' s personal copy Feasibility , Acceptability , and Effects of Gentle Hatha Yoga for Women With Major Depression : Findings From a Randomized Controlled Mixed-Methods Study

Major depressive disorder (MDD) is a common, debilitating chronic condition in the United States and worldwide. Particularly in women, depressive symptoms are often accompanied by high levels of stress and ruminations, or repetitive self-critical negative thinking. There is a research and clinical imperative to evaluate complementary therapies that are acceptable and feasible for women with depression and that target specific aspects of depression in women, such as ruminations. To begin to address this need, we conducted a randomized, controlled, mixed-methods community-based study comparing an 8-week yoga intervention with an attention-control activity in 27 women with MDD. After controlling for baseline stress, there was a decrease in depression over time in both the yoga group and the attention-control group, with the yoga group having a unique trend in decreased ruminations. Participants in the yoga group reported experiencing increased connectedness and gaining a coping strategy through yoga. The findings provide support for future large scale research to explore the effects of yoga for depressed women and the unique role of yoga in decreasing rumination. © 2013 Elsevier Inc. All rights reserved. One of the most common and debilitating health conditions in the United States and worldwide is major depression, considered in this paper to include major depressive disorder (MDD) and dysthymia (Branchi & Schmidt, 2011; Kessler et al., 2003). Clinically, the condition presents as a persistently depressed mood with anhedonia, feelings of worthlessness, impaired cognitive abilities, altered sleep and appetite patterns, and suicidal ideations (American Psychiatric Association (APA), 2000). Epidemiological studies have demonstrated that women are disproportionately affected by depression, such that women have approximately double the prevalence rate of depression compared to men (Kessler et al., 2003). The interplay of biological and psychosocial vulnerabilities, stress, and individual personality and coping behaviors may be responsible for this increased prevalence of depression in women (Kinser, Goehler, & Taylor, 2012). Depression is a complex disorder that can be difficult to treat successfully. Many women with depression express frustration about the usual care, citing reasons such as inadequate symptom management, unacceptable side effects, and inadequate methods for coping (Kessler et al., 2003; Lafrance & Stoppard, 2006; Nolen-Hoeksema & Hilt, 2009). The efficacy of the usual care for depression (pharmaceutical management and cognitive therapy) is poorer than originally thought; recent close evaluation of large-scale studies on these usual care methods has revealed large participant dropout rates and low remission rates as well as a generalized reporting bias (Mathew & Charney, 2009; Pigott, Leventhal, Alter, & Boren, 2010; Turner, Matthews, Linardatos, Tell, & Rosenthal, 2008). More research is called for regarding innovative psychosocial treatments, particularly in typically under-studied populations such as women with severe depression (National Institute of Mental Health, 2005). Although depression is characterized by a depressed mood, many women experience a variety of psychological, cognitive, and physical symptoms beyond the depressed mood (APA, 2000). For example, up to half of all women with a diagnosis of depression may experience “anxious depression,” typified by excessive ruminations (Halbreich & Kahn, 2007; Marcus et al., 2008). Rumination is a complex concept, typically defined as repetitive negative thinking about one's depression and life situations (Smith & Alloy, 2009). Individual differences in coping patterns and ruminations play a role in the cycle of stress and depression (Hauenstein, 1996; Nolen-Hoeksema, 2006). Rumination is generally considered to be an emotion-focused coping style that is often ineffective or maladaptive because it can perpetuate stress and depressive symptoms (Lyubomirsky & Tkach, 2004; Weinstein, Brown, & Ryan, 2009). A low sense of mastery seems to contribute to brooding, a factor of rumination, when one repeatedly contemplates what is wrong in one's life and why it is not better (Treynor, Archives of Psychiatric Nursing 27 (2013) 137–147 ⁎ Corresponding Author: Patricia Anne Kinser, PhD, WHNP, RN, Virginia Commonwealth University, School of Nursing, 1100 East Leigh Street, PO Box 980567,