The Effect of Mindfulness-Based Yoga on Psychological Well-Being and Happiness in Individuals with Schizophrenia: A Randomized Controlled Trial

Abstract

Objective:

To evaluate the effect of a mindfulness-based yoga program on psychological well-being and happiness in individuals diagnosed with schizophrenia.

Methods:

This randomized controlled trial was conducted between February and August 2024 in two Community Mental Health Centers (CMHCs) located in Malatya, Türkiye. Ninety-six individuals diagnosed with schizophrenia were randomly assigned in a 1:1 ratio to either a mindfulness-based yoga group (n = 48) or a control group (n = 48). The intervention group participated in a 6-week mindfulness-based yoga program consisting of 12 sessions, while the control group received routine CMHC care only. Outcome measures included the Psychological Well-Being Scale (PWB) and the Oxford Happiness Questionnaire Short Form (OHQ-SF). Three participants in the intervention group withdrew consent during follow-up, and two participants in the control group were lost to follow-up. The final analyses included 45 participants in the mindfulness-based yoga group and 46 participants in the control group.

Results:

No statistically significant differences were observed between the groups at baseline (p > 0.05). Following the intervention, participants in the mindfulness-based yoga group demonstrated significantly higher psychological well-being scores (36.50 ± 4.57 vs. 12.86 ± 3.69, p < 0.001) and happiness scores (21.44 ± 3.55 vs. 10.58 ± 5.64, p < 0.001) compared with the control group. Within-group analyses also showed significant improvements in psychological well-being and happiness in the intervention group (p < 0.001), whereas no significant changes were observed in the control group. No intervention-related adverse events or safety concerns were reported during the study period.

Conclusions:

Mindfulness-based yoga appears to be a promising complementary intervention for improving psychological well-being and happiness among individuals with schizophrenia. Further multicenter randomized controlled trials with larger samples and longer follow-up periods are needed to confirm these findings.

Keywords

mindfulness yoga schizophrenia psychological well-being happiness psychiatric nursing

Introduction

Schizophrenia is a chronic and severe mental disorder characterized by profound disturbances in thought, perception, emotion, and behavior.¹ After realizing that only pharmacological treatment is insufficient in the treatment of the disease, the effectiveness of many psychosocial interventions has been studied.² One of the integrative interventions increasingly used for this purpose is mindfulness-based yoga.³

Mindful yoga refers to an initiative that combines mindfulness-based stress reduction programs (MBSR) with yoga practices.^4,5 The studies conducted with different populations have indicated the psychological benefits of mindful yoga.^4,6–9 A limited number of studies on the use of mindful yoga in schizophrenia has been found.¹⁰ However, its use in mental problems such as depression and anxiety has been found to be beneficial.^11–13

When mindfulness interventions are supported with traditional yoga, the potential benefits of the approaches converge. Studies on mindful yoga in patients with depression have indicated that mindful yoga is an effective method for alleviating depressive symptoms and preventing relapses, along with improving physical health and enhancing emotional and physical self-control.^12,14 Also, since both MBSR and yoga are therapies that include meditation, physical exercise, and spiritual teachings, they contribute to physical, psychological, and spiritual well-being.¹⁵ In the study by Lee, it was found that the psychological well-being of elderly depressive patients increased with the mindful yoga program.¹² Hylander applied mindful yoga on patients with high-stress levels and stated that their stress and anxiety alleviated and their well-being increased.¹⁴ A study by Kwok revealed that mindful yoga improved well-being in Parkinson’s patients with anxiety and depression.⁷

Psychological well-being is a sensation that can be described as the state of being at one’s best spiritually. In this sense, it stands very close to happiness.¹⁶ Since MBSR and yoga are interventions that relieve anxiety, they are effective interventions in reducing negative affect and thus boosting positive affect in schizophrenia.^15,17 The study by Sistig on psychosis patients indicated that mindful yoga relieved stress and promoted calmness and happiness.¹⁰ In his study with acute mental patients, Lavey indicated that mindful yoga reduced negative affect.¹⁸

As the transition from hospital-based care to community-based care has gained momentum in psychiatric nursing, the significance of psychosocial therapies in schizophrenia has become much stronger. Mindful yoga is a novel intervention that combines cognitive therapies. We believe that its practice in schizophrenia would be beneficial for psychiatric nursing and schizophrenia treatment.

This study aimed to evaluate the effects of mindfulness-based yoga on psychological well-being and happiness among individuals diagnosed with schizophrenia.

Research hypotheses

H1.

Mindfulness-based yoga improves psychological well-being in individuals diagnosed with schizophrenia.

H2.

Mindfulness-based yoga elevates the level of happiness in individuals diagnosed with schizophrenia.

Methods

Study design

The study was a randomized controlled trial conducted between February 2024 and August 2024 among individuals diagnosed with schizophrenia. The study was carried out at two Community Mental Health Centers (CMHCs), namely the Battalgazi Community Mental Health Center and the Yeşilyurt Community Mental Health Center, located in Malatya, Türkiye. The CMHCs included facilities such as reading rooms, kitchens, gyms, training halls, recreational areas, television lounges, and dining rooms. Each CMHC was staffed by a multidisciplinary team consisting of one psychiatrist, one psychologist, three nurses, one secretary, and two support personnel. These CMHCs provide rehabilitation services, psychosocial support, skills training, and community reintegration programs for individuals with severe mental disorders. In addition, patients receive regular psychiatric follow-up and treatment monitoring. Individuals who are unable or unwilling to attend the centers are followed through home visits conducted by the multidisciplinary mental health team. All participants were registered at the participating CMHCs and were receiving regular psychiatric follow-up and antipsychotic treatment. Participants were in remission and clinically stable at the time of enrollment. Both the intervention and control groups continued their routine psychiatric treatment throughout the study period, including typical and/or atypical antipsychotic medications, and no medication changes were introduced as part of the study protocol.

Population and sample selection of the study

The population of the study consisted of 200 individuals diagnosed with schizophrenia who were registered at two CMHCs in the same province. A priori power analysis indicated that at least 40 participants per group were required to achieve 80% statistical power at a 5% significance level. Considering possible attrition, 96 participants were recruited and randomly assigned in a 1:1 ratio to either the mindfulness-based yoga group (n = 48) or the control group (n = 48).

A computer-generated randomization sequence was created using the Random Integer Generator available at Random.org by an independent researcher who was not involved in participant recruitment, intervention delivery, or outcome assessment. Block randomization was used to ensure balanced group allocation throughout the study. Participants were assigned to the intervention or control group according to the randomization sequence.

Due to the nature of the intervention, participants and intervention providers could not be blinded to group allocation. However, data were coded prior to statistical analysis to reduce potential assessment bias.

During follow-up, three participants in the mindfulness-based yoga group withdrew consent and did not complete postintervention assessments. In the control group, two participants were lost to follow-up. Consequently, the final analyses included 45 participants in the mindfulness-based yoga group and 46 participants in the control group. The participant flow is presented in the CONSORT flow diagram (Fig. 1).

Inclusion criteria

•

Being diagnosed with schizophrenia according to DSM-V

•

Being between the ages of 18 and 65

•

Being registered and actively followed at one of the participating CMHCs

•

Receiving regular antipsychotic treatment prescribed by a psychiatrist

•

Being in remission and clinically stable at the time of enrollment

•

Being able to communicate verbally and provide informed consent

Exclusion criteria

•

Being in an acute exacerbation phase of schizophrenia

•

Having experienced a psychiatric hospitalization or major change in antipsychotic medication during the previous 3 months

•

Having participated in a mindfulness-based yoga program within the previous 6 months

•

Having a diagnosis of dementia, delirium, intellectual disability, traumatic brain injury, or another neurological disorder that could interfere with participation

•

Having an active substance use disorder

•

Having a physical condition that would prevent safe participation in yoga exercises

Withdrawal criteria

Participants were withdrawn from the study if they: •

Voluntarily chose to withdraw their consent to participate at any stage of the study;

•

Became unable to complete the intervention or outcome assessments;

•

Experienced a psychiatric relapse, acute exacerbation of symptoms, or hospitalization during the study period;

•

Required a substantial change in antipsychotic medication or treatment plan as determined by their treating psychiatrist;

•

Missed more than 20% of the mindfulness-based yoga sessions;

•

Developed a medical or physical condition that prevented safe participation in the intervention.

Participants who met any of these criteria were excluded from further participation and follow-up assessments.

Blinding

Due to the nature of the mindfulness-based yoga intervention, blinding of participants and intervention providers was not feasible. Participants were aware of their group assignments, and the researchers delivering the intervention also knew the allocation status. However, standardized outcome measures were used for all participants, and statistical analyses were conducted using coded datasets to minimize potential assessment bias.

Harms

Participants were monitored throughout the intervention period for any adverse events potentially associated with mindfulness-based yoga, including physical discomfort, falls, dizziness, worsening psychiatric symptoms, or hospitalization. Any adverse events reported by participants were documented and reviewed by the research team.

Data collection tools

Descriptive characteristics form

The form consisted of a total of eight questions about the sociodemographic characteristics of the patients (age, gender, marital status, education level, duration of illness, income status, and family history of mental illness).

Psychological well-being scale

Psychological well-being is a concept that incorporates significant elements ranging from positive relationships that foster human well-being to having a purposeful life. Diener developed the scale in 2009 and Telef conducted its Turkish validity and reliability study in 2013.^19,20 The Cronbach’s α coefficient of the scale was found to be 0.87. In this study, the Cronbach’s α coefficient of the scale was found to be .92. It is a seven-point Likert scale with eight items. Total score of the scale varies between 8 and 56. A high score indicates that the person has many psychological resources and power.²⁰

The Oxford happiness questionnaire short form

The Oxford Happiness Questionnaire Short Form was developed by (21) based on the Oxford Happiness Questionnaire, which originally consisted of 29 items.²¹ (22) adapted the scale into Turkish, which is utilized to determine the happiness level of individuals. The scale has 8 items and the 4th item in the Turkish adaptation was omitted due to the low correlation value, 38, in the item analysis. The total number of items in the scale was determined as 7. While the original version of the scale was designed as a 6-point Likert-type scale, it was deemed appropriate to be prepared as a 5-point Likert type scale in order to avoid problems with its Turkish translation. The responses on the scale are rated as (1) strongly disagree, (2) disagree, (3) somewhat agree, (4) agree, and (5) somewhat agree. As the score on the scale increases, so does the level of happiness. The reliability of the scale was found to be .74 for internal consistency coefficient and .85 for test-retest reliability. Items 1 and 7 of the scale are coded in reverse.²² In this study, the Cronbach’s αa coefficient of the scale was determined as 0.91.

Implementation of data collection tools

Data were collected by the principal researcher through face-to-face interviews conducted in private interview rooms at the participating CMHCs. In the study, the pre-test forms for the experimental and control groups were applied in February 2024 and the post-test forms were filled out in August 2024. The data collection tools were filled out by the researcher based on the responses taken after reading them to the individuals diagnosed with schizophrenia. It took approximately 20 min to complete the forms. During the study, measures of mask and social distancing were followed as part of the COVID-19 pandemic. The mindful yoga program was delivered to the experimental group in the garden of the CMHC within the scope of COVID-19 measures.

Research process

The researchers delivering the mindfulness-based yoga intervention completed certified training programs in “Mindfulness and Its Use in the Therapeutic Process” and “Use of Simple Yoga Techniques.”

The individuals diagnosed with schizophrenia in the sample were informed about mindful yoga at CMHC. After the experimental and control groups were designated, pre-tests (Descriptive Characteristics Form, PWB, OHQ-SF) were run on both groups and mindful yoga days were scheduled with the patients in the experimental group. The patients in the experimental group were divided into 4 groups of 10–11 people. The yoga program consisted of 12 sessions twice a week. Each session lasted for approximately 45–60 min and was completed as group training in 6 weeks.

No intervention was applied to individuals diagnosed with schizophrenia in the control group. After the pre-test data were collected from the individuals diagnosed with schizophrenia in the control group, these individuals resumed their routine treatment and control follow-up at the CMHC.

Mindfulness-based yoga practice program

The content of the mindful yoga program was prepared by the researchers. No mantra-based meditation techniques were used during the intervention. All mindfulness exercises focused on present-moment awareness of breathing, bodily sensations, thoughts, emotions, and environmental stimuli. Details concerning the mindful yoga program are provided in Table 1.

Table 1.

Mindful Yoga Program

Session 1: Preparation session * Introduction of participants and facilitators * Explanation of group rules and expectations * Overview of mindfulness and yoga concepts * Discussion of program goals and structure	Session 2: Awareness and perspectives * Introduction to mindfulness in daily life * Discussion of the principles of yoga and mindful yoga * Raisin meditation exercise: participants slowly observed, touched, smelled, and tasted a raisin while focusing attention on present-moment sensory experiences
Session 3: Mindfulness of the body * Mindful breathing practice (5–10 min) * Body scan meditation: participants directed attention sequentially to different parts of the body while observing sensations without judgment * Homework: Observing the sky and natural surroundings mindfully	Session 4: Mindful movement * Mindful movement meditation involving slow and gentle body movements synchronized with breathing * Attention focused on bodily sensations during movement * Homework: Mindful observation while waiting for water to boil
Session 5: Mindful breathing and yoga * Diaphragmatic breathing exercises * Slow nasal inhalation and prolonged exhalation * Introduction to basic yoga breathing techniques * Homework: Mindful walking practice.	Session 6: Awareness of thoughts * Sounds and thoughts meditation: participants were instructed to observe environmental sounds and spontaneous thoughts without attempting to change, suppress, or evaluate them * Guided deep relaxation meditation focusing on breath awareness and bodily relaxation * Homework: Mindful participation in a social activity (e.g., cinema attendance)
Session 7: Coping with difficult emotions * Meditation focused on recognizing and accepting difficult emotions * Practice of simple yoga postures (stretching, seated poses, balance exercises) * Homework: Planting and caring for seeds as a mindfulness exercise	Session 8: Connections between thoughts, emotions, and behaviors * Breathing meditation practice * Integration of yoga postures with breathing exercises * Reflection exercises regarding emotions and thoughts * Homework: Thought–emotion awareness activities
Session 9: Enjoying pleasant experiences * “Treasure of Pleasure” meditation focusing on positive daily experiences * Yoga postures combined with mindful breathing * Homework: Writing a compassionate letter to oneself	Session 10: Living in the present moment * Loving-kindness and friendship meditation * Guided relaxation and meditation practices * Homework: performing random acts of kindness mindfully
Session 11: Day of silence * Extended mindfulness movement practice * Body scan meditation * Reduced verbal communication to enhance present-moment awareness	Session 12: Review and closure * Review of mindfulness and yoga skills learned throughout the program * Group discussion of experiences * Feedback collection and program evaluation * Planning for continued practice after program completion

Data assessment

SPSS 26.0 program was used in the assessment and the significance level was accepted as p < 0.05. The demographic and descriptive characteristics were represented in mean and percentage values. Compliance with normal distribution was analyzed by Shapiro–Wilk and Kolmogorov–Smirnov tests, histogram, P-P plot, and Q-Q plot. For the assessment of the data, which were found to be normally distributed as a result of the analyses, the percentage distribution, arithmetic mean, Chi-square test, Standard deviation, Min–max (minimum–maximum values) values, the independent samples t-test (if n < 30 or not normally distributed; Mann–Whitney U), and paired t-test were applied.

Ethical considerations

An ethical committee approval was acquired from the scientific research and publication ethics committee of a university (Approval No: 2018/18-6), and then legal permission was obtained from the institutions where the study would be conducted in accordance with the ethical principles of the Declaration of Helsinki. The patients included in the study were informed about the objective of the study and their questions were responded. The researcher explained to the patients that the information they provided would be kept confidential and would not be used elsewhere and they had the right to withdraw from the study at any time. Before starting the study, the patients and their relatives were informed about the purpose of the study and their verbal and written consents were obtained. The trial has been retrospectively registered at ClinicalTrials.gov. (NCT07497516). The study was retrospectively registered due to administrative reasons. No changes were made to the study protocol, outcomes, or analyses after trial initiation.

Results

Table 2 shows that the intervention and control groups were comparable with respect to all baseline sociodemographic and clinical characteristics (p > 0.05). As shown in Table 3, there were no statistically significant differences between the intervention and control groups in baseline PWB and OHQ-SF scores (p > 0.05). Post-intervention PWB and OHQ-SF scores were significantly higher in the mindfulness-based yoga group than in the control group (Table 4, p < 0.05). Within-group analyses revealed significant improvements in both PWB and OHQ-SF scores in the intervention group, whereas no significant changes were observed in the control group (Table 5).

Table 2.

Descriptive Characteristics of the Control and Experimental Groups

Group	Control group(n = 46)		Experimental group(n = 45)		Test and value
Descriptive characteristics	n	%	n	%	Test and value
Age					χ² = 0.310 p = 0.605
18–28	5	10.9	6	13.3
29–39	21	45.6	20	44.4
40–50	20	43.4	19	42.2
Gender
Male	30	65.2	29	64.4
Female	16	34.8	16	35.5
Marital status
Married	15	32.6	13	28.8	χ² = 1.398 p = 0.134
Single	31	67.3	32	71.1	χ² = 1.398 p = 0.134
Education level
Literate	20	43.4	21	46.6
Primary Education	16	34.7	14	31.1	χ² = 3.605 p = 0.269
Secondary	8	17.3	9	20.0
University	2	4.3	1	2.2
Working status
Yes	5	10.8	7	15.5	χ² = 0.990 p = 0.863
No	41	89.1	38	84.4	χ² = 0.990 p = 0.863
Perception of income level
Low	7	15.2	6	13.3	χ² = 5.157 p = 0.461
Middle	36	78.2	38	84.4
Good	3	6.5	1	2.2
Family history of mental illness
Yes	12	26.0	15	33.3	χ² = 0.409 p = 0.210
No	34	73.9	30	66.6	χ² = 0.409 p = 0.210
Disease duration
0–5 years	4	8.7	5	11.1	χ² = 4.339 p = 0.688
6–11 years	11	23.9	10	22.2	χ² = 4.339 p = 0.688
12 years and over	31	67.3	30	66.6

Table 3.

Pretest Comparison of the Mean PWB and OHQ-SF Scores of the Patients in the Control and Experimental Groups (n = 91)

Pretest
Outcome measure	Experimental group(n = 45)	Control group (n = 46)
Outcome measure	(M ± SD)	(M ± SD)	^aTest and value
PWB	13.58 ± 5.27	12.00 ± 5.30	t = 1.193 p = 0.239
OHQ-SF	10.36 ± 6.68	10.34 ± 4.79	t = 0.110 p = 0.434

Independent samples t test.

OHQ-SF, The Oxford Happiness Questionnaire Short Form; PWB, Psychological Well-Being Scale.

Table 4.

Posttest Comparison of the Mean PWB and OHQ-SF Scores of the Patients in the Control and Experimental Groups (n = 91)

Posttest
Outcome measure	Experimental group(n = 45)	Control group (n = 46)
Outcome measure	(M ± SD)	(M ± SD)	^aTest and value
PWB	36.50 ± 4.57	12.86 ± 3.69	t = 26.96 p = 0.001
OHQ-SF	21.44 ± 3.55	10.58 ± 5.64	t = 10.96 p = 0.001

Bold p-values indicate statistically significant results (p < .05).

Independent samples t test.

OHQ-SF, The Oxford Happiness Questionnaire Short Form; PWB, Psychological Well-Being Scale.

Table 5.

Comparison of the Pretest and Posttest PWB and OHQ-SF Total Score Means of the Patients in the Experimental and Control Groups (n = 91)

Groups	Scale	Pre-test	Post-test
Groups	Scale	(X ± S.S)	(X ± S.S)	^aTest and value
Experimental group (n = 45)	PWB	13.58 ± 5.27	36.50 ± 4.57	t = 1.295 p = 0.001
Experimental group (n = 45)	OHQ-SF	10.36 ± 6.68	21.44 ± 3.55	t = 1.692 p = 0.001
Control group (n = 46)	PWB	12.00 ± 5.30	12.86 ± 3.69	t = 1.899 p = 0.301
Control group (n = 46)	OHQ-SF	10.34 ± 4.79	10.58 ± 5.64	t = −1.844 p = 0.119

Bold p-values indicate statistically significant results (p < .05).

Paired t test.

OHQ-SF, The Oxford Happiness Questionnaire Short Form; PWB, Psychological Well-Being Scale.

Adverse events and safety outcomes

Participants were monitored throughout the intervention period for potential adverse events, including physical injury, falls, dizziness, worsening psychiatric symptoms, hospitalization, or any other intervention-related safety concerns. No adverse events, intervention-related injuries, hospitalizations, or exacerbations of psychotic symptoms were reported in either group during the study period. These findings suggest that the mindfulness-based yoga program was safely implemented among clinically stable individuals with schizophrenia.

Discussion

The findings of the study to determine the effect of mindfulness-based yoga on psychological well-being and happiness in individuals diagnosed with schizophrenia were discussed with the recent literature.

It was found that the pre-test psychological well-being mean scores of the individuals in the experimental group increased statistically significantly in their post-test psychological well-being mean scores. The post-test psychological well-being mean scores of the individuals in the experimental group were statistically significantly higher than the post-test psychological well-being mean scores of the individuals in the control group.

To our knowledge, no previous study has specifically examined the effects of mindfulness-based yoga on psychological well-being among individuals with schizophrenia.

In the study by Lee, it was found that the psychological well-being of elderly patients suffering from depression increased with the mindful yoga program.¹² In her study, Hylander practiced mindful yoga on patients with high-stress levels and stated that their stress and anxiety were relieved and their well-being increased.¹⁴ In their study, Kwok et al., applied mindful yoga with Parkinson’s patients suffering from anxiety and depression and showed that the spiritual well-being of patients increased with mindful yoga.⁷ Schulze et al., implemented a yoga-based interview program for schizophrenic individuals and described the post-program experiences of the patients with a qualitative cross-section. Similar to the findings of the previous study, the patients stated that they were relaxed after the program, felt psychologically better, and their stress was alleviated.²³ In his study, Vancampfort compared the effect of yoga and exercise in schizophrenic individuals to the control group without any intervention (receiving routine treatment) and found that both yoga and exercise relieved anxiety and stress and improved psychological well-being.²⁴ Paikkatt found that the yoga program applied on individuals with schizophrenia improved their well-being.²⁵ In their study, Sistig et al., investigated the effects of mindful yoga on schizophrenia and analyze the statements of patients with qualitative interviews. The patients noted that they were relaxed, their stress reduced, and their energy and motivation boosted in the themes used after the study.¹⁰ Özdemir and Kavak compared mindfulness-based stress reduction programs and psychoeducation among schizophrenic individuals and found that mindfulness-based stress reduction programs improved psychological well-being in schizophrenic individuals.²⁶

Both yoga and mindfulness-based meditations highlight deep, slow, and relaxed breathing, and this inner concentration alleviates stress by minimizing the mental focus on external stressors or threats. Yoga restores the balance between the sympathetic and parasympathetic nervous systems.^27,28 It then creates an effect on blood pressure reduction, depression and improvement in cardiac ventricular function.^29–31 These improvements in the physical health of individuals with schizophrenia may have a direct positive effect on their mental health. Also, Streeter demonstrated that yoga could be beneficial for depression and anxiety disorders as it lowers Gamma-Aminobutyric Acid (GABA) levels.³² Therefore, mindful yoga is a therapeutic bridge between the body, soul and mind with its spiritual and physical meditations, breathing exercises, and mindfulness awareness.³³ The study results are compatible with the literature. The results confirmed our hypothesis “Mindful yoga elevates the level of psychological well-being in individuals diagnosed with schizophrenia.”

It was determined that the pre-test happiness mean score of the individuals in the experimental group for the increased statistically significantly in the post-test, and their post-test happiness mean score was statistically significantly higher than the post-test happiness mean score of the individuals in the control group. To the best of our knowledge, no previous study has specifically examined the effects of mindfulness-based yoga on happiness among individuals with schizophrenia. Therefore, the findings were interpreted in light of the available literature on mindfulness, yoga, and positive mental health outcomes.

Studies on happiness in individuals with schizophrenia have yielded different results depending on the sample group. Schizophrenic individuals with high depression scores were found to have low levels of happiness. Likewise, schizophrenic individuals with high positive symptoms and negative symptoms had low levels of happiness.^34–37

Doğan et al. determined in their study that psychological well-being had positive effects on happiness. Conversely, subjective well-being means happiness.¹⁶ Happiness scores in the schizophrenia group were associated with resilience, optimism and low perceived stress, but not with the severity of psychopathology.³⁸ The mindfulness and meditation facets of yoga represent pathways to educate the mind so that one is not distracted and caught up in an endless stream of turbulent thoughts. These practices provide resilience and help the patient cope with stress and manage potential triggers for anxiety. They can also encourage self-reflection that can uncover the source(s) of one’s anxiety.³⁹ Yoga helps a person to develop a positive state of health by not only treating the disease but also helping to understand the underlying causes of the disease. It also offers an individualized, personalized, and holistic approach that takes into account not only the patient’s mind, body and spirit but also their family, support network, employment status and culture.⁴⁰ Yoga can help people with schizophrenia to cope with stress by teaching self-regulation skills to control emotions and stress. These practices promote the well-being and mental health of people with schizophrenia, improve overall resilience and help to keep their lives positively balanced.⁴¹ Therefore, yoga and mindfulness are closely correlated with happiness. The study results are compatible with the literature. The results confirmed our hypothesis “Mindful yoga raises the level of happiness in individuals diagnosed with schizophrenia.”

Limitations

This study has several limitations that should be considered when interpreting the findings. First, the study was conducted in only two CMHC located in a single geographical region, which may limit the generalizability of the results to other settings and populations. Second, although the sample size met the requirements of the a priori power analysis, the relatively small sample may have limited the detection of smaller intervention effects.

Third, the outcome measures were based on self-report instruments, which may be subject to response bias and social desirability effects. Fourth, because of the nature of the mindfulness-based yoga intervention, participant blinding was not feasible, which may have introduced performance or expectancy bias. Fifth, no long-term follow-up assessments were conducted; therefore, the sustainability of the observed improvements in psychological well-being and happiness remains unknown.

Another important limitation of this study is the use of a routine-care control group rather than an active control condition. Participants in the mindfulness-based yoga group received structured group sessions, regular contact with the intervention provider, and engagement in physical and mindfulness-based activities. Therefore, it is not possible to determine the extent to which the observed benefits were attributable specifically to mindfulness-based yoga, rather than to nonspecific factors such as increased social interaction, attention from facilitators, or participation in regular physical activity. Future studies should consider the use of active control groups, such as walking programs, stretching exercises, or health education interventions, to better isolate the specific effects of mindfulness-based yoga.

In addition, there are numerous cognitive, behavioral, psychosocial, and environmental factors that may influence psychological well-being and happiness among individuals with schizophrenia and could not be fully controlled in the present study. Finally, although the trial was retrospectively registered at ClinicalTrials.gov, no changes were made to the study protocol, outcome measures, or statistical analysis plan after the initiation of the study.

Despite these limitations, the randomized controlled design, adequate sample size based on power analysis, low attrition rate, and implementation of the intervention in real-world community mental health settings strengthen the validity and practical relevance of the findings.

Conclusions

The findings of this randomized controlled trial suggest that mindfulness-based yoga may be an effective complementary intervention for improving psychological well-being and happiness among individuals with schizophrenia receiving community-based mental health services. Participants who received the mindfulness-based yoga program demonstrated significantly greater improvements in psychological well-being and happiness compared with those receiving routine care alone.

No intervention-related adverse events were reported during the study period, suggesting that mindfulness-based yoga may be a feasible and safe intervention for clinically stable individuals with schizophrenia when implemented in community mental health settings.

Despite these promising findings, the results should be interpreted in light of the study limitations, including the relatively small sample size, the inclusion of participants from only two community mental health centers, the use of self-report measures, and the absence of long-term follow-up assessments. Therefore, further multicenter randomized controlled trials with larger samples and longer follow-up periods are needed to confirm the effectiveness and sustainability of mindfulness-based yoga interventions in individuals with schizophrenia.

Mental health nurses may consider incorporating mindfulness-based yoga as a complementary component of psychosocial rehabilitation programs where appropriate and feasible. Given its low cost, feasibility, and favorable safety profile, mindfulness-based yoga may represent a valuable adjunct to standard community-based psychiatric care for individuals with schizophrenia.

Authors’ Contributions

A.A. contributed to the conception and design of the study. A.A. and F.K.B. performed the data analysis. A.A. and F.K.B. contributed to the drafting and revision of the article. All authors read and approved the final version of the article.

Author Disclosure Statement

The authors declare that they have no conflict of interest.

Footnotes

Acknowledgment

The authors sincerely thank all participants who generously contributed their time to this research.

Funding Information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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