Ann. N.Y. Acad. Sci. ISSN 0077-8923 ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Issue: Advances in Meditation Research Yoga in school settings: a research review Sat Bir S. Khalsa1,2 and Bethany Butzer2 1Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. 2Kripalu Center for Yoga & Health, Stockbridge, Massachusetts Address for correspondence: Sat Bir S. Khalsa, Ph.D., Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, 900 Commonwealth Ave., Brookline, MA 02215. [email protected] Research on the efficacy of yoga for improving mental, emotional, physical, and behavioral health characteristics in school settings is a recent but growing field of inquiry. This systematic review of research on school-based yoga interventions published in peer-reviewed journals offers a bibliometric analysis that identified 47 publications. The studies from these publications have been conducted primarily in the United States (n = 30) and India (n = 15) since 2005, with the majority of studies (n = 41) conducted from 2010 onward. About half of the publications were of studies at elementary schools; most (85%) were conducted within the school curriculum, and most (62%) also implemented a formal school-based yoga program. There was a high degree of variability in yoga intervention characteristics, including overall duration, and the number and duration of sessions. Most of these published research trials are preliminary in nature, with numerous study design limitations, including limited sample sizes (median = 74; range = 20–660) and relatively weak research designs (57% randomized controlled trials, 19% uncontrolled trials), as would be expected in an infant research field. Nevertheless, these publications suggest that yoga in the school setting is a viable and potentially efficacious strategy for improving child and adolescent health and therefore worthy of continued research. Keywords: yoga; meditation; schools; education; mind–body; prevention Introduction education of the whole child in school (i.e., men- tal, emotional, and physical health skills, in addi- Adolescents and children in the United States are tion to academic skills),6 it is clear that this has not confronted with a large number of life stressors occurred. There is now growing evidence that both from both family and school environments,1 many academic and cognitive achievements are affected of which are known risk factors for the develop- by, and dependent on, student health.7 However, ment of mood and other psychological disorders.2 the education system is under ongoing and continu- A survey study on the prevalence of psychiatric con- ous pressure to remain focused on student academic ditions in adolescents reported that indicators of performance, with few resources and efforts devoted stress were the most consistent predictors of the to instruction in SEL skills. As a consequence, ado- incidence of psychiatric disorders.3 Arecentlon- lescents complete their K–12 education with the gitudinal survey following children from ages 9 to training sufficient for securing employment in the 21 found that the cumulative prevalence of psychi- workforce, but lack crucial and preventive SEL skills atric conditions well exceeds 80% and is therefore for maintaining their mental health and well-being.8 virtually universal.4 Another survey in adults has However, the promotion of SEL in U.S. schools indicated that the majority of psychiatric conditions has made significant initial progress with the have childhood/adolescent onsets.5 There is there- activities of the Collaborative for Academic, Social, fore a strong need for children and adolescents to and Emotional Learning (CASEL), whose goal acquire behavioral skills that can improve social– is to address problematic behaviors of children emotional learning (SEL), such as stress manage- and adolescents and their underlying contributing ment and emotional self-regulation. Despite histor- causes, while still supporting academic achievement ical arguments dating back over 100 years for the doi: 10.1111/nyas.13025 Ann. N.Y. Acad. Sci. 1373 (2016) 45–55 C 2016 New York Academy of Sciences. 45 Yoga in school settings Khalsa & Butzer in public schools.9 The recently published CASEL fitness), with their subsequent positive outcomes Guide describes existing evidence-based SEL pro- on student behavior, mental state, health, and per- grams that CASEL has determined are worthy and formance, yield many of the improvements targeted have the potential for broad implementation.10 The by school-based SEL programs. They also likely sat- stated CASEL goal of SEL programs is to enhance isfy the five SEL program goals, while also adding core competencies in the following five areas: additional important life skills and competencies. self-management (emotions, including stress), Although programs consisting only of medita- self-awareness (recognizing emotions and having tion/mindfulness practices provide a key and impor- awareness of their influence on behavior), social tant component of yoga, it could be argued that the awareness (appreciating the perspectives of others), additional physical practices of yoga may enhance relationship skills (establishing and maintaining and facilitate meditation/mindfulness while, at functional relationships), and responsible decision the same time, improving psychophysiological making (making positive choices about behavior functioning.25 The physical postures/exercises, and social interactions).10 There is currently a call breath regulation, and relaxation techniques prac- for such initiatives by many educators, parents, ticed in yoga may be especially relevant in support- and students to provide more in our educational ing contemplative/meditative/mindfulness practice curricula than just academic instruction.8,9,11,12 in youth, who exhibit high levels of psychophysio- Yoga is a holistic system of practices that, in its logical energy and arousal and are not accustomed traditional form, includes multiple techniques, to sitting in the stillness required for formal medi- including physical postures/exercises, breathing tation for long periods of time. In summary, there exercises, deep relaxation techniques, and medi- is a compelling rationale for the implementation of tation/mindfulness practices. Biomedical and psy- yoga in school settings.11,21 chosocial research on the clinical efficacy of yoga for Accordingly, there has been substantial and both adults and children has been growing rapidly growing interest in the development and applica- in recent years, especially over the past 5 years,13 tion of meditation- and yoga-based interventions in and systematic research reviews have suggested that school settings.11,25,26 Hyde27 has described recent yoga is particularly efficacious for reducing stress government initiatives aimed at educating the and enhancing mood and well-being.14,15 The ther- “whole child” and suggests that the implementation apeutic application of yoga has also been shown to of yoga in school settings is an important aspect be viable for children and adolescents in improv- of this movement. A number of organizations ing both physical and mental health.16–20 Three have been founded and are active in supporting particular skills or attributes that yoga enhances these initiatives, including the Garrison Institute, include mind–body awareness, self-regulation, and the Association for Mindfulness in Education, physical fitness, which can subsequently promote the International Association for School Yoga improvements in mental state, health, behavior, and Mindfulness, and the Yoga Service Council, and performance.21 Through the practice of med- which has published a white book delineating the itation and mindfulness, mind–body awareness is best practices for yoga in schools.28 The prevalence increased, which contributes to gravitation toward of meditation- and mindfulness-based interven- positive behaviors and outcomes as a result of an tions in schools has grown substantially, including increasing awareness of the positive feelings associ- programs such as MindUp, the Quiet Time Pro- ated with healthful behaviors. There is now strong gram, and Learning to BREATHE, among many neurobiological evidence for the efficacy of yoga others.25 The implementation of yoga in school set- in improving stress management, resilience, and tings is alsogrowing,29 as shownby ourrecentsurvey self-regulation of internal state, including emotion of formally organized yoga programs in school regulation.22 Finally, several aspects of physical fit- settings, which revealed three dozen such programs ness, including neuromuscular coordination and currently being implemented across North America strength, flexibility, balance, and respiratory func- in over 900 schools, and over 5400 instructors tion, are directly improved following yoga practice trained by these programs to offer yoga in edu- over time.23,24 These three core attributes (mind– cational settings.30 Despite significant variability body awareness, self-regulation, and physical in the characteristics of implementation among 46 Ann. N.Y. Acad. Sci. 1373 (2016) 45–55 C 2016 New York Academy of Sciences. Khalsa & Butzer Yoga in school settings different school yoga programs, including dif- more randomized controlled trials with larger ferences in training requirements, geographical sample sizes, objective physiological measures, regions served, age ranges, and schools, most of longer