Original Article

Efficacy of yoga practices on emotion regulation and

mindfulness in type 2 diabetes mellitus patients
Downloaded from http://journals.lww.com/yomi by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

Amit Kanthi, Singh Deepeshwar, Chidananda Kaligal, Mahadevappa Vidyashree, Dwivedi Krishna

Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2023

Abstract Introduction: Poor emotion regulation (ER) is linked to diabetes distress and depression that may contribute to
uncontrolled glycemic levels among type 2 diabetes mellitus (T2DM) patients. As ER can adversely affect the
physiological and psychological health of patients with T2DM, holistic management of the disease is essential.
Yoga therapy is one such method that can positively impact both the mental and physical health of T2DM patients.
Methods: Individuals with T2DM (n = 54) were recruited for the study and were randomly allocated to the intervention
(yoga) group and control (conventional treatment) group. Cognitive reappraisal (CR) and expressive suppression
(ES) were assessed as ER skills, and mindfulness was evaluated before and after the intervention. The intervention
was provided for 3 months.
Results: Participants of the yoga group showed an improved ER ability with increased CR and decreased ES.
However, these changes were not statistically significant. ES was significantly reduced (p < 0.05) in the control
group. In addition, the yoga group showed significantly increased (p < 0.05) mindfulness and was decreased in
the control group.
Conclusion: Yoga therapy positively affects the psychological well-being of T2DM patients.

Key Words: Emotion regulation, mindfulness, Type 2 diabetes mellitus, yoga

Address for correspondence:

Mr. Amit Kanthi, Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, No. 19, Eknath Bhavan,
Gavipuram Circle, K.G. Nagar, Bengaluru - 560 019, Karnataka, India.
E-mail: namitsk@gmail.com
Submitted: 09-Jan-2022 Revised: 24-Mar-2022 Accepted: 26-Mar-2022 Published: 30-Jun-2022

INTRODUCTION and mild conditions, such as dysthymia, anxiety, stress, and

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder
(T2DM) that results in excessive blood glucose circulation.[1]
Individuals with T2DM are at high risk of decreased psychological
well-being.[2-4] It inflicts stress, depression, apathy in the absence of
depression, or anxiety.[5-7] An international survey of diabetic people
across four continents shows that around 13.8% and 44.6% of people
reported having depression and diabetes distress (DD), respectively.[8]
Previous studies have focused on the relationship between
depression and diabetes.[9,10] However, sub-syndromal depressive
Access this article online
Quick Response Code:
Website:
www.ym-kdham.in
DOI:
10.4103/ym.ym_1_22
distress, are more prevalent than depressive disorders.[11] Emotion
regulation (ER) is one such psychological factor that needs to be
addressed as emotions and emotional experiences are associated
with health outcomes.[12,13]
ER includes extrinsic and intrinsic processes responsible for
monitoring, evaluating, and modifying emotional reactions to
accomplish one’s goals.[14] It is defined as “attempts individuals
make to influence which emotions they have when they have
them, and how these emotions are expressed.”[15] The burden of
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work non-commercially, as long as
appropriate credit is given and the new creations are licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
How to cite this article: Kanthi A, Deepeshwar S, Kaligal C, Vidyashree
M, Krishna D. Efficacy of yoga practices on emotion regulation and
mindfulness in type 2 diabetes mellitus patients. Yoga Mimamsa
2022;54:12-7.

12 © 2022 Yoga Mīmāṃsā | Published by Wolters Kluwer - Medknow

 Kanthi, et al.: Emotion regulation and mindfulness in T2DM patients
adherence to restrictive lifestyle and self-care and its relationship
to awareness, expression, and modulation of feelings, makes
ER an important psychological variable of interest in T2DM
management.[16] ER is also important because of its impact on
self-help compliance and health behavior in general.[1] Moreover,
a recent study reported the contribution of poor ER in increasing
DD among type 1 diabetes patients.[17] Thus, it is imperative that
Downloaded from http://journals.lww.com/yomi by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
psychological constructs such as ER are addressed, and all the
possible interventions are explored and developed to improve the
psychological health of T2DM individuals.
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2023
Yoga therapy is a widely known and accepted intervention
method for T2DM across the globe. It is exceptionally beneficial
in preventing and managing T2DM.[18]
In addition, the practice of yoga has a multitude of benefits for
T2DM patients, including glycemic control, insulin resistance,
lipid profile, blood pressure, stress, anxiety, and depression.[19-22]
One of the ways that yoga might impact the psychological health
of T2DM patients is mindfulness, as it is an essential element
of the yoga practice. Conceptually, mindfulness contains two
elements: awareness of the present moment and the quality of
that awareness.[23] In the clinical context, it is described as a
nonelaborative and nonjudgmental awareness of present moment
experience. Developing the ability of mindfulness is thought to
promote objective and adaptive strategies of responding to emotional
or cognitive triggers.[24] Consequentially, many researchers have
proposed a link between mindfulness and adaptive ER.[25] Moreover,
mindfulness has shown to be effective in ER, reducing stress and
anxiety.[26,27] Therefore, it is important to investigate if yoga practice
can help in improving ER with increased mindfulness.
With the increasing cases of T2DM, the risk of associated
complications also increases. It is important to utilize therapeutic
approaches that benefit the management of both T2DM and related
complications. One such approach is yoga therapy, and the present
study attempts to assess the efficacy of yoga practice on ER skills
and mindfulness in T2DM patients.
METHODS
Participants
T2DM patients with ages ranging between 37 and 65 years were
recruited from different parts of Bengaluru city. The participants
were randomly allocated to the yoga group (n = 27) and the
wait-list control group (n = 27). These participants were recruited
through newsletter writings and advertisements. The participants
included in the study met the following criteria: no presence of
complications including neuropathy, nephropathy, retinopathy,
and other cardiovascular disorders, absence of neurological or
neuropsychiatric disorders, and are familiar with the English
language. In addition, none of the participants were advised to
stop their conventional medical treatment. The CONSORT flow
diagram presents participant selection and allocation details
[Figure 1].
Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022
Ethical considerations
The study was approved by the Institutional Ethics Committee
(IEC) of Swami Vivekananda Yoga Anusandhana Samsthana
(S-VYASA) University (No. RES/IEC-SVYASA-03/020/2016)
and was registered in the Clinical Trial Registry (CTRI) of
Government of India. The study protocol was informed to the
participants and their informed consent was obtained.
Study design
The study is a randomized, parallel group design. Recruited
participants were T2DM patients who were randomly divided
into two groups, i.e., the yoga group with the intervention of
recommended common yoga protocol for T2DM patients and the
wait-list control group without any form of yoga interventions.
Both groups consisted of 27 participants and were assessed on
day 1 and day 90.
Intervention
The yoga intervention protocol adopted in the study was a common
yoga protocol recommended for T2DM patients by the Indian
Yoga Association,[28] which includes Asanas (yoga postures),
pranayama (breathing practice), and relaxation techniques. The
duration of the yoga intervention was 60 min and was administered
for 5 days a week for 3 months. The detailed protocol of the yoga
intervention is provided in Table 1.
OUTCOME MEASURES
Emotion Regulation Questionnaire
Emotion Regulation Questionnaire (ERQ) assesses ER tendencies
using two different strategies, reappraisal, and suppression.
Reappraisal is an antecedent-focused strategy that involves
changing the way one thinks about emotional stimuli in an
attempt to alter the emotional response before it is fully activated.
Suppression is a response-focused strategy that involves attempts
to lessen the emotional impact of events by inhibiting emotionally
expressive behavior once the emotional response is in full effect.
The 10-item ERQ includes six reappraisal and four suppression
items, forming two respective subscales.
Freiburg Mindfulness Questionnaire
The Freiburg Mindfulness Questionnaire (FMI), short form is
intended to measure the general factor of mindfulness and is highly
correlated (r=0.95) with the long form. It consists of 14 items and
is rated on a 4-point Likert scale with answer options ranging
from 1 (rarely) to 4 (almost always). Although the scale measures
mindfulness as a general context that has some interrelated facets,
“Mindfulness presence,” “Nonjudgmental acceptance,” “openness
to Experience,” and “Insight” are the tentative factors identified.[29]
Data analysis
Statistical analysis was performed using a statistical analysis
software package named SPSS (IBM Corp. Released 2020.
IBM SPSS Statistics for Windows, Version 27.0. Armonk,
NY: IBM Corp. The normality of data was assessed using the
Shapiro‑Wilk test. Within-group and between-group differences
13
 Kanthi, et al.: Emotion regulation and mindfulness in T2DM patients

Enrollment Assessed for eligibility (n = 72)

Excluded (n = 18)
• Not meeting inclusion criteria (n = 17)
• Declined to participate (n = 1)
• Other reasons (n = 0)
Downloaded from http://journals.lww.com/yomi by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

Randomized (n = 54)

Allocation
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2023

Allocated to intervention (n = 27) Allocated to conventional treatment (n = 27)

• Received allocated intervention (n = 27) • Received allocated intervention (n = 27)
• Did not receive allocated intervention • Did not receive allocated intervention
(give reasons) (n = 0) (give reasons) (n = 0)

Follow-Up

Lost to follow-up (give reasons) (n = 0) Lost to follow-up (give reasons) (n = 0)

Discontinued intervention (give reasons) Discontinued intervention (give reasons)
(n = 0) (n = 0)

Analysis

Analysed (n = 27) Analysed (n = 27)

• Excluded from analysis (give reasons) (n = 0) • Excluded from analysis (give reasons) (n = 0)

Figure 1: CONSORT flow diagram

40 the control group. Mindfulness was also correlated positively

35
(r = 0.47, p = 0.01) with CR and negatively (r = −0.48, p = 0.01)
with ES in the yoga group. The details of the changes in ERQ and
30
mindfulness are given in Table 3 and [Figures 2-5].
25
20
DISCUSSION
15
10 The present study was intended to investigate the efficacy of yoga
5 practices on mindfulness and ER skills. The ER skills assessed in
0 the current study are CR and ES. Both mindfulness and ER skills
Pre Post
were improved after the intervention. Therefore, the findings of the
Yoga Control current study exhibit the potential of yoga therapy in the holistic
Figure 2: Between group difference for cognitive reappraisal management of T2DM.

were assessed using paired sample t-test and independent sample
t-test, respectively. Pre- and post-mean values were compared for
each outcome measure. The results were considered statistically
significant if the p ≤ 0.05.
RESULTS
The demographic characteristics of the patients are given in
Table 2. The cognitive reappraisal (CR) was increased in the yoga
group and decreased in the control group after the intervention.
Expressive suppression (ES) was found to be reduced in the
yoga group and increased in the control group. None of these
changes was statistically significant except ES in the control group
(p < 0.05). Mindfulness was significantly improved (p < 0.05)
in the yoga group after the intervention, whereas it reduced in
The nature of the yoga practice might shed some light on how it
helps improve mindfulness and ER skills. Mindfulness, however,
is also a core feature of yoga practice and can be defined as a
present-focused state where the mind attunes to moment-by-
moment sensations rather than “wandering” or dwelling on the
past or future.[30] Furthermore, the concentration required to
balance and coordinate the movements of a posture synchronizing
breath patterns may also facilitate attentional enhancement[30] that
eventually might cultivate the habit of being aware of the present
moment. This ultimately may contribute to increased mindfulness.
Increased mindfulness has cognitive and psychological effects in
terms of improved attention, executive function, reduced stress,
and anxiety levels. One of the pathways, mindfulness is thought
to yield these psychological benefits is through the facilitation

14 Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022

 Kanthi, et al.: Emotion regulation and mindfulness in T2DM patients

Table 1: Common yoga protocol for type 2 25

diabetes mellitus
Name of the practice Duration 20
(min)
15
Starting prayer: Asatoma Sat Gamaya 2
Preparatory SukshmaVyayamas and Shithilikarana 6
Practices 10
Downloaded from http://journals.lww.com/yomi by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

Urdhva‑hasta Shvasana (hand stretch breathing 3

rounds at 90°, 135°, 180° each) 5
Kati‑Shakti Vikasaka (3 rounds each)
Forward and backward bending 0
Pre Post
Twisting
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2023

Sarvanga Pushti (3 rounds clockwise, 3 rounds Yoga Control

counterclockwise)
Surya Namaskara – SN 9 Figure 3: Between group difference for expressive suppression
10 step fast SN 6 rounds
12 step slow SN 1 round (to be avoided by those 50
with knee pain, cardiac problems, renal problem,
45
low back pain, retinopathy and the elderly who are
40
weak and not flexible; instead they can do Chair SN)
35
modified version Chair SN: 7 rounds
30
Asanas (1 min per asana) 15
Standing (1 min per asana) 25
Trikonasana, Pravritta Trikonasana, Prasarita 20
pada‑hastasana 15
Supine 10
Jathara Parivartanasana, Pavanamuktasana, 5
Viparitakarani 0
Prone Pre Post
Bhujangasana, Dhanurasana followed by Yoga Control
Pavanmuktasana Figure 4: Between group difference for mindfulness
Sitting
Mandukasana, Vakrasana/Ardhamatsyendrasana,
Paschimatanasana, ArdhaUshtrasana
At the end, relaxation with abdominal breathing in
supine position (vishranti), 10–15 rounds (2 min)
Kriyas 3
Agnisara: 1 min
Kapalabhati (at 60 breaths per minute for 1 min
followed by rest for 1 min)
Pranayama 9
Nadishuddhi (for 6 min, with Antarkumbhaka and
Jalandharbandha for 2 s)
Bhramari (3 min)
Meditation (for stress management for deep 15 a b
relaxation and silencing the mind) cyclic meditation Figure 5: Panel a: Correlation between mindfulness and CR in
(those who are willing to practice techniques of
yoga group. Panel b: Correlation between mindfulness and ES) in
relaxation evolved by their own institutes may do so)
yoga group. FMI, Freiburg mindfulness inventory; CR, Cognitive
Resolve (I am completely healthy) 1
Closing prayer: Sarvebhavantu Sukhinah 1
reappraisal; ER, Emotion regulation; ES, Expressive suppression
Total 60
SN: Sun salutation of adaptive ER.[31] Moreover, mindfulness correlated positively
with CR and negatively with ES. It indicates that the increase
Table 2: Demographic details in mindfulness enables an individual to reinterpret an emotion-
Participants Yoga (n=27) Control eliciting situation in a manner that alters its meaning and changes
(n=27) its emotional impact.
Gender (males) ‑ 42 (77.77%)
Male (age, years) 21 (49±8.3) 21 (53±8.7) Participants in the current study showed improved CR ability than
Female (age, years) 6 (59.5±2.42) 6 (52±5.9) ES after the intervention, suggesting that yoga practice has assisted
HbA1c (%) 7.90±1.36 8.04±1.21
Disease duration (years), 6.61±4.99 10.33±6.89
in improving ER. As mentioned earlier, one must be attentive
mean±SD and be aware while practicing yoga. As a result, the internal
SD: Standard deviation, HbA1c: Hemoglobin A1c distractions are reduced due to continued focus and awareness

Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022 15

 Kanthi, et al.: Emotion regulation and mindfulness in T2DM patients

Table 3: Changes in emotion regulation questionnaire measures and mindfulness after the
intervention
Mean±SD Within group (pre‑post)
Yoga group (n=27) Control group t (df) Mean difference Percentage change
(n=27) Yoga Control Yoga Control Yoga Control
ERQ – Reappraisal 30.2±6.34 31.5±4.95 30.4±6.69 28.5±6.80 1.17 (26) 1.22 (26) 1.33 1.93 3.44 6.2
Downloaded from http://journals.lww.com/yomi by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

ERQ – Suppression 15.6±5.23 15.7±4.88 15.3±5.23 17.3±4.62* 0.107 (26) 2.21 (26) 0.11 2.03 0.64 13.07
FMI – Mindfulness 37.9±7.40 39.9±7.21 36.7±7.14 36.2±6.08# 1.79 (26) 0.52 (26) 2.00 0.48 5.27 1.36
*p<0.05 (within the group), #p<0.05 (between‑group). ERQ, Emotion Regulation Questionnaire; FMI, Frieberg Mindfulness Questionnaire; SD: Standard deviation

of the practice, which could be a potential factor contributing to intervention to improve ER skills and mindfulness in patients
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2023

the improved ER. with T2DM.

It is noted that mindfulness affects ER differently at the different Acknowledgment

stages of practice. Initially, it reduces stress and may subsequently
enhance an open experience of emotion that promotes new
emotional learning and reestablishes adaptive ER strategies.[32]
Webb et al. even categorize mindfulness as a reappraisal strategy
suggesting that mindfulness involves a reappraisal of an emotional
response.[33]
Some studies report that people with low heart rate variability
show greater orientation toward negative emotion and slower
attentional disengagement from negative stimuli. It suggests that
the worse regulation of cardiac vagal tone negatively interacts
with the bottom-up and top-down processing of emotions.[34] Yoga
practices have shown to downregulate the sympathetic nervous
system activity and hypothalamic-pituitary-adrenal axis response
to stress.[35] For example, sympathetic activation and heart rate
are found to be reduced after the yoga practice,[36,37] In addition,
a reduction was reported in anxiety scores that correlated with
increased GABA levels and reduced morning cortisol levels post
yoga intervention.[38,39] Similar interesting finding was a positive
correlation between melatonin levels and well-being scores in
participants receiving 3-month yoga intervention.[37] Notably,
melatonin attenuates the sympathetic activity in response to stress.
These findings suggest that the yoga practice seems to affect ER
through the regulation of autonomic and endocrine systems.
Broadly, these findings are in line with the previous studies
demonstrating the psychological benefits of yoga practices.
However, the current study also directs the attention toward the
psychological constructs underlying yoga practice’s benefits.
This line of inquiry may open new avenues in thinking about and
measuring the impact of yoga practices.
CONCLUSION
In the current study, yoga practice has helped T2DM patients
in improving ER and mindfulness. However, the increased
mindfulness itself might have contributed to the improved ER
skills. These results are encouraging as improved ER skills might
reduce or prevent DD in T2DM patients that in turn is associated
with glycemic control. Furthermore, better ER might enable
individuals to improve their health behaviors for the effective
management of T2DM. Thus, yoga practice is an effective
This study was primarily funded by Ministry of AYUSH,
Government of India. (Sanction number - Z.28015/209/2015HPC
[EMR]-AYUSH). The authors express deep gratitude to the
research fellows and Anvesana Research Laboratories for their
consistent support to accomplish this project.
Financial support and sponsorship
The funding source is reported.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Hall PA, Rodin GM, Vallis TM, Perkins BA. The consequences of anxious
temperament for disease detection, self-management behavior, and quality
of life in Type 2 diabetes mellitus. J Psychosom Res 2009;67:297-305.
2. Robertson SM, Stanley MA, Cully JA, Naik AD. Positive emotional health
and diabetes care: Concepts, measurement, and clinical implications.
Psychosomatics 2012;53:1-12.
3. Rane K, Wajngot A, Wändell PE, Gåfvels C. Psychosocial problems in
patients with newly diagnosed diabetes: Number and characteristics.
Diabetes Res Clin Pract 2011;93:371-8.
4. Anderson RJ, Grigsby AB, Freedland KE, de Groot M, McGill JB,
Clouse RE, et al. Anxiety and poor glycemic control: A meta-analytic
review of the literature. Int J Psychiatry Med 2002;32:235-47.
5. Katon WJ. The comorbidity of diabetes mellitus and depression. Am J
Med 2008;121 11 Suppl 2:S8.
6. Padala PR, Desouza CV, Almeida S, Shivaswamy V, Ariyarathna K,
Rouse L, et al. The impact of apathy on glycemic control in diabetes: A
cross-sectional study. Diabetes Res Clin Pract 2008;79:37-41.
7. Sagui SJ, Levens SM. Cognitive reappraisal ability buffers against the
indirect effects of perceived stress reactivity on Type 2 diabetes. Health
Psychol 2016;35:1154-8.
8. Nicolucci A, Kovacs Burns K, Holt RI, Comaschi M, Hermanns N, Ishii H,
et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2™):
Cross-national benchmarking of diabetes-related psychosocial outcomes
for people with diabetes. Diabet Med 2013;30:767-77.
9. Park M, Katon WJ, Wolf FM. Depression and risk of mortality in
individuals with diabetes: A meta-analysis and systematic review. Gen
Hosp Psychiatry 2013;35:217-25.
10. Baumeister H, Hutter N, Bengel J. Psychological and pharmacological
interventions for depression in patients with diabetes mellitus and
depression. Cochrane Database Syst Rev 2012;12:CD008381.
11. Das-Munshi J, Stewart R, Ismail K, Bebbington PE, Jenkins R, Prince MJ.
Diabetes, common mental disorders, and disability: Findings from the UK

16 Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022

 Kanthi, et al.: Emotion regulation and mindfulness in T2DM patients
National Psychiatric Morbidity Survey. Psychosom Med 2007;69:543-50.
12. Gonzalez JS, Fisher L, Polonsky WH. Depression in diabetes: Have we
been missing something important? Diabetes Care 2011;34:236-9.
13. Beveridge RM, A Berg C, J Wiebe D, L Palmer D. Mother and adolescent
representations of illness ownership and stressful events surrounding
diabetes. J Pediatr Psychol 2006;31:818-27.
14. Gullone E, Hughes EK, King NJ, Tonge B. The normative development
Downloaded from http://journals.lww.com/yomi by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
of emotion regulation strategy use in children and adolescents: A 2-year
follow-up study. J Child Psychol Psychiatry 2010;51:567-74.
15. Gross JJ. The Emerging Field of Emotion Regulation : An Integrative
Review. Review of General Psychology. 1998;2:271-299.
16. Rasmussen NH, Smith SA, Maxson JA, Bernard ME, Cha SS, Agerter DC,
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2023
et al. Association of HbA 1c with emotion regulation, intolerance of
uncertainty, and purpose in life in type 2 diabetes mellitus. Primary Care
Diabetes 2013;7:213-21.
17. Fisher L, Hessler D, Polonsky W, Strycker L, Guzman S, Bowyer V, et al.
Emotion regulation contributes to the development of diabetes distress
among adults with type 1 diabetes. Patient Educ Couns 2018;101:124-31.
18. Raveendran AV, Deshpandae A, Joshi SR. Therapeutic role of yoga in
type 2 diabetes. Endocrinol Metab (Seoul) 2018;33:307-17.
19. Balaji PA, Varne RS, Ali SS. Effects of yoga-pranayama practices
on metabolic parameters and anthropometry in type 2 diabetes. Int
Multidiscip Res J 2011;1:01-4.
20. Hegde S, Adhikari P, Kotian S, Pinto VJ, D’souza S, D’souza V. Effect
of 3-month yoga on oxidative stress in type 2 diabetes with or without
complications A controlled clinical trial. Diabetes Care 2011;34:2208-210.
21. Sharma M, Knowlden AP. Role of yoga in preventing and controlling
type 2 diabetes mellitus. J Evid Based Complement Alternat Med
2012;17:88-95.
22. Singh VP, Khandelwal B, Sherpa NT. Psycho-neuro-endocrine-
immune mechanisms of action of yoga in type II diabetes. Anc Sci Life
2015;35:12-7.
23. Bishop SR. Mindfulness: A Proposed Operational Definition. Clinical
Psychology: Science and Practice; Autumn 2004;11.
24. Kang Y, Gruber J, Gray JR. Mindfulness and de-automatization. Emot
Rev 2013;5:192-201.
25. Roemer L, Williston SK, Rollins LG. Mindfulness and emotion regulation.
Curr Opin Psychol 2015;3:52-7.
26. Bamber MD, Schneider JK. Mindfulness-based meditation to decrease
stress and anxiety in college students: A narrative synthesis of the research.
Educ Res Rev 2016;18:1-32.
27. Goldin PR, Gross JJ. Effects of mindfulness-based stress reduction
Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022
(MBSR) on emotion regulation in social anxiety disorder. Emotion
2010;10:83-91.
28. Nagarathna R, Rajesh SK, Amit S, Patil S, Anand A, Nagendra HR.
Methodology of Niyantrita Madhumeha Bharata Abhiyaan-2017, a
nationwide multicentric trial on the effect of a validated culturally
acceptable lifestyle intervention for primary prevention of diabetes: Part
2. Int J Yoga 2019;12:193-205.
29. Harald Walach K, Feldman G, Tschacher W, Walach H, Buchheld N,
Buttenmü ller V, et al. Measuring mindfulness - the Freiburg Mindfulness
Inventory (FMI). Personality and Individual Differences. 2006;40:1543–
55.
30. Froeliger B, Garland EL, McClernon FJ. Yoga meditation practitioners
exhibit greater gray matter volume and fewer reported cognitive failures:
Results of a preliminary voxel-based morphometric analysis. Evid Based
Complement Alternat Med 2012;2012:821307.
31. Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, et al.
Mindfulness-based therapy: A comprehensive meta-analysis. Clin Psychol
Rev 2013;33:763-71.
32. Hayes AM, Feldman G. Clarifying the Construct of Mindfulness in the
Context of Emotion Regulation and the process of change in therapy.
Clinical Psychology: Science and Practice. 2004; 11:254-62.
33. Webb TL, Miles E, Sheeran P. Dealing with feeling: A meta-analysis of
the effectiveness of strategies derived from the process model of emotion
regulation. Psychol Bull 2012;138:775-808.
34. Park G, Van Bavel JJ, Vasey MW, Thayer JF. Cardiac vagal tone predicts
attentional engagement to and disengagement from fearful faces. Emotion
2013;13:645-56.
35. Ross A, Thomas S. The health benefits of yoga and exercise: A review of
comparison studies. J Altern Complement Med 2010;16:3-12.
36. Kiecolt-Glaser JK, Christian L, Preston H, Houts CR, Malarkey WB,
Emery CF, et al. Stress, inflammation, and yoga practice. Psychosom
Med 2010;72:113-21.
37. Harinath K, Malhotra AS, Pal K, Prasad R, Kumar R, Kain TC,
et al. Effects of Hatha yoga and Omkar meditation on cardiorespiratory
performance, psychologic profile, and melatonin secretion. J Altern
Complement Med 2004;10:261-8.
38. Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M,
Vanitha N, et al. Effects of a yoga program on cortisol rhythm and mood
states in early breast cancer patients undergoing adjuvant radiotherapy:
A randomized controlled trial. Integr Cancer Ther 2009;8:37-46.
39. Streeter CC, Whitfield TH, Owen L, Rein T, Karri SK, Yakhkind A,
et al. Effects of yoga versus walking on mood, anxiety, and brain GABA
levels: A randomized controlled MRS study. J Altern Complement Med
2010;16:1145-52.
17