Combining Yoga with Acceptance and Commitment Therapy for Mental Well Being and Psychological Flexibility

The college-age population is increasingly suffering from psychiatric and behavioral issues. In the United States alone, up to 25% of students have been diagnosed with or treated for some type of mental illness.1 Further, an estimated 37% of college students suffer from clinically significant levels of depression that can inhibit daily function. Although treatment for these issues has traditionally been made available for little to no cost in the college setting, many factors contribute to low enrollment and retention rates in these programs. Many students may not want to use college counseling services due to time restrictions, low quality of treatment, or anxiety about sharing their experiences. This article summarizes the findings of a 2021 study in the Journal of Contextual Behavioral Science which investigated the efficacy of a curriculum-based yoga intervention for college students struggling with mental illness. 

yoga, act

Why don’t existing options work?

The most common resources for college students struggling with mental illness are on-campus counseling programs. One of the most significant problems with these programs is the volume of students that need their help. According to a global study including over 570 school counseling centers, the wait time for an appointment ranges between 6 and 18 days.2 This wait time reduces the likelihood that students in need of services will seek treatment, and has been shown to negatively impact the quality of treatment by necessitating time-limited treatment plans.3

Other outreach-based programs exist that aim to provide group-based therapy for college students. These programs often have better funding than on-campus resources, although they suffer from similar time-related issues. Often, programs like this consist of short-term psychoeducation workshops or presentations to first-year students in an effort to teach students coping strategies and study skills. However, these programs are typically held in addition to normal class time meaning students have to make extra time in their already busy schedules to attend. Additionally, many students prefer not to share their experiences in a group setting due to embarrassment, lack of relationships with students and healthcare workers, or stigma related to mental illness.4,5 

yoga, act

What’s different about curriculum-based interventions?

One way to solve many of the problems with typical treatment options is to build interventions into scheduled class time. This structure can help remove some of the stigma surrounding mental illness as well as make it easier for students to attend. Curriculum-based interventions have been shown to have high rates of receptivity among students, in addition to higher rates of usefulness.6 Still, many students prefer to have one-on-one or small group sessions as opposed to sharing and working in a larger setting. Mindfulness is often a key component of curriculum-based interventions and helps alleviate this issue. The focus of mindfulness practice is to bring nonjudgmental attention to the present moment to better understand how actions and reactions to different circumstances affect mood and behavior. Some of the key outcomes of mindfulness interventions are increased mental flexibility and coping skills.  

Yoga-based interventions have similar goals as mindfulness-based interventions, although there is a greater focus on movement and attention to the body. Research suggests that yoga is effective for improving mood and depression symptoms as well as for reducing stress-related biomarkers.7,8,9 Yoga is also effective when combined with existing evidence-based treatment options including acceptance and commitment therapy (ACT). One of these combined intervention programs demonstrated that yoga and ACT significantly decreased testing anxiety when compared to a control group that received typical mental health resources.10 

yoga, act

How effective are curriculum-based yoga interventions for college students?

The main goals of the present study were to increase undergraduate students’ psychological flexibility and decrease psychological distress. To accomplish this, the researchers created a curriculum-based yoga and ACT intervention and compared the results with an ACT-only group and a teaching-as-normal group. The impact of each of the three interventions was assessed in two major categories:

Psychological Flexibility

The Acceptance and Action Questionnaire (AAQ-II) was used to determine students’ psychological flexibility pre- and post- intervention as well as at a follow-up session. Higher scores on the Questionnaire indicate lower psychological flexibility, whereas lower scores indicate increased flexibility. Interestingly,  AAQ-II scores increased from pre- to post- intervention among the students in the ACT and yoga intervention whereas scores decreased in both other groups. Scores decreased significantly between the post-intervention screening and follow-up for students in the combined intervention group, and mildly in the other two groups. 

Psychological Distress 

Psychological distress was measured using the Depression, Anxiety, and Stress Scale (DASS-21). When controlled for age and gender, there was no significant difference between the scores in any category of the test across all three interventions. 

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These results confirmed the hypothesis that a combined ACT and yoga curriculum-based intervention would have a positive impact on students’ mental flexibility. Results for the yoga group were comparable to those of the ACT-only group at follow-up even considering the large spike in mental inflexibility noted in the yoga group post-intervention. This suggests that yoga-based interventions may have the capacity to promote greater change than ACT-only or teaching-as-normal options. Moreover, receptivity scores were high among students in the yoga group with a mean score of 4.09 out of 5. These results prove that students are interested in learning more about alternatives to typical campus mental health resources. Overall, the study makes it clear that both students and researchers have a good reason to start investigating the benefits of adding movement activities to existing psychopathology treatments.


  1. American College Health Association. (2015). American college health association-national college health assessment II: Reference group data report 2015. Hanover, MD. 
  2. Reetz, D., Krylowicz, B., Bershad, C., Lawrence, J., & Mistler, B. (2016). Directors Annual survey (pp. 1–79). The Association for University and College Counseling Center [Review of The Association for University and College Counseling Center Directors Annual Survey]
  3. Ghetie, D. (2007). The debate over time-limited treatment in college counseling centers. Journal of College Student Psychotherapy, 22(1), 41.
  4. Booth, M. L., Bernard, D., Quine, S., Kang, M. S., Usherwood, T., Alperstein, G., & Bennett, D. L. (2004). Access to health care among Australian adolescents young people’s perspectives and their sociodemographic distribution. Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 34 (1), 97–103.
  5. Rayan, A., & Fawaz, M. (2017). Cultural misconceptions and public stigma against mental illness among Lebanese university students. Perspectives in Psychiatric Care, 54 (2), 258–265.
  6. Stallman, H. M. (2011). Embedding resilience within the tertiary curriculum: A feasibility study. Higher Education Research and Development, 30 (2), 121–133.
  7. Skowronek, I. B., Mounsey, A., & Handler, L. (2014). Clinical inquiry: Can yoga reduce symptoms of anxiety and depression? Journal of Family Practice, 63, 398–407.
  8. Streeter, C. C., Whitfield, T. H., Owen, L., Rein, T., Karri, S. K., Yakhkind, A., & Jensen, J. E. (2010). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: A randomized controlled MRS study. Journal of Alternative & Complementary Medicine, 16, 1145–1152.
  9. Pascoe, M. C., & Bauer, I. E. (2015). A systematic review of randomised control trials on the effects of yoga on stress measures and mood. Journal of Psychiatric Research, 68, 270–282.
  10. Nemati, A. (2013). The effect of pranayama on test anxiety and test performance. International Journal of Yoga, 6 (1), 55–60.

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