Trauma-Informed Yoga: Investigating an Intervention for Mitigating Adverse Childhood Experiences in Rural Contexts

Figures & data

Table 1. Conceptual framework for trauma-informed yoga intervention (Cook-Cottone, Talebkhah, et al., 2017).

Symptoms related to trauma exposure	Elements of YIS-TIY
Hyperarousal and Dissociation	Embodied Practice (Physicality and Interoceptive Awareness)
Avoidance and Reexperiencing	Engagement in the Present Moment (Yoga and Mindfulness Practices)
Alterations in Cognitions	Intentional, Empowered Thinking (12 Cognitive Intentions)
Relational Disconnection	Yoga Teacher Presence and Responsiveness (Relational Attunement)

Table 2. Assessment measures.

Description of measure	Source (if applicable)	Timeline for dissemination	Cronbach’s alpha/validity & reliability from prior research
Center for Youth Wellness ACE-Q Self-Reporting Screener for Teens	Burke-Harris & Renschler, 2015	Pre-intervention (in order to determine ACE scores of participants)	Longitudinal testing currently underway to measure content and construct validity/reliability
Generalized Anxiety Disorder Scale (GAD-7)	Spitzer et al., 2006	Pre- and post-intervention	Cronbach’s alpha: .79–.91 Reliability = .85 Validity = 73.3%
Patient Health Questionnaire for Depressive Symptomology for Adolescents (PHQ-A)	Johnson et al., 2002	Pre- and post-intervention	Chronbach’s alpha = .835 Reliability = .875 Validity = 89.5%
Strengths and Difficulties Questionnaire for ages 11–17 (SDQ Self-Report 11–17), Teachers and Parents Report (SDQ-Teacher/Parent Report 11–17)	Goodman, 1997	Pre- and post-intervention	Chronbach’s alpha = .86 Reliability and validity vary according to respondent type and age of child self-reporting
Cortisol salivary assays	Salimetrics Laboratories	Pre (beginning of week 1)-, mid- (week 4) and post-intervention (end of week 8)	Mean accuracy of salivary cortisol testing >90%
Collection of secondary data, including attendance and academic data (MAPS benchmark/progress monitoring standardized assessment scores, attendance, office referrals, and reflective journals)	N/A	Office referrals/behavioral data: Collected 8 weeks prior to study and during 8 weeks of intervention for comparison Attendance data: Collected 8 weeks prior to study and during 8 weeks of intervention for comparison MAPS: Pre- and post-intervention	MAPS Data: Pearson correlation coefficients range from .76–.82 in reading and .82–.86 in mathematics Other measures: N/A

Table 3. Descriptive statistics of sample (n = 16), pre-yoga intervention (T1).

Measure	Mean	SD	Range
GAD-7	7.33	5.44	0−18
PHQ-A	6.72	4.42	0−15
SDQ total difficulties score	23.72	7.48	12−36
SDQ emotional symptoms scale	3.33	2.03	1−7
SDQ conduct problem scale	2.67	1.64	0−6
SDQ hyperactivity scale	5.06	2.60	1−9
SDQ peer problem scale	1.67	1.24	0−4
SDQ prosocial scale	7.11	2.03	3−10
SDQ impact	1.78	2.16	0−6

Figure 1. GAD-7 simple difference plot. Note. Points below the blue line indicate observations where baseline was greater than post-intervention, that is where (post—pre) is negative.

Figure 2. SDQ overall simple difference plot. Note. Points below the blue line indicate observations where baseline was greater than post-intervention, that is where (post—pre) is negative.

Table 4. Pre/post difference in means for outcomes.

	Pre-yoga	Post-yoga
Outcome	M (SD)	SD (SD)	95% CI	p	Cohen’s d
GAD-7	7.33 (5.44)	4.20 (5.36)	0.56, 4.90	0.02	0.70
PHQ-A^a	6.72 (4.42)	4.20 (7.06)	−1.00, 5.00	0.08	0.40
SDQ (overall score)	23.72 (7.48)	20.47 (7.33)	0.41, 5.46	0.03	0.64
SDQ emotional symptoms subscale	3.33 (2.03)	2.33 (2.13)	0.09, 1.65	0.03	0.62
SDQ conduct problems subscale	2.67 (1.64)	2.13 (1.30)	−0.40, 1.47	0.24	0.32
SDQ hyperactivity subscale	5.06 (2.60)	4.93 (2.28)	−0.77, 1.84	0.40	0.23
SDQ peer problems subscale	1.67 (1.24)	2.73 (1.83)	−2.50, −0.000003	0.047	0.59
SDQ prosocial subscale	7.11 (2.03)	6.47 (2.56)	−0.84, 1.77	0.46	0.20
SDQ impact subscale ^a	1.78 (2.16)	0.93 (1.91)	−0.00004, 2.50	0.08	0.49

^aWilcoxon signed rank test with continuity correction

Figure 3. Pre/mid-intervention difference plot in means for salivary cortisol levels.

Table 5. Pre/mid-intervention difference in means for salivary cortisol (salivary cortisol levels (ug/dL).

Collection time point	Mean (SD)	Median (IQR)	N
Time Point 1	0.31 (0.16)	0.27 (0.22, 0.33)	17
Time Point 3	0.24 (0.13)	0.23 (0.15, 0.28)	17
Change in Cortisol	Mean (SD)	95% CI	p Value*
Time 3- Time 1	−0.07 (0.19)	(−0.17, 0.02)	0.15

*p Value derived from paired, two-sided t test.

Table 6. Pre/mid-intervention difference in means for previous night’s sleep duration.

Collection time point	Mean (SD)	Median (IQR)	N
Time Point 1	6.87 (2.19)	7.00 (6.00, 8.50)	17
Time Point 3	7.74 (2.55	7.75 (7.17, 8.50)	17
Change in hours slept previous night	Mean (SD)	95% CI	p Value*
Time 3–Time 1	0.87 (1.78)	(−0.05, 1.78)	0.06

*p Value derived from paired, two-sided t test.

Table 7. Sample student survey responses.

Question	Positive responses	Neutral/negative responses
How did the yoga classes make you feel emotionally and mentally (feelings, stress, anxiety, etc.)?	It made me feel good like even if I messed up it was okay and made me relax more It was very good help me take a break during stressful school hours did calm me down It was almost like having a morning cup of coffee but in the middle of the day and WAY healthier They made me feel way more relaxed in school than I've been in the past.
How did the yoga classes make you feel physically (in your body)?	Definitely helped with flexibility, strength and recovery with injuries/muscle soreness I made my muscles sore but it was nice using muscles that i would have not thought of using before. Relaxed and happy	Sore at first but after loose
Do you think the yoga classes impacted your work at school? If so, how?	Allowed me to preform (sic) better on some test in the upcoming school day I do believe that it helped me in school and not be so stressed out. It has made me pay more attention in classes. Yes. I was more focused Yes because it makes me relaxed and focus better
Do you think the yoga classes impacted your life outside of school? If so, how?	With sports and other physical activities I was able to preform (sic) better I believe it has made me a happier person over all. It cleared some head space for sure Yes it makes me feel good about myself
What aspect(s) of the yoga classes did you enjoy the most—yoga poses or meditation at the end of the sessions (when you were lying down)?	Meditation: 71% Yoga Poses: 29%
Are there any tools or practices from this experience you feel that will be useful for your life moving forward?	Yeah, learning to breath (sic) and relax then try something new allowed me to go into my mind in certian (sic) stressful negative (sic) situations I believe that these practices will help me out in the marine keeping my breathing proper and keeping my body relaxed after stressful events. - Breathing, I tend to forget
How could the classes have been better?	More challenging and more spaced out More music	Better time management and more time to get comfortable with certain poses. Also less disruptions from students Could’ve been longer
Would you like to continue a yoga practice in your future?	Yes: 35%; Maybe: 59%; No: 6%
Please share anything else you'd like us to know about your experiences in this study.	I really enjoyed all [the] positivity in the class. Thanks to all the teachers and instructors. I would like to find out more routines and practices also would like to know how or what to use on my back as mentioned in class would like more information Everyone should do yoga	Had a good time although wish Some of the other students would’ve taken advantage of the opportunity or let others enjoy instead of taking from the overall experience

Table

Instructions: How often have you been bothered by each of the following symptoms during the past two weeks? For each symptom put an “X” in the box beneath the answer that best describes how you have been feeling.
	(0) Not at all	(1) Several days	(2) More than half the days	(3) Nearly every day
1. Feeling down, depressed, irritable, or hopeless?
2. Little interest or pleasure in doing things?
3. Trouble falling asleep, staying asleep, or sleeping too much?
4. Poor appetite, weight loss, or overeating?
5. Feeling tired, or having little energy?
6. Feeling bad about yourself—or feeling that you are a failure, or that you have let yourself or your family down?
7. Trouble concentrating on things like school work, reading, or watching TV?
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you were moving around a lot more than usual?
9. Thoughts that you would be better off dead, or of hurting yourself in some way?

Not difficult at all____

Somewhat difficult_____

Very difficult_____

Extremely difficult_____

Total Score (add numerical responses) = ________

Cook-Cottone, C., Talebkhah, K., Guyker, W., & Keddie, E. (2017). Mindfulness and yoga in schools. New York, NY: Springer Publishing.

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Burke Harris, N., & Renschler, T. (2015). Center for Youth Wellness ACE-Questionnaire (CYW ACE-Q Child, Teen, Teen SR). Center for Youth Wellness. San Francisco, CA.

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Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. doi:10.1001/archinte.166.10.1092

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Johnson, J., Harris, E., Spitzer, R., & Williams, J. (2002). The Patient health questionnaire for adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 30(3), 196–204. doi:10.1016/S1054-139X(01)00333-0

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Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 38(5), 581–586. doi:10.1111/j.1469-7610.1997.tb01545.x

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Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.