1 2822 138 YOGA V. HEALTH EDUCATION FOR ATTENTIONAL PROCESSES RELEVANT TO MAJOR DEPRESSIVE DISORDER. OBJECTIVES: RESEARCH HAS SHOWN THAT YOGA MAY BE AN EFFECTIVE ADJUNCTIVE TREATMENT FOR PERSISTENT DEPRESSION, THE BENEFITS OF WHICH MAY ACCUMULATE OVER TIME. THE OBJECTIVES OF THIS STUDY WERE TO EVALUATE THE FOLLOWING IN A SAMPLE OF PERSISTENTLY DEPRESSED INDIVIDUALS: WHETHER YOGA INCREASES MINDFULNESS AND WHETHER YOGA ATTENUATES RUMINATION. RUMINATION AND MINDFULNESS BOTH REPRESENT ATTENTIONAL PROCESSES RELEVANT FOR ONSET AND MAINTENANCE OF DEPRESSIVE EPISODES. METHODS: ONE-HUNDRED-TEN INDIVIDUALS WHO WERE PERSISTENTLY DEPRESSED DESPITE ONGOING USE OF PHARMACOLOGICAL TREATMENT WERE RECRUITED INTO AN RCT COMPARING YOGA WITH A HEALTH EDUCATION CLASS. MINDFULNESS AND RUMINATION WERE ASSESSED AT BASELINE AND ACROSS 3 TIME POINTS DURING THE TEN-WEEK INTERVENTION. RESULTS: FINDINGS DEMONSTRATE THAT, COMPARED TO HEALTH EDUCATION, YOGA WAS ASSOCIATED WITH HIGHER MEAN LEVELS OF THE OBSERVE FACET OF MINDFULNESS RELATIVE TO THE CONTROL GROUP DURING THE INTERVENTION PERIOD (P =.004, D =0.38), AND THAT YOGA WAS ASSOCIATED WITH A FASTER RATE OF INCREASE IN LEVELS OF ACTING WITH AWARENESS OVER THE INTERVENTION PERIOD (P= .03, F(2) =0.027). THERE WERE NO DIFFERENCES BETWEEN INTERVENTION GROUPS WITH RESPECT TO RUMINATION. CONCLUSIONS: RESULTS SUGGEST A SMALL EFFECT OF YOGA ON COMPONENTS OF MINDFULNESS DURING A 10-WEEK INTERVENTION PERIOD. PREVIOUS RESEARCH SUGGESTS THAT CONTINUED ASSESSMENT AFTER THE INITIAL 10 WEEKS MAY REVEAL CONTINUED IMPROVEMENT. FUTURE RESEARCH MAY ALSO EXAMINE MODERATORS OF THE IMPACT OF YOGA ON MINDFULNESS AND RUMINATION, INCLUDING CLINICAL FACTORS SUCH AS DEPRESSION SEVERITY OR DEPRESSION CHRONICITY, OR DEMOGRAPHIC FACTORS SUCH AS AGE. 2021 2 1254 38 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 3 115 31 A PILOT STUDY OF A YOGA INTERVENTION FOR THE TREATMENT OF ANXIETY IN YOUNG PEOPLE WITH EARLY PSYCHOSIS. BACKGROUND: ANXIETY IS COMMON IN YOUNG PEOPLE WITH EARLY PSYCHOSIS AND TREATMENT OPTIONS FOR THIS CO-MORBIDITY REMAIN LIMITED. YOGA IS A PROMISING ADJUNCT INTERVENTION THAT HAS BEEN SHOWN TO REDUCE ANXIETY FOR ADULTS WITH SCHIZOPHRENIA, THEREFORE THIS PILOT STUDY EVALUATED THE ACCEPTABILITY AND POTENTIAL EFFECTIVENESS OF YOGA FOR ANXIETY IN EARLY PSYCHOSIS. METHODS: A PROSPECTIVE SINGLE ARM PILOT STUDY OF A YOGA INTERVENTION WAS CONDUCTED WITHIN AN EARLY INTERVENTION FOR PSYCHOSIS SERVICE. RATES OF ATTENDANCE, AS WELL AS SYMPTOMS OF ANXIETY PRE AND POST YOGA SESSION WERE MEASURED. RESULTS: A TOTAL OF 14 YOUNG PEOPLE PARTICIPATED IN THE STUDY AND OVER 70% ATTENDED HALF OR MORE OF THE YOGA SESSIONS OFFERED. SIGNIFICANT TRANSIENT REDUCTION IN STATE ANXIETY AFTER A SINGLE SESSION OF YOGA WAS OBSERVED (P < 0.01). CONCLUSIONS: YOGA WAS FOUND TO BE AN ACCEPTABLE AND POTENTIALLY EFFECTIVE ADJUNCTIVE TREATMENT FOR ANXIETY IN EARLY PSYCHOSIS AND THE RESULTS WARRANT FURTHER CLINICAL TRIALS. 2022 4 1684 34 OPEN TRIAL OF VINYASA YOGA FOR PERSISTENTLY DEPRESSED INDIVIDUALS: EVIDENCE OF FEASIBILITY AND ACCEPTABILITY. THE AIM OF THIS STUDY WAS TO ASSESS THE ACCEPTABILITY AND FEASIBILITY OF VINYASA YOGA AS AN ADJUNCTIVE TREATMENT FOR DEPRESSED PATIENTS WHO WERE NOT RESPONDING ADEQUATELY TO ANTIDEPRESSANT MEDICATION. THE AUTHORS ALSO PLANNED TO ASK PARTICIPANTS FOR QUALITATIVE FEEDBACK ON THEIR EXPERIENCE OF THE CLASS AND TO ASSESS CHANGE OVER TIME IN DEPRESSION AND IN POSSIBLE MEDIATING VARIABLES. THE AUTHORS RECRUITED 11 PARTICIPANTS IN 1 MONTH FOR AN 8-WEEK OPEN TRIAL OF YOGA CLASSES. THEY FOUND THAT 10 PARTICIPANTS COMPLETED FOLLOW-UP ASSESSMENTS, 9 OF 10 WERE POSITIVE ABOUT THEIR EXPERIENCE, AND ALL PROVIDED FEEDBACK ABOUT WHAT WAS AND WAS NOT HELPFUL ABOUT YOGA, AS WELL AS BARRIERS TO CLASS ATTENDANCE. OVER THE 2-MONTH PERIOD, PARTICIPANTS EXHIBITED SIGNIFICANT DECREASES IN DEPRESSION SYMPTOMS AND SIGNIFICANT INCREASES IN AN ASPECT OF MINDFULNESS AND IN BEHAVIOR ACTIVATION. THIS PILOT STUDY PROVIDED SUPPORT FOR CONTINUING TO INVESTIGATE VINYASA YOGA AS AN ADJUNCT TREATMENT FOR DEPRESSION. THE NEXT STEP REQUIRED IS A RIGOROUS RANDOMIZED CLINICAL TRIAL. 2010 5 2837 43 YOGA'S IMPACT ON RISK AND PROTECTIVE FACTORS FOR DISORDERED EATING: A PILOT PREVENTION TRIAL. YOGA HAS BEEN PROPOSED AS A STRATEGY FOR IMPROVING RISK AND PROTECTIVE FACTORS FOR EATING DISORDERS, BUT FEW PREVENTION TRIALS HAVE BEEN CONDUCTED. THE PURPOSE OF THIS PILOT STUDY WAS TO ASSESS THE FEASIBILITY AND ACCEPTABILITY OF A YOGA SERIES IN FEMALE COLLEGE STUDENTS (N = 52). PARTICIPANTS WERE RANDOMIZED TO A YOGA INTERVENTION (THREE 50-MINUTE YOGA CLASSES/WEEK FOR 10 WEEKS CONDUCTED BY CERTIFIED YOGA TEACHERS WHO RECEIVED A 3-DAY INTENSIVE TRAINING) OR A CONTROL GROUP. RISK AND PROTECTIVE FACTORS, ASSESSED AT BASELINE, 5 AND 10 WEEKS, INCLUDED BODY DISSATISFACTION, NEGATIVE AFFECT, LONELINESS, SELF-COMPASSION, POSITIVE AFFECT, AND MINDFULNESS. MIXED MODELS CONTROLLING FOR BASELINE LEVELS OF OUTCOME VARIABLES WERE RUN. ON AVERAGE, PARTICIPANTS ATTENDED 20 OUT OF 30 YOGA CLASSES, AND THE MAJORITY OF PARTICIPANTS REPORTED HIGH LEVELS OF SATISFACTION WITH THE YOGA SERIES. APPEARANCE ORIENTATION DECREASED AND POSITIVE AFFECT INCREASED IN THE YOGA GROUP RELATIVE TO THE CONTROL GROUP. AFTER CONTROLLING FOR BASELINE LEVELS, THE YOGA GROUP HAD A SIGNIFICANTLY HIGHER POSITIVE AFFECT THAN THE CONTROL GROUP. CHANGES IN OTHER OUTCOMES WERE NOT STATISTICALLY SIGNIFICANT, AS COMPARED TO THE CONTROL CONDITION. FUTURE YOGA RESEARCH DIRECTIONS ARE DISCUSSED INCLUDING EDUCATION ABOUT BODY IMAGE, MEASURE AND SAMPLE SELECTION, AND USE OF AN IMPLEMENTATION SCIENCE FRAMEWORK. 2020 6 1770 53 POTENTIAL LONG-TERM EFFECTS OF A MIND-BODY INTERVENTION FOR WOMEN WITH MAJOR DEPRESSIVE DISORDER: SUSTAINED MENTAL HEALTH IMPROVEMENTS WITH A PILOT YOGA INTERVENTION. DESPITE PHARMACOLOGIC AND PSYCHOTHERAPEUTIC ADVANCES OVER THE PAST DECADES, MANY INDIVIDUALS WITH MAJOR DEPRESSIVE DISORDER (MDD) EXPERIENCE RECURRENT DEPRESSIVE EPISODES AND PERSISTENT DEPRESSIVE SYMPTOMS DESPITE TREATMENT WITH THE USUAL CARE. YOGA IS A MIND-BODY THERAPEUTIC MODALITY THAT HAS RECEIVED ATTENTION IN BOTH THE LAY AND RESEARCH LITERATURE AS A POSSIBLE ADJUNCTIVE THERAPY FOR DEPRESSION. ALTHOUGH PROMISING, RECENT FINDINGS ABOUT THE POSITIVE MENTAL HEALTH EFFECTS OF YOGA ARE LIMITED BECAUSE FEW STUDIES HAVE USED STANDARDIZED OUTCOME MEASURES AND NONE OF THEM HAVE INVOLVED LONG-TERM FOLLOW-UP BEYOND A FEW MONTHS AFTER THE INTERVENTION PERIOD. THE GOAL OF OUR RESEARCH STUDY WAS TO EVALUATE THE FEASIBILITY, ACCEPTABILITY, AND EFFECTS OF A YOGA INTERVENTION FOR WOMEN WITH MDD USING STANDARDIZED OUTCOME MEASURES AND A LONG FOLLOW-UP PERIOD (1YEAR AFTER THE INTERVENTION). THE KEY FINDING IS THAT PREVIOUS YOGA PRACTICE HAS LONG-TERM POSITIVE EFFECTS, AS REVEALED IN BOTH QUALITATIVE REPORTS OF PARTICIPANTS' EXPERIENCES AND IN THE QUANTITATIVE DATA ABOUT DEPRESSION AND RUMINATION SCORES OVER TIME. ALTHOUGH GENERALIZABILITY OF THE STUDY FINDINGS IS LIMITED BECAUSE OF A VERY SMALL SAMPLE SIZE AT THE 1-YEAR FOLLOW-UP ASSESSMENT, THE TRENDS IN THE DATA SUGGEST THAT EXPOSURE TO YOGA MAY CONVEY A SUSTAINED POSITIVE EFFECT ON DEPRESSION, RUMINATIONS, STRESS, ANXIETY, AND HEALTH-RELATED QUALITY OF LIFE. WHETHER AN INDIVIDUAL CONTINUES WITH YOGA PRACTICE, SIMPLE EXPOSURE TO A YOGA INTERVENTION APPEARS TO PROVIDE SUSTAINED BENEFITS TO THE INDIVIDUAL. THIS IS IMPORTANT BECAUSE IT IS RARE THAT ANY INTERVENTION, PHARMACOLOGIC OR NON-PHARMACOLOGIC, FOR DEPRESSION CONVEYS SUCH SUSTAINED EFFECTS FOR INDIVIDUALS WITH MDD, PARTICULARLY AFTER THE TREATMENT IS DISCONTINUED. 2014 7 1707 41 PATTERNS OF YOGA PRACTICE AND PHYSICAL ACTIVITY FOLLOWING A YOGA INTERVENTION FOR ADULTS WITH OR AT RISK FOR TYPE 2 DIABETES. BACKGROUND: THE CURRENT STUDY DESCRIBED PATTERNS OF YOGA PRACTICE AND EXAMINED DIFFERENCES IN PHYSICAL ACTIVITY OVER TIME BETWEEN INDIVIDUALS WITH OR AT RISK FOR TYPE 2 DIABETES WHO COMPLETED AN 8-WEEK YOGA INTERVENTION COMPARED WITH CONTROLS. METHODS: A LONGITUDINAL COMPARATIVE DESIGN MEASURED THE EFFECT OF A YOGA INTERVENTION ON YOGA PRACTICE AND PHYSICAL ACTIVITY, USING DATA AT BASELINE AND POSTINTERVENTION MONTHS 3, 6, AND 15. RESULTS: DISPARATE PATTERNS OF YOGA PRACTICE OCCURRED BETWEEN INTERVENTION AND CONTROL PARTICIPANTS OVER TIME, BUT THE SUBJECTIVE DEFINITION OF YOGA PRACTICE LIMITS INTERPRETATION. MULTILEVEL MODEL ESTIMATES INDICATED THAT TREATMENT GROUP DID NOT HAVE A SIGNIFICANT INFLUENCE IN THE RATE OF CHANGE IN PHYSICAL ACTIVITY OVER THE STUDY PERIOD. WHILE AGE AND EDUCATION WERE NOT SIGNIFICANT INDIVIDUAL PREDICTORS, THE INCLUSION OF THESE VARIABLES IN THE MODEL DID IMPROVE FIT. CONCLUSIONS: FINDINGS INDICATE THAT AN 8-WEEK YOGA INTERVENTION HAD LITTLE EFFECT ON PHYSICAL ACTIVITY OVER TIME. FURTHER RESEARCH IS NECESSARY TO EXPLORE THE INFLUENCE OF YOGA ON BEHAVIORAL HEALTH OUTCOMES AMONG INDIVIDUALS WITH OR AT RISK FOR TYPE 2 DIABETES. 2012 8 110 39 A PILOT STUDY MEASURING THE IMPACT OF YOGA ON THE TRAIT OF MINDFULNESS. BACKGROUND: THE CURRENT STUDY EXAMINED WHETHER YOGA WOULD INCREASE LEVELS OF MINDFULNESS IN A HEALTHY POPULATION. METHOD: FORTY-SIX PARTICIPANTS WERE RANDOMLY ASSIGNED TO AN 8-WEEK YOGA INTERVENTION GROUP OR A WAIT-LIST CONTROL GROUP. MINDFULNESS WAS ASSESSED PRE AND POST YOGA, USING THE FREIBURG MINDFULNESS INVENTORY (FMI). RESULTS: RESULTS INDICATE THAT THE YOGA GROUP EXPERIENCED A SIGNIFICANT INCREASE IN OVERALL MINDFULNESS, AND IN THREE MINDFULNESS SUBSCALES; ATTENTION TO THE PRESENT MOMENT, ACCEPTING AND OPEN ATTITUDES TOWARD EXPERIENCE, AND INSIGHTFUL UNDERSTANDING (P < .01). THE CONTROL GROUP EXPERIENCED A SIGNIFICANT INCREASE IN OVERALL MINDFULNESS (P < .02) AND INSIGHTFUL UNDERSTANDING (P < .01). FINDINGS SUGGEST THAT A YOGA INTERVENTION MAY BE A VIABLE METHOD FOR INCREASING LEVELS OF TRAIT MINDFULNESS IN A HEALTHY POPULATION, POTENTIALLY IMPLICATING YOGA AS A PREVENTIVE METHOD FOR THE LATER DEVELOPMENT OF NEGATIVE EMOTIONAL MOOD STATES (I.E. ANXIETY AND DEPRESSION). THE CONTROL GROUP ALSO EXPERIENCED MODERATE ELEVATIONS OF MINDFULNESS AT THE SECOND ASSESSMENT. 2009 9 177 42 A RANDOMIZED CONTROLLED TRIAL OF MINDFULNESS VERSUS YOGA: EFFECTS ON DEPRESSION AND/OR ANXIETY IN COLLEGE STUDENTS. BACKGROUND: DEPRESSION AND ANXIETY DISORDERS ARE TWO OF THE MOST COMMON MENTAL DISORDERS IN THE UNITED STATES. THESE DISORDERS ARE PREVALENT AMONG COLLEGE STUDENTS. OBJECTIVE: THE MAIN OBJECTIVE OF THIS STUDY IS TO COMPARE THE EFFECTIVENESS OF TWO DIFFERENT TYPES OF INTERVENTION PRACTICES (MINDFULNESS VS. YOGA) AND A NONINTERVENTIONAL CONTROL GROUP IN MITIGATING THE EFFECTS OF DEPRESSION AND/OR ANXIETY IN COLLEGE STUDENTS. METHOD: A SAMPLE OF 90 STUDENTS (BOTH GENDERS) OVER AGE 18 WHO HAD A DIAGNOSIS OF ANXIETY AND/OR DEPRESSION WAS RECRUITED FROM 11,500 UNDERGRADUATE COLLEGE STUDENTS IN A MID-SIZE UNIVERSITY. THE STUDY'S DESIGN INCLUDED STRATIFIED-RANDOMIZED CONTROLLED REPEATED MEASURES WITH THREE GROUPS: A MINDFULNESS INTERVENTION GROUP, A YOGA-ONLY INTERVENTION GROUP, AND A NONINTERVENTIONAL GROUP. PARTICIPANTS WERE RANDOMLY ASSIGNED TO THE AFOREMENTIONED THREE GROUPS. PARTICIPANTS IN THE INTERVENTION GROUPS RECEIVED AN 8-WEEK TRAINING EITHER IN MINDFULNESS OR YOGA. DEPRESSIVE, ANXIETY, STRESS SYMPTOMS, SELF-COMPASSION, AND MINDFULNESS WERE MEASURED AT BASELINE, WEEK 4, WEEK 8, AND WEEK 12. RESULTS: DEPRESSIVE, ANXIETY, AND STRESS SYMPTOMS DECREASED SIGNIFICANTLY (P < .01) FROM BASELINE TO FOLLOW-UP CONDITIONS IN BOTH THE MINDFULNESS AND YOGA INTERVENTION GROUPS. THE CHANGES IN MINDFULNESS SCORES WERE ALSO SIGNIFICANT IN BOTH GROUPS. HOWEVER, THE CHANGES IN SELF-COMPASSION SCORES WERE SIGNIFICANT ONLY IN THE MINDFULNESS INTERVENTION GROUP. NO SIGNIFICANT CHANGES IN THE CONTROL GROUP WERE DEMONSTRATED. CONCLUSIONS: THE FINDINGS FROM THIS STUDY CAN PROVIDE USEFUL INFORMATION TO NURSES AND OTHER HEALTH CARE PROVIDERS. THIS STUDY MAY HAVE IMPLICATIONS FOR A COST-EFFECTIVE TREATMENT FOR DEPRESSION AND ANXIETY. 2016 10 1630 48 MINDFULNESS-BASED YOGA INTERVENTION FOR WOMEN WITH DEPRESSION. OBJECTIVES: THE PURPOSE OF THIS STUDY WAS TO EXAMINE THE EFFICACY OF A 12-WEEK MINDFULNESS-BASED YOGA INTERVENTION ON DEPRESSIVE SYMPTOMS AND RUMINATION AMONG DEPRESSED WOMEN. DESIGN: PROSPECTIVE, RANDOMIZED, CONTROLLED 12 WEEK INTERVENTION PILOT STUDY. DEPRESSIVE SYMPTOMS WERE ASSESSED AT BASELINE, POST-INTERVENTION (12 WEEKS), AND ONE-MONTH FOLLOW-UP. SETTING: WOMEN WITH A HISTORY OF DIAGNOSED DEPRESSION AND CURRENTLY DEPRESSED WERE RANDOMIZED TO A MINDFULNESS-BASED YOGA CONDITION OR A WALKING CONTROL. INTERVENTIONS: THE MINDFULNESS-BASED YOGA INTERVENTION CONSISTED OF A HOME-BASED YOGA ASANA, PRANAYAMA AND MEDITATION PRACTICE WITH MINDFULNESS EDUCATION SESSIONS DELIVERED OVER THE TELEPHONE. THE WALKING CONTROL CONDITION CONSISTED OF HOME-BASED WALKING SESSIONS AND HEALTH EDUCATION SESSIONS DELIVERED OVER THE PHONE. MAIN OUTCOME MEASURES: THE BECK DEPRESSION INVENTORY (BDI) AND RUMINATIVE RESPONSES SCALE (RRS). RESULTS: BOTH GROUPS REPORTED DECREASES IN DEPRESSIVE SYMPTOMS FROM BASELINE TO POST-INTERVENTION, F(1,33)=34.83, P<0.001, AND FROM BASELINE TO ONE-MONTH FOLLOW-UP, F(1,33)=37.01, P<0.001. AFTER CONTROLLING FOR BASELINE, THERE WERE NO SIGNIFICANT BETWEEN GROUP DIFFERENCES ON DEPRESSION SCORES AT POST-INTERVENTION AND THE ONE-MONTH FOLLOW-UP ASSESSMENT. THE MINDFULNESS-BASED YOGA CONDITION REPORTED SIGNIFICANTLY LOWER LEVELS OF RUMINATION THAN THE CONTROL CONDITION AT POST-INTERVENTION, AFTER CONTROLLING FOR BASELINE LEVELS OF RUMINATION, F(1,31)=6.23, P<0.01. CONCLUSIONS: THESE FINDINGS SUGGEST THAT MINDFULNESS-BASED YOGA MAY PROVIDE TOOLS TO MANAGE RUMINATIVE THOUGHTS AMONG WOMEN WITH ELEVATED DEPRESSIVE SYMPTOMS. FUTURE STUDIES, WITH LARGER SAMPLES ARE NEEDED TO ADDRESS THE EFFECT OF YOGA ON DEPRESSION AND FURTHER EXPLORE THE IMPACT ON RUMINATION. 2016 11 1373 35 IMPACT OF A YOGA INTERVENTION ON PHYSICAL ACTIVITY, SELF-EFFICACY, AND MOTIVATION IN WOMEN WITH PTSD SYMPTOMS. BACKGROUND: STUDIES USING YOGA HAVE DEMONSTRATED INITIAL EFFICACY FOR TREATING SYMPTOMS ACROSS ANXIETY DISORDERS, INCLUDING POSTTRAUMATIC STRESS DISORDER. OBJECTIVE: UNDERSTANDING HOW INTERVENTIONS INFLUENCE PARTICIPANTS' PHYSICAL ACTIVITY AND WHAT DETERMINANTS AFFECT CONTINUED PHYSICAL ACTIVITY BEHAVIOR CHANGE IS IMPORTANT BECAUSE MAINTENANCE OF THE BEHAVIOR MAY BE CRITICAL TO CONTINUED MENTAL HEALTH GAINS AND SYMPTOM REDUCTION. METHODS: THIS STUDY INVESTIGATED CHANGE IN PHYSICAL ACTIVITY AND POSSIBLE PSYCHOLOGICAL MECHANISMS OF PHYSICAL ACTIVITY BEHAVIOR CHANGE, INCLUDING SELF-EFFICACY AND REGULATORY MOTIVATION, IN A RANDOMIZED CONTROLLED TRIAL OF YOGA FOR WOMEN WITH POST-TRAUMATIC STRESS DISORDER SYMPTOMS (N=38). RESULTS: GROWTH CURVE MODELING RESULTS SHOWED NO SIGNIFICANT CHANGES IN PHYSICAL ACTIVITY OR SELF-EFFICACY FOR EITHER GROUP, WHEREAS EXTERNAL MOTIVATION DECREASED SIGNIFICANTLY IN THE YOGA GROUP BUT NOT IN THE CONTROL GROUP. CONCLUSIONS: INVESTIGATORS OF FUTURE YOGA INTERVENTIONS MAY WANT TO FOCUS ON INCREASING SELF-EFFICACY AND INTERNAL REGULATORY MOTIVATION, SO THAT PHYSICAL ACTIVITY AND RESULTANT SYMPTOM RELIEF CAN BE MAINTAINED. 2015 12 112 32 A PILOT STUDY OF A MINDFULNESS INFORMED YOGA INTERVENTION IN YOUNG PEOPLE WITH PSYCHOSIS. AIM: TO DETERMINE THE ACCEPTABILITY AND SAFETY OF A MINDFULNESS INFORMED YOGA INTERVENTION AS ADJUNCT TO USUAL CARE FOR YOUNG PEOPLE WITH EARLY PSYCHOSIS. METHODS: PEOPLE AGED 16-25 YEARS ATTENDING A COMMUNITY-BASED SPECIALIST EARLY PSYCHOSIS CLINIC WERE INVITED TO PARTICIPATE IN A 12-WEEK YOGA INTERVENTION. THE INTERVENTION CONSISTED OF 1-H WEEKLY CLASSES OF MINDFULNESS INFORMED YOGA. ACCEPTABILITY WAS MEASURED BY UPTAKE, ATTENDANCE AND PARTICIPANTS' SATISFACTION. SAFETY WAS MEASURED BY INCIDENCE OF PHYSICAL INJURY, PARTICIPANTS' LEVEL OF COMFORT, DISTRESS AND ANXIETY DURING THE SESSIONS, AND THE FOLLOWING MENTAL HEALTH OUTCOMES: POSITIVE AND NEGATIVE PSYCHOTIC, DEPRESSION, ANXIETY AND STRESS SYMPTOMS, SLEEP QUALITY AND FUNCTIONING. RESULTS: OF THOSE WHO CONSENTED TO THE STUDY, 80% (12) PARTICIPATED AND ON AVERAGE ATTENDED 4.4 YOGA CLASSES. THERE WERE NO PHYSICAL INJURIES AND PARTICIPANTS REPORTED MINIMAL DISTRESS AND ANXIETY. POST-INTERVENTION, THERE WAS A SIGNIFICANT REDUCTION IN ANXIETY SYMPTOMS AND AN IMPROVEMENT IN FUNCTION. CONCLUSIONS: MINDFULNESS-BASED YOGA INTERVENTIONS ARE BOTH ACCEPTABLE AND SAFE AS AN INTERVENTION FOR YOUTH WITH EARLY PSYCHOSIS. THOUGH NUMBERS WERE SMALL, THE STUDY SHOWS PROMISE FOR YOGA AS A POTENTIALLY USEFUL INTERVENTION. IMPORTANTLY, THERE WAS NO DETERIORATION IN MENTAL HEALTH OUTCOMES. A LARGER TRIAL EVALUATING CLINICAL EFFECTIVENESS IS NOW TIMELY. 2022 13 1182 32 EVALUATION OF THE MENTAL HEALTH BENEFITS OF YOGA IN A SECONDARY SCHOOL: A PRELIMINARY RANDOMIZED CONTROLLED TRIAL. THE GOAL OF THIS STUDY WAS TO EVALUATE POTENTIAL MENTAL HEALTH BENEFITS OF YOGA FOR ADOLESCENTS IN SECONDARY SCHOOL. STUDENTS WERE RANDOMLY ASSIGNED TO EITHER REGULAR PHYSICAL EDUCATION CLASSES OR TO 11 WEEKS OF YOGA SESSIONS BASED UPON THE YOGA ED PROGRAM OVER A SINGLE SEMESTER. STUDENTS COMPLETED BASELINE AND END-PROGRAM SELF-REPORT MEASURES OF MOOD, ANXIETY, PERCEIVED STRESS, RESILIENCE, AND OTHER MENTAL HEALTH VARIABLES. INDEPENDENT EVALUATION OF INDIVIDUAL OUTCOME MEASURES REVEALED THAT YOGA PARTICIPANTS SHOWED STATISTICALLY SIGNIFICANT DIFFERENCES OVER TIME RELATIVE TO CONTROLS ON MEASURES OF ANGER CONTROL AND FATIGUE/INERTIA. MOST OUTCOME MEASURES EXHIBITED A PATTERN OF WORSENING IN THE CONTROL GROUP OVER TIME, WHEREAS CHANGES IN THE YOGA GROUP OVER TIME WERE EITHER MINIMAL OR SHOWED SLIGHT IMPROVEMENTS. THESE PRELIMINARY RESULTS SUGGEST THAT IMPLEMENTATION OF YOGA IS ACCEPTABLE AND FEASIBLE IN A SECONDARY SCHOOL SETTING AND HAS THE POTENTIAL OF PLAYING A PROTECTIVE OR PREVENTIVE ROLE IN MAINTAINING MENTAL HEALTH. 2012 14 2754 48 YOGA PRACTICE PREDICTS IMPROVEMENTS IN DAY-TO-DAY PAIN IN WOMEN WITH METASTATIC BREAST CANCER. CONTEXT: WOMEN WITH METASTATIC BREAST CANCER (MBC) EXPERIENCE A SIGNIFICANT SYMPTOM BURDEN, INCLUDING CANCER PAIN. YOGA IS A MIND-BODY DISCIPLINE THAT HAS SHOWN PROMISE FOR ALLEVIATING CANCER PAIN, BUT FEW STUDIES HAVE INCLUDED PATIENTS WITH METASTATIC DISEASE OR EXAMINED THE ACUTE EFFECTS OF YOGA PRACTICE. OBJECTIVES: TO DETERMINE WHETHER DAILY PAIN CHANGED SIGNIFICANTLY DURING A RANDOMIZED CONTROLLED TRIAL OF THE MINDFUL YOGA PROGRAM AMONG WOMEN WITH MBC AND WHETHER TIME SPENT IN YOGA PRACTICE WAS RELATED TO DAILY PAIN. METHODS: ON ALTERNATE WEEKS DURING THE INTERVENTION PERIOD, WE COLLECTED DAILY MEASURES OF PAIN FROM A SUBSET OF 48 WOMEN RANDOMIZED TO EITHER YOGA (N = 30) OR A SUPPORT GROUP CONDITION (N = 18). WE ALSO ASSESSED DAILY DURATION OF YOGA PRACTICE AMONG PATIENTS RANDOMIZED TO YOGA. RESULTS: PAIN LEVELS WERE LOW FOR WOMEN IN BOTH CONDITIONS, AND NO DIFFERENTIAL TREATMENT EFFECTS WERE FOUND ON DAILY PAIN. HOWEVER, AMONG WOMEN RANDOMIZED TO YOGA, A DOSE/RESPONSE RELATIONSHIP WAS FOUND BETWEEN YOGA PRACTICE DURATION AND DAILY PAIN. WHEN PATIENTS HAD SPENT RELATIVELY MORE TIME PRACTICING YOGA ACROSS TWO CONSECUTIVE DAYS, THEY WERE MORE LIKELY TO EXPERIENCE LOWER PAIN ON THE NEXT DAY. THIS FINDING IS CONSISTENT WITH AN EARLIER MBC STUDY. MEDITATION PRACTICE SHOWED THE STRONGEST ASSOCIATION WITH LOWER DAILY PAIN. CONCLUSION: FINDINGS SUGGEST THAT YOGA PRACTICE (MEDITATION PRACTICE IN PARTICULAR) IS ASSOCIATED WITH ACUTE IMPROVEMENTS IN CANCER PAIN, AND THAT YOGA INTERVENTIONS MAY BE MORE IMPACTFUL IF TESTED IN A SAMPLE OF PATIENTS WITH ADVANCED CANCER IN WHICH PAIN IS RELATIVELY ELEVATED. 2021 15 1884 34 REDUCING STRESS IN SCHOOL-AGE GIRLS THROUGH MINDFUL YOGA. INTRODUCTION: SCHOOL-AGE CHILDREN REPORT MUCH STRESS IN THEIR DAILY LIVES, WHICH MAY LEAD TO PSYCHOLOGICAL AND PHYSICAL PROBLEMS. MINDFULNESS-BASED STRESS REDUCTION IS A PROGRAM OF AWARENESS-BASED PRACTICES EFFECTIVE WITH ADULTS. THE PURPOSE OF THIS STUDY WAS TO INVESTIGATE THE EFFICACY OF MINDFULNESS TRAINING THROUGH YOGA WITH SCHOOL-AGE GIRLS TO REDUCE PERCEIVED STRESS, ENHANCE COPING ABILITIES, SELF-ESTEEM, AND SELF-REGULATION, AND EXPLORE THE RELATIONSHIP BETWEEN THE DOSE OF THE INTERVENTION AND OUTCOMES. METHOD: FOURTH- AND FIFTH-GRADE GIRLS WERE RECRUITED FROM TWO PUBLIC SCHOOLS AND RANDOMLY ASSIGNED TO INTERVENTION AND WAIT-LIST CONTROL GROUPS. THE INTERVENTION GROUP MET 1 HOUR A WEEK FOR 8 WEEKS AND COMPLETED 10 MINUTES OF DAILY HOMEWORK. RESULTS: SELF-ESTEEM AND SELF-REGULATION INCREASED IN BOTH GROUPS. THE INTERVENTION GROUP WAS MORE LIKELY TO REPORT GREATER APPRAISAL OF STRESS (P < .01) AND GREATER FREQUENCY OF COPING (P < .05). HOMEWORK ACCOUNTED FOR 7% OF THE VARIANCE IN REPORTED STRESS. DISCUSSION: CONSISTENT WITH REPORTS OF MINDFULNESS TRAINING, GREATER AWARENESS OF THE FEELINGS ASSOCIATED WITH STRESS MAY ENHANCE COPING ABILITIES. HOWEVER, IT IS POSSIBLE THAT THE INCREASING AWARENESS OF STRESSORS IN ITSELF INCREASED STRESS, POSSIBLY AS PART OF THE PROCESS OF DEVELOPING MINDFULNESS OR RELATED TO COGNITIVE, EMOTIONAL, OR SOCIAL DEVELOPMENT. MINDFULNESS IN CHILDREN MAY DIFFER FROM MINDFULNESS IN ADULTS AND WARRANTS FURTHER INVESTIGATION. 2012 16 2458 42 YOGA AS A COMPLEMENTARY TREATMENT OF DEPRESSION: EFFECTS OF TRAITS AND MOODS ON TREATMENT OUTCOME. PRELIMINARY FINDINGS SUPPORT THE POTENTIAL OF YOGA AS A COMPLEMENTARY TREATMENT OF DEPRESSED PATIENTS WHO ARE TAKING ANTI-DEPRESSANT MEDICATIONS BUT WHO ARE ONLY IN PARTIAL REMISSION. THE PURPOSE OF THIS ARTICLE IS TO PRESENT FURTHER DATA ON THE INTERVENTION, FOCUSING ON INDIVIDUAL DIFFERENCES IN PSYCHOLOGICAL, EMOTIONAL AND BIOLOGICAL PROCESSES AFFECTING TREATMENT OUTCOME. TWENTY-SEVEN WOMEN AND 10 MEN WERE ENROLLED IN THE STUDY, OF WHOM 17 COMPLETED THE INTERVENTION AND PRE- AND POST-INTERVENTION ASSESSMENT DATA. THE INTERVENTION CONSISTED OF 20 CLASSES LED BY SENIOR IYENGAR YOGA TEACHERS, IN THREE COURSES OF 20 YOGA CLASSES EACH. ALL PARTICIPANTS WERE DIAGNOSED WITH UNIPOLAR MAJOR DEPRESSION IN PARTIAL REMISSION. PSYCHOLOGICAL AND BIOLOGICAL CHARACTERISTICS WERE ASSESSED PRE- AND POST-INTERVENTION, AND PARTICIPANTS RATED THEIR MOOD STATES BEFORE AND AFTER EACH CLASS. SIGNIFICANT REDUCTIONS WERE SHOWN FOR DEPRESSION, ANGER, ANXIETY, NEUROTIC SYMPTOMS AND LOW FREQUENCY HEART RATE VARIABILITY IN THE 17 COMPLETERS. ELEVEN OUT OF THESE COMPLETERS ACHIEVED REMISSION LEVELS POST-INTERVENTION. PARTICIPANTS WHO REMITTED DIFFERED FROM THE NON-REMITTERS AT INTAKE ON SEVERAL TRAITS AND ON PHYSIOLOGICAL MEASURES INDICATIVE OF A GREATER CAPACITY FOR EMOTIONAL REGULATION. MOODS IMPROVED FROM BEFORE TO AFTER THE YOGA CLASSES. YOGA APPEARS TO BE A PROMISING INTERVENTION FOR DEPRESSION; IT IS COST-EFFECTIVE AND EASY TO IMPLEMENT. IT PRODUCES MANY BENEFICIAL EMOTIONAL, PSYCHOLOGICAL AND BIOLOGICAL EFFECTS, AS SUPPORTED BY OBSERVATIONS IN THIS STUDY. THE PHYSIOLOGICAL METHODS ARE ESPECIALLY USEFUL AS THEY PROVIDE OBJECTIVE MARKERS OF THE PROCESSES AND EFFECTIVENESS OF TREATMENT. THESE OBSERVATIONS MAY HELP GUIDE FURTHER CLINICAL APPLICATION OF YOGA IN DEPRESSION AND OTHER MENTAL HEALTH DISORDERS, AND FUTURE RESEARCH ON THE PROCESSES AND MECHANISMS. 2007 17 1628 28 MINDFULNESS, SELF-COMPASSION, ANXIETY AND DEPRESSION MEASURES IN SOUTH AUSTRALIAN YOGA PARTICIPANTS: IMPLICATIONS FOR DESIGNING A YOGA INTERVENTION. AIM: THE AIM OF THE STUDY WAS TO EXAMINE THE DEMOGRAPHIC AND PRACTICE CHARACTERISTICS OF CURRENT YOGA PARTICIPANTS AND ASSESS THEIR LEVELS OF MINDFULNESS, SELF-COMPASSION, STRESS, ANXIETY, DEPRESSION AND WELLBEING AND IMPLICATIONS FOR DESIGNING A YOGA INTERVENTION. METHODS: A WEB-BASED SURVEY WAS ADMINISTERED TO SOUTH AUSTRALIAN YOGA TEACHERS AND STUDENTS FROM SEPTEMBER 2014 TO FEBRUARY 2015. RESULTS: RESULTS SHOWED A POSITIVE CORRELATION WITH MINDFULNESS AND SELF-COMPASSION AND NEGATIVE CORRELATION WITH DEPRESSION, ANXIETY AND STRESS SCORES WITH MONTHS OF PRACTICE. MINDFULNESS AND SELF-COMPASSION SCORES WERE SIGNIFICANTLY HIGHER WITH TWO OR MORE CLASSES PER WEEK AND MINDFULNESS HIGHER IN THOSE WITH A REGULAR MEDITATION PRACTICE. DISCUSSION: KEY FINDINGS INDICATE THAT CLASS FREQUENCY, PRACTICE EXPERIENCE AND MEDITATION PRACTICE ARE IMPORTANT FACTORS IN DESIGNING A YOGA INTERVENTION EXAMINING MINDFULNESS AND MENTAL HEALTH. CONCLUSION: FINDINGS PROVIDE IMPORTANT INFORMATION FOR GUIDING DEVELOPMENT OF A YOGA INTERVENTION FOR ANXIETY AND DEPRESSION. 2018 18 976 45 EFFECTS OF AN INTERVENTION PROGRAM WITH HEALTH EDUCATION AND HATHA YOGA ON THE HEALTH OF PROFESSIONALS WITH MUSCULOSKELETAL SYMPTOMS. INTRODUCTION: MUSCULOSKELETAL AND MENTAL DISORDERS ARE RELEVANT IN THE WORKERS' DISEASE PROCESS, AND ERGONOMIC INTERVENTIONS THAT INCLUDE GUIDANCE AND PHYSICAL EXERCISE CONSIST OF STRATEGIES OF HEALTH PROMOTION. INTEGRATIVE AND COMPLEMENTARY PRACTICES ARE PRESENTED AS A POSSIBILITY OF PROMOTING COMPREHENSIVE CARE AND YOGA CONSISTS OF A THERAPEUTIC ALTERNATIVE. OBJECTIVE: TO EVALUATE THE EFFECTS OF AN INTERVENTION INCLUDING EDUCATIONAL MEASURES AND HATHA YOGA IN MUSCULOSKELETAL PAIN, DISABILITY, AND STRESS IN PROFESSIONALS OF A UNIVERSITY HOSPITAL. METHODS: WE SELECTED 125 PROFESSIONALS WITH MUSCULOSKELETAL SYMPTOMS OF INTENSITY >/= 1 WHO DID NOT PRACTICE YOGA AND RANDOMLY ASSIGNED THEM TO INTERVENTION (N = 63) AND CONTROL (N = 62) GROUPS, REQUESTING ANSWERS TO THE FOLLOWING QUESTIONNAIRES: INITIAL CHARACTERIZATION, THE NORDIC MUSCULOSKELETAL QUESTIONNAIRE AND A NUMERIC SCALE, THE PAIN DISABILITY QUESTIONNAIRE, AND THE PERCEIVED STRESS SCALE. THE INTERVENTION GROUP WENT THROUGH A 12-WEEK PROGRAM WITH EDUCATIONAL MEASURES AND HATHA YOGA. AT THE END OF THE STUDY PERIOD, BOTH GROUPS ANSWERED TO THE QUESTIONNAIRES ONCE AGAIN. WE COMPARED DATA BEFORE AND AFTER THE INTERVENTION AND BETWEEN GROUPS. RESULTS: BOTH GROUPS PRESENTED IMPROVEMENTS AFTER 12 WEEKS, BUT THE DIFFERENCE BETWEEN MEAN RESULTS OBTAINED IN THE FIRST AND SECOND DATA COLLECTIONS REVEALED THAT THE LEVELS OF PAIN, DISABILITY, AND STRESS DECREASED MORE STRONGLY IN THE INTERVENTION GROUP THAN IN THE CONTROL GROUP. CONSIDERING THAT THE INTERVENTION GROUP BEGAN THE PROGRAM IN WORSE CLINICAL CONDITIONS, THE PROGRAM LED TO A REDUCTION IN THE DIFFERENCE BETWEEN GROUPS, BUT THIS WAS NOT ENOUGH FOR THE INTERVENTION GROUP TO REACH BETTER RESULTS THAN THE CONTROL. CONCLUSIONS: THE INTERVENTION PROMOTED IMPROVEMENTS IN THE INTENSITY OF PAIN, DISABILITY, AND STRESS AMONG THE PARTICIPANTS OF THE INTERVENTION GROUP. SIMILAR PROGRAMS COULD BE EXPLORED IN THE PROMOTION OF OCCUPATIONAL HEALTH. 2020 19 2235 34 THE IMPACT OF YOGA UPON FEMALE PATIENTS SUFFERING FROM HYPOTHYROIDISM. OBJECTIVE: TO STUDY THE EFFECT OF YOGA ON THE QUALITY OF LIFE OF FEMALE HYPOTHYROID PATIENTS. DESIGN: THE WHO QUALITY OF LIFE SCALE(22) WAS USED TO ASSESS THE QUALITY OF LIFE OF 20 FEMALE HYPOTHYROID PATIENTS. SUBJECTS ATTENDED ONE HOUR YOGA SESSIONS DAILY FOR A PERIOD OF ONE MONTH. A PRETEST-POST-TEST RESEARCH DESIGN WAS USED FOR DATA ANALYSIS. RESULTS: PATIENTS' QUALITY OF LIFE SCORES FOLLOWING THE YOGA PROGRAM WERE GREATER THAN SCORES OBTAINED PRIOR TO UNDERTAKING YOGA (P < 0.01). PATIENTS ALSO REPORTED SIGNIFICANT IMPROVEMENT IN THEIR PERCEPTION OF THE OVERALL QUALITY OF LIFE AND OF THEIR HEALTH POST YOGA INTERVENTION. CONCLUSIONS: IT CAN BE CONCLUDED THAT YOGA IS VALUABLE IN HELPING THE HYPOTHYROID PATIENTS TO MANAGE THEIR DISEASE-RELATED SYMPTOMS. YOGA MAY BE CONSIDERED AS SUPPORTIVE OR COMPLEMENTARY THERAPY IN CONJUNCTION WITH MEDICAL THERAPY FOR THE TREATMENT OF HYPOTHYROID DISORDER. 2011 20 1239 31 FEASIBILITY OF A MANUALIZED MINDFUL YOGA INTERVENTION FOR PATIENTS WITH CHRONIC MOOD DISORDERS. CHRONIC MOOD DISORDERS POSE AN IMPORTANT MENTAL HEALTH PROBLEM. INDIVIDUALS WITH THESE DISORDERS EXPERIENCE A SIGNIFICANT IMPAIRMENT, OFTEN FAIL TO SEEK HELP, AND THEIR ILLNESSES FREQUENTLY DO NOT RESPOND TO TREATMENT. IT IS THEREFORE IMPORTANT TO DEVELOP INNOVATIVE AND ATTRACTIVE TREATMENTS FOR THESE DISORDERS. MINDFUL YOGA REPRESENTS A PROMISING TREATMENT APPROACH. THIS PILOT STUDY TESTED THE FEASIBILITY OF A 9-WEEK MANUALIZED MINDFUL YOGA INTERVENTION FOR PATIENTS WITH CHRONIC MOOD DISORDERS. ELEVEN PATIENTS RECEIVING STANDARD TREATMENT WERE RECRUITED TO COMPLETE A 9-WEEK MINDFUL YOGA INTERVENTION. QUALITATIVE METHODS WERE USED TO ASSESS PATIENTS' EXPERIENCES OF THE INTERVENTION AND QUANTITATIVE METHODS WERE USED TO ASSESS PSYCHOLOGICAL DISTRESS AND MECHANISMS THAT PLAY A ROLE IN CHRONIC MOOD DISORDERS. EIGHT PATIENTS COMPLETED THE INTERVENTION AND RATED THE OVERALL QUALITY OF THE INTERVENTION WITH A MEAN SCORE OF 8.8 (RANGE OF 8 TO 9, USING A SCALE OF 1 TO 10). ALL PARTICIPANTS REPORTED A REDUCTION IN PSYCHOLOGICAL DISTRESS AND NO ADVERSE EVENTS. AMONG THE MECHANISMS THAT PLAY A ROLE IN CHRONIC MOOD DISORDERS, THE MOST POTENTIALLY PROMISING EFFECTS FROM THE INTERVENTION WERE FOUND FOR WORRY, FEAR OF DEPRESSION AND ANXIETY, RUMINATION, AND AREAS RELATED TO BODY AWARENESS, SUCH AS TRUSTING BODILY EXPERIENCES AND NOT DISTRACTING FROM SENSATIONS OF DISCOMFORT. A 9-WEEK MINDFUL YOGA INTERVENTION APPEARS TO BE A FEASIBLE AND ATTRACTIVE TREATMENT WHEN ADDED TO TREATMENT AS USUAL FOR A GROUP OF PATIENTS WITH CHRONIC MOOD DISORDERS. A RANDOMIZED CONTROLLED TRIAL TO STUDY THE EFFECTS OF MINDFUL YOGA IS RECOMMENDED. 2021