Practice and proficiency of Isha Yoga for better mental health outcomes: insights from a COVID-19 survey

The study addresses the urgent need for interventions to mitigate heightened mental health problems observed during COVID-19, including increased anxiety, depression, and stress. Well-being encompasses hedonic and eudaimonic components and is integral to health. Mind and Body practices (MBPs), including Yoga and meditation, have demonstrated efficacy in reducing stress and improving well-being. Isha Yoga is a comprehensive tradition integrating multiple yogic paths. Prior studies on Isha practices suggest benefits for stress reduction, well-being, autonomic regulation, attention, neuroendocrine and immunologic markers. However, many pandemic-era surveys had small samples and few involved Indian populations. The authors hypothesized that Isha Yoga practice would be associated with lower perceived stress and mental distress and higher well-being and affect balance, and that practitioner expertise and proficiency would influence outcomes.

The introduction reviews substantial evidence that MBPs (e.g., mindfulness, Heartfulness, Raja Yoga, Transcendental Meditation) reduce stress and enhance well-being, including RCTs. Prior Isha Yoga studies reported reduced stress, anxiety, and depression; improved well-being; autonomic balance; attention improvements; elevated BDNF and cortisol awakening response; increased anandamide; enhanced antiviral gene expression; and increased EEG gamma during meditation. Pandemic-era surveys among Isha practitioners suggested lower negative and higher positive mental health outcomes but were limited by small samples and lack of Indian cohorts. This gap motivates the present large cross-sectional survey in Karnataka, India.

Design: Cross-sectional online survey (Google Forms) conducted in Karnataka, India, from August to October 2021. Target population: Isha Yoga practitioners in Karnataka. Sampling and recruitment: Address-based email sampling via Isha Foundation’s Karnataka database (40,682 contacts). Email campaigns in August and October 2021 yielded 15,588 unique opens, 1,890 unique clicks, and 1,352 responses (participation rate 71.53%). Practitioners were asked to nominate friends/family; convenience and snowball sampling yielded 221 responses, from which non-practitioners of any Yoga/meditation were identified to form the control group (n=110). CHERRIES guidelines were followed. Inclusion criteria: Isha Yoga practitioners—practice only Isha Yoga, age ≥18, English literacy, Karnataka resident; Controls—no current Yoga/meditation, age ≥18, English literacy, Karnataka resident. Isha Yoga practices described include Shambhavi Mahamudra Kriya (taught after Inner Engineering), Shoonya, and Samyama. Measures: Four validated questionnaires—Perceived Stress Scale (PSS-10; 0–40; higher=more stress; Cronbach’s α=0.86), PHQ-4 for anxiety/depression (0–12 total; α=0.80), SPANE (SPANE-P, SPANE-N, SPANE-B; −24 to +24 balance; α=0.92), WHO-5 Well-Being Index (0–100%; α=0.90). Additional items covered sleep, physical activity, diet, medical history, COVID-19 impact. Practice profiling: For Isha practitioners, daily practices, frequency/duration, lifetime hours, and self-rated proficiency were captured. Expertise groups (novice, intermediate, advanced) were defined in consultation with Isha experts. Regularity groups: Regular (≥5 times/week; n=1,097), Moderately regular (3–4 times/week; n=139), Irregular (<3 times/week; n=108). Lifetime hours categories spanned <100 to >10,000 hours. Statistical analysis: Conducted in RStudio. Descriptive statistics reported. Welch’s one-way ANOVA for between-group comparisons; Games–Howell post hoc tests; Holm’s correction for multiple comparisons. Effect sizes included Hedges g, omega squared, and Cramer’s V with 95% CIs. Chi-squared tests for categorical variables (sleep, diet, physical activity). Significance at p<0.05, APA reporting standards followed.

- Compared with controls (n=110), Isha Yoga practitioners showed: • Lower perceived stress: PSS mean 13.61 (low stress) vs 19.52 (moderate stress), p<0.001, Hedges g=0.94 (large). • Lower mental distress (PHQ-4): 1.85 (normal) vs 3.88 (moderate), p<0.001, Hedges g=0.75 (medium). • Higher well-being (WHO-5): 71.43 vs 57.16, p<0.001, Hedges g≈0.78 (medium). • Higher affect balance (SPANE-B): 11.65 vs 5.36, p<0.001, Hedges g≈0.80 (large). - Expertise: Significant differences across novice, intermediate, and advanced Isha practitioners vs controls on all scales; advanced showed the largest improvements; effect sizes large. - Regularity: Significant overall differences across control, irregular (<3/week), moderately regular (3–4/week), and regular (≥5/week) groups. Irregular practitioners did not differ significantly from controls; practicing at least 3–4 days/week showed significant benefits vs controls; no significant differences between moderately regular and regular groups. - Dose-response (lifetime hours): Most improvement occurred within the first 100 hours; scores tended to plateau from 500 to 3,000 hours, with further improvements beyond 3,000 hours. Similar trends by years of practice and daily practice time; even <30 minutes/day associated with benefits vs no practice. - Healthcare workers (HCWs): Among HCWs, Yoga practitioners showed significantly better perceived stress, mental distress, well-being, and affect balance than HCWs not practicing Yoga; effect sizes medium (mental distress, well-being) to large (perceived stress, balance). - Sleep, diet, physical activity: Significant group differences in sleep quality and quantity but with very small effect sizes; Isha practitioners more likely to follow a predominantly vegetarian diet; no significant differences in physical activity levels.

The findings support the hypothesis that Isha Yoga practice is associated with lower negative mental health outcomes (stress, mental distress) and higher positive outcomes (well-being, affect balance), with medium-to-large effect sizes comparable to or exceeding some benchmarks from psychotherapy meta-analyses. Benefits scale with practitioner expertise and depend on practice regularity, suggesting a dose-response effect where at least 3–4 sessions per week are associated with improvements; the largest gains often occur within the first 100 lifetime hours. Among HCWs—an especially stressed population—Yoga practice was associated with better outcomes, indicating broader applicability. Proposed mechanisms include top-down processes (reduced mind-wandering and DMN activity, enhanced attention and salience network engagement, altered functional/anatomical brain markers) and bottom-up processes (improved autonomic balance, HPA/SAM axis modulation, reduced inflammation). Sleep and diet differences may contribute but likely explain only a small portion of effects given very small sleep effect sizes and mixed literature on vegetarian diets. Results reinforce MBPs as complementary strategies to enhance mental health and resilience during crises.

Isha Yoga practice was significantly associated with lower perceived stress and mental distress and higher well-being and affect balance during the COVID-19 pandemic, including among healthcare workers. Benefits increased with practitioner expertise and regularity, with meaningful improvements seen with at least 3–4 days/week and within the first 100 hours of practice; irregular practice (<3/week) resembled controls. While supportive, causal inference requires longitudinal and randomized controlled trials with active comparators and objective measures. Future research should address self-selection, language/regional bias, and incorporate diverse populations and objective outcomes. Isha Yoga and similar MBPs should be considered complementary to standard care, with implementation strategies (community engagement, technology-enabled access, tailored programs) to enhance adherence and public health integration.

- Cross-sectional design prevents causal inference. - Volunteer/self-selection bias; control group recruited via convenience/snowball methods. - English-only inclusion may introduce language/regional bias, limiting generalizability. - Reliance on self-reported measures introduces potential recall/reporting bias; lack of objective assessments due to pandemic constraints. - Online survey limitations (non-representativeness, non-response bias) despite adherence to CHERRIES guidelines.