Contents lists available at ScienceDirect Complementary Therapies in Medicine journal homepage: www.elsevier.com/locate/ctim Mindfulness and avoidance mediate the relationship between yoga practice and anxiety Marina Boni a , Robert Schütze a,b, ⁎ , Robert T. Kane a , Katherine L. Morgan-Lowes a , Jean Byrne c , Sarah J. Egan a a School of Psychology, Curtin University, Perth, Australia b School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia c School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia ARTICLE INFO Keywords: Yoga Mindfulness Anxiety Transdiagnostic Avoidance Mediation ABSTRACT Objectives: There is accumulating evidence that yoga and mindfulness meditation can alleviate symptoms of anxiety, although the mechanisms by which this occurs remain unclear. The purpose of this study was to ex- amine the relationship between yoga practice and self-reported anxiety as well as the potential mediating roles of mindfulness and emotional avoidance. Methods: Using a cross-sectional design, 367 participants were recruited online and completed measures of anxiety, avoidance, and mindfulness. Results: Results showed that length of yoga practice was significantly correlated with lower anxiety in yoga practitioners. Avoidance and mindfulness mediated the relationship between length of yoga practice and an- xiety, shedding light on possible mechanisms by which these practices reduce anxiety. Conclusions: Future experimental and longitudinal research is needed to examine the causal role of mindfulness and avoidance in the relationship between yoga practice and anxiety, and whether yoga is a useful adjunct to cognitive behaviour therapy for anxiety disorders. 1. Introduction Yoga is a heterogenous group of mind-body practices that have been used to reduce human suffering for millennia, with origins in Indian philosophy and culture. 1 Historically, the goal of yoga was to ‘yoke’ or unify mind, body and spirit through various mental, physical and ethical practices. 2 However, in contemporary settings, particularly in developed countries, yoga is a largely secular practice mainly com- prised of physical postures (asana), breathing exercises (pranayama) and meditation techniques (dyana) aimed at fostering physical and mental health. 3,4 Similarly, contemporary mindfulness meditation in- terventions such as Mindfulness-Based Stress Reduction (MBSR; 5 ) are secularised adaptations of Buddhist teachings, 6,7 which themselves emerged within a yogic context. 2 In modern health research settings, there is accumulating evidence supporting the benefits of yoga and mindfulness meditation for im- proving psychological functioning. 8–10 For yoga, the strongest evidence exists for its use in treating depression 11,12 ; however there is increasing evidence of its efficacy in reducing anxiety. 13,14 For example, re- searchers studied the effects of a two-month yoga intervention in 34 healthy women and found a significant reduction in anxiety compared to wait-list control. 15 Similarly, a 6-week yoga intervention resulted in significant decreases in anxiety compared to a relaxation control group. 16 The anxiolytic effect of yoga has been observed in various groups including college students, 17 musicians, 18 and breast cancer patients. 19 However, despite evidence for the efficacy of yoga in re- ducing anxiety, systematic reviews suggest there are several methodo- logical limitations in this area, including a paucity of evidence about mechanisms of change in these typically heterogeneous interven- tions. 20–23 One potential explanation for how yoga and mindfulness meditation reduce anxiety is that these interventions reduce avoidance of negative affect. 22,24 Avoidance of negative affect has been proposed as a central ‘transdiagnostic’ maintaining mechanism across anxiety and mood disorders. 25,26 Treatments that are applicable across all anxiety dis- orders – known as ‘transdiagnostic’ approaches – aim to combat emo- tional and behavioural avoidance, in part with a sustained present-fo- cused awareness and acceptance of negative emotions. 25,27,28 The concept of acceptance is central to third-wave cognitive behavioural therapies, such as Acceptance and Commitment Therapy (ACT 29 ;) and https://doi.org/10.1016/j.ctim.2018.08.002 Received 24 June 2018; Received in revised form 7 August 2018; Accepted 7 August 2018 ⁎ Corresponding author at: School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6847, Australia. E-mail address: r.schutze@curtin.edu.au (R. Schütze). Complementary Therapies in Medicine 40 (2018) 89–94 Available online 08 August 2018 0965-2299/ © 2018 Elsevier Ltd. All rights reserved. T