Program Profile: Be BOLD Yoga for High-Risk Adolescents

This is a mindfulness-based yoga program intended to reduce substance use (and the subsequent negative effects of use) for adolescents at high risk of dropping out of school. The program is rated Ineffective. There were no statistically significant differences in measures of substance use, self-regulation, mood, mindfulness, or coping skills for youth who participated in the program, compared with the control group youth.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

Be BOLD Yoga was a yoga intervention designed to decrease the emotional, cognitive, and psychophysiological factors known to be precursors to substance use. The name Be BOLD represented key phrases that were emphasized throughout the program: Breathe, Observe, Let it go, and Do it again. The program introduced common yoga practices (breathing, meditation, and movement techniques) into adolescents’ routine to achieve the following goals: 1) reduce substance use, 2) improve cognitive and affective processes that underlie the effects of yoga on substance use (such as mindfulness, mood, and self-regulation); and 3) improve psychophysiological responses to stress found in individual-level traits such as respiratory sinus arrhythmia, heart rate, and skin conductance, which are reflective of self-regulation of behavior and emotion. This intervention targeted high-risk adolescents (ages 14 or older) who were enrolled in a nontraditional, public school specifically for youth at risk for dropping out.

Program Components

The yoga intervention consisted of 20 sessions that took place three times a week for 50 minutes each, across a 7-week timeframe. Each week was structured around a new mindfulness theme, including a focus on breath, stress, observing without judgment, awareness of thoughts and emotions, cultivating positive emotion, and skill integration. Each session followed a strict curriculum. The session began with 5 minutes of an opening meditation, followed by 5 minutes of gentle stretching. Most of the session comprised 30 minutes of yoga postures with mindfulness prompts. The session concluded with 10 minutes of a closing meditation and an affirmation of respect to self and others.

Mindfulness-based concepts were kept simple and repetitive in order to place an emphasis on active learning and skill generation. The curriculum also focused on skills generalization outside of the session by explaining how practices learned through the program can be used in real-life situations such as an argument with a parent. The program suggested ways for the adolescents to observe how their thoughts influence their behavior and how to let them pass.

Key Personnel

Each session was led by an instructor and an assistant instructor. The lead yoga instructor was a previous school social worker, and the assistant instructor was a clinical social worker. Both instructors were registered yoga teachers through Yoga Alliance.

Program Theory

The use of mindful yoga as an intervention for high-risk teens is based upon the affective-behavioral-cognitive-dynamic model of development (Greenberg and Kusche 1996). This model explains that emotional awareness, cognitive control over physiological stress responses, and contextual-cognitive processing form the basis for self-regulation, which is considered one of the key protective factors against substance use. An emphasis is placed on mindfulness, due to the body of research that attests to the positive effects that mindfulness interventions have on an individual’s psychological state of being (Serwacki and Cook-Cottone 2012).

Study

Fishbein and colleagues (2015) conducted a randomized controlled trial to examine whether high-risk adolescents who participated in the Be BOLD Yoga Intervention demonstrated a decrease in substance use and subsequently experienced positive effects with regard to emotional and physical health. The study authors hypothesized that adolescents who participated in the yoga intervention would report a decrease in use of various substances (alcohol, marijuana, illicit drugs), and that these students would experience positive changes in cognitive and affective processes. The authors also theorized that participants in the treatment group would demonstrate improved psychophysiological responses to stress, reflected in heart rate and respiratory sinus arrhythmia.

This study took place in a mid-sized city at a nontraditional public school, which was for students who were at high risk of dropping out. These students had mostly been failing in traditional schools; were 1 to 2 years behind in credits; and struggled with absenteeism, academic issues, and personal/family problems. To be eligible for the study, adolescents had to be students at this school and older than 14. Their fitness level also had to be assessed. Students were not permitted to participate in the study if they had any health conditions that could increase the risk of side effects from the yoga intervention such as dizziness, heart trouble, or breathlessness. Students were also excluded from participating if their blood pressure exceeded 140/90 at rest.

The initial sample comprised 104 students, but 19 students dropped out of the study following the pretest. The final sample at posttest comprised 85 students. These 85 participants were randomly assigned to either the treatment group (n = 45), which received the yoga intervention, or the control group (n = 40), which carried on with care as usual and went to their regularly scheduled classes. There were three different cohorts of students recruited: one was from the middle school program from within the school, and two were from the high school program. This study took place across the following three periods: 1) fall of 2010, 2) spring of 2011, and 3) fall of 2011. Participant ages ranged from 14 to 20 years old (the average age was 16.7 years), and there were slightly more females in the sample (54 percent). In terms of race/ethnicity, 59 percent of the participants were African American, 17 percent were Hispanic, 9 percent were white, and 14 percent were multiracial.

The posttest was conducted after 20 sessions of the program had been completed. A variety of measures were used pre- and posttest to determine the effectiveness of the intervention. The Drug Use Screening Inventory–Revised (DUSI–R) was used to assess the extent of substance use, including marijuana, alcohol, and illicit drug use. The Abbreviated Dysregulation Inventory (ADI), a 31-item scale, was used to measure emotional, behavioral, and cognitive ability. The Brunel Mood Scale, a 24-item scale, was also used to assess negative moods across six different levels: 1) anger, 2) confusion, 3) depression, 4) fatigue, 5) tension, and 6) vigor. To measure coping skills, the researchers used the Response to Stress Questionnaire (RSQ), a 57-item measure that looks at both voluntary and involuntary coping skills. For this study, the researchers used the involuntary coping scale, which concentrates on responses such as disengagement, rumination, and emotional numbing. They also used the Five Facet Mindfulness Questionnaire (FFMQ), a 39-item scale that measures mindfulness across five dimensions: 1) observing, 2) describing, 3) acting with awareness, 4) non-judging of inner experience, and 5) non-reactivity. Finally, they used the Behavior Assessment Scale for Children (BASC-2) to measure externalizing behaviors and social competency. Teachers in the school rated each student pretest and posttest on this 46-item scale.

To determine the effectiveness of the yoga intervention, a multilevel model, equivalent to a two-time-point longitudinal growth model, was used. The principal estimate of the effect was the group (treatment versus control) by time (pretest to posttest). The models controlled for age, and age and gender were included as covariates. The study authors did not conduct subgroup analyses.

This Be BOLD Yoga Intervention curriculum was developed by a team with experience in yoga practice, developmental and clinical psychology, prevention of adolescent substance abuse and violence, curriculum development for preventative interventions, and mindfulness. The yoga instructors who took part in the Be BOLD Yoga Intervention were both registered yoga teachers through the Yoga Alliance (Fishbein et al. 2015).

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Greenberg, M.T., and C.A. Kusche. 1996. The PATHS Project: Preventative Intervention for Children. National Institute of Mental Health, and Pennsylvania State University, College of Health and Human Development, Prevention Research Center for the Promotion of Human Development.

Miller, Shari, Mindy Herman-Stahl, Diana Fishbein, Bud Lavery, Michelle Johnson, and Lara Markovits. 2014. “Use of Formative Research to Develop a Yoga Curriculum for High-Risk Youth: Implementation Considerations.” Advances in School Mental Health Promotion 7(3):171–83.

Segal, Z.V., J.M.G. Williams, and J.D. Teasdale. 2002. Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York, N.Y.: Guilford.

Serwacki, Michelle L., and Catherine Cook-Cottone. 2012. “Yoga in Schools: A Systematic Review of the Literature.” International Journal of Yoga Therapy 22(1):101–10.