THE EFFECTS OF YOGA THERAPY ON STIGMA IN PATIENTS WITH ALCOHOL USE DISORDERS: A SINGLE-BLIND RANDOMIZED CONTROLLED STUDY
Authors: Asano *Keisuke , Ikai-Tani Saeko , Ohtani Yohei , Uchida Hiroyuki 
Published: February 2025

Abstract

Background
Stigma hinders the recovery from mental disorders due to societal statuses, social networks, and patients' pride. Self-stigma particularly internalizes fear of standing out, leading patients to experience self-blame, despair, and shame associated with their mental disorders. Patients with alcohol use disorders face self-stigma due to the lack of social acceptance for such conditions. Yoga is a mind-body exercise intervention that has gained popularity over the last decade. Previous randomized controlled trials (RCTs) reported that yoga therapy effectively reduced anxiety and depressive symptoms among severe mental illnesses. However, there are limited RCTs for patients with alcohol disorders using yoga therapy, and no comprehensive evaluation for internal stigma has been conducted.

Aims & Objectives
In this RCT, we aimed to evaluate the effects of 10-week online yoga on stigma in outpatients with alcohol use disorders.

Methods
This study design is a single-blind, randomized controlled trial for outpatients with alcohol use disorders according to the International Classification of Diseases, the 11th edition, aged 20 or above under treatment at Inokashira Hospital in Japan. Participants were randomly divided into two groups; the yoga group received a 50-minute yoga session once a week for ten weeks, and the control group participated in the treatment as usual. Each session was conducted in addition to their ongoing treatments. We measured stigma using the Internalized Stigma of Mental Illness Scale (ISMI) as primary evaluation items, the Alcohol Use Disorders Identification Test (AUDIT), the Alcohol Relapse Risk Scale (ARRS), the Quick Inventory of Depressive Symptomatology (QIDS-J), the Generalized Anxiety Disorder-7 (GAD-7), Global assessment of functioning (GAF), the EuroQol-5 dimensions classification system (EQ-5D) and salivary alpha-amylase (SAA) activity as secondary evaluation items. These assessments were performed before and after the intervention and at the two-week follow-up. The data analysis was conducted using analysis of covariance (ANCOVA) and repeated-measures analysis of variance (ANOVA) by R.

Results
Results of preliminary analyses were reported herein. Twenty-seven patients participated in this study (mean± SD age 59.1±9.4 years; male, 85.2% (n=23); duration of illness, 11.3±9.2 years; duration of outpatient period, 5.1±6.0 years). Two patients (7.4%) were excluded before intervention. In the yoga group (n=13), ISMI score decreased from 62.8±10.5 at baseline to 50.4±8.2 after the intervention, and SAA activity decreased from 76.2±83.1 U/L to 27.3±25.0 U/L. In addition, ARRS score decreased from 54.4±8.3 to 41.9±5.0 and EQ-5D Index also changed from 0.80±0.23 to 0.78±0.35. While the ANCOVA demonstrated significant differences in stigma (p=0.045) and QoL (Index) (p&lt;0.05), they disappeared after multiple comparison corrections. No significant differences were observed in other assessment scores.

Conclusion
The initial findings from our RCT indicate the potential advantages of 10-week online yoga sessions in mitigating internal stigma among individuals with alcohol use disorders. This study is still in progress, with a planned enrollment of 60 participants. Further inquiry is necessary to establish the efficacy of yoga sessions for individuals with alcohol use disorders.