoga on psycho-
logical health in older adults. J Phys Act Health 2007;11:
1334–1341.
89. Elavsky S, McAuley E. Exercise and self-esteem in
menopausal women: A randomized controlled trial in-
volving walking and yoga. Am J Health Promot 2007;22:
83–92.
90. Haber D. Yoga as a preventive health care program for
white and black elders: An exploratory study. Int J Aging
Hum Dev 1983;17:169–176.
A SYSTEMATIC REVIEW AND META-ANALYSIS
91. Shelov DV, Suchday S, Friedberg JP. A pilot study
measuring the impact of yoga on the trait of mindfulness.
Behav Cogn Psychother 2009;37:595–598.
92. Wolever RQ, Kusnick CA, Bobinet KJ, et al. Effective
and viable mind-body stress reduction in the workplace: A
randomized controlled trial. J Occup Health Psychol 2012;
17:246–258.
93. Bowden D, Gaudry C, An SC, et al. A comparative ran-
domised controlled trial of the effects of brain wave vi-
bration training, Iyengar yoga, and mindfulness on mood,
well-being, and salivary cortisol. Evid Based Complement
Alternat Med 2012;234713.
94. Bowden DE, McLennan D, Gruzelier J. A randomised
controlled trial of the effects of Brain Wave Vibration
training on mood and well-being. J Complement Integr
Med 2014;11:223–232.
95. Hartfiel N, Havenhand J, Khalsa SB, et al. The effec-
tiveness of yoga for the improvement of well-being and
resilience to stress in the workplace. Scand J Work En-
viron Health 2011;37:70–76.
96. Hartfiel N, Burton C, Rycroft-Malone J, et al. Yoga for
reducing perceived stress and back pain at work. Occup
Med (Lond) 2012;62:606–612.
97. Vogler J, O’Hara L, Gregg J, et al. The impact of a short-
term iyengar yoga program on the health and well-being
of physically inactive older adults. Int J Yoga Ther 2011;
21:61–72.
98. Cusumano JA, Robinson SE. The short-term psychophys-
iological effects of hatha yoga and progressive relaxation
on female Japanese students. Appl Psychol 1992;42:77–90.
99. Taspinar B, Aslan UB, Agbuga B, et al. A comparison of
the effects of hatha yoga and resistance exercise on mental
health and well-being in sedentary adults: A pilot study.
Complement Ther Med 2014;22:433–440.
100. Kabat-Zinn J. Mindfulness-based interventions in context:
Past, present and future. Clin Psychol (New York) 2003;10.
101. Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness
on psychological health: A review of empirical studies.
Clin Psychol Rev 2011;31:1041–1056.
102. Brown KW, Ryan RM. The benefits of being present:
Mindfulness and its role in psychological well-being. J
Pers Soc Psychol 2003;84:822–848.
103. Harrington R, Loffredo DA, Perz CA. Dispositional
mindfulness as a positive predictor of psychological well-
being and the role of the private self-consciousness insight
factor. Pers Individ Diff 2014;71:15–18.
104. Weinstein N, Brown KW, Ryan RR. A multi-method ex-
amination of the effects of mindfulness on stress attribution,
coping, and emotional well-being. J Res Pers 2009;43:
374–385.
105. Davey J, Turner RM, Clarke MJ, et al. Characteristics of
meta-analyses and their component studies in the Cochrane
Database of Systematic Reviews: A cross-sectional, de-
scriptive analysis. BMC Med Res Methodol 2011;11:1.
13
106. Lamers SMA, Westerhof GJ, Bohlmeijer ET, et al.
Evaluating the psychometric properties of the Mental
Health Continuum-Short Form (MHCSF). J Clin Psychol
2011;67:99–110.
107. Seow LSE, Vaingankar JA, Abdin E, et al. Positive mental
health in outpatients with affective disorders: Associations
with life satisfaction and general functioning. J Affect
Disord 2016;190:499–507.
108. Watson D, Clark LA, Tellegen A. Development and val-
idation of brief measures of positive and negative affect:
The PANAS scales. J Pers Soc Psychol 1988;54:1063–
1070.
109. Schulz KF, Altman DG, Moher D. CONSORT 2010
Statement: Updated guidelines for reporting parallel group
randomized trials. Ann Intern Med 2010;152:726–732.
110. Büssing A, Michalsen A, Khalsa SBS, et al. Effects of
yoga on mental and physical health: A short summary of
reviews. Evid Based Complement Alternat Med 2012;
165410.
111. Patañjali. The Yoga-Sutra of Patañjali: A New Translation
with Commentary. Boston, MA: Shambhala Publications,
Inc, 2003.
112. Dahm KA, Meyer EC, Neff KD, et al. Mindfulness, self-
compassion, posttraumatic stress disorder symptoms, and
functional disability in U.S. Iraq and Afghanistan war
veteran. J Trauma Stress 2015;28:460–464.
113. Lo HHM, Ng SM, Chan CLW. Evaluating compassion-
mindfulness therapy for recurrent anxiety and depression:
A randomized control trial. Res Soc Work Pract 2015;
25:715–725.
114. Williams MJ, Dalgleish T, Karl A, et al. Examining the
factor structures of the five facet mindfulness question-
naire and the self-compassion scale. Psychol Assess 2014;
26:407–418.
115. Sahdra BK, Shaver PR, Brown KW. A scale to measure
nonattachment: A Buddhist complement to Western re-
search on attachment and adaptive functioning. J Pers
Assess 2010;92:116–127.
116. Sahdra BK, Ciarrochi J, Parker PD, et al. Empathy and
nonattachment independently predict peer nominations of
prosocial behavior of adolescents. Front Psychol 2015;
6:263.
Address correspondence to:
Tom Hendriks, MSc
Anton de Kom University of Suriname
Faculty of Social Sciences, Department of Psychology
Leysweg 86
P.O.B. 9212
Paramaribo
Suriname
E-mail: tom.hendriks@uvs.edu