Need for Systematic Development and Validation of Yoga Modules in Yoga Research

Dear Editor,

We read with interest a research article titled ‘Development and Validation of Yoga Protocol for Patients with Depression’ that has been published in your esteemed journal recently. ¹ We were surprised that this article states that there is no published validated yoga module for depression! We want to bring to the attention of you and the readers of this journal that a specific yoga module for patients with depression has been scientifically developed, tested for feasibility and then applied in several controlled trials at the National Institute of Mental Health and Neurosciences, Bengaluru, India. The development and feasibility testing of the yoga module and the results of the trials on Major Depression have been published in peer-reviewed Scopus/PubMed-indexed Indian and international journals, which are available online.^2–9 Recently, a case series demonstrated preliminary evidence for this module as an effective monotherapy for treating mild to moderate depression. ¹⁰ However, suppose an existing yoga module for depression is not feasible in a specific population. In that case, authors/clinicians/therapists can propose adaptations from the existing yoga module and test its feasibility further. Developing multiple yoga modules for the same disorder without adequate justification amounts to confusion among the end-users and may not be useful for scientific progress in this field.

In the article referred to above, ¹ the authors have technically adopted a systematic procedure for developing and validating the yoga module for depression. However, the authors have stated that there is no published yoga module for depression, citing the module in the article! Also, the authors have missed reviewing and citing the literature on yoga for depression. No rationale for the requirement of an entirely new and different yoga module for depression has been discussed. Further, several yoga practices such as backward bending asanas, suryanamasakara, right nostril breathing, ujjayi pranayama^{2, 11} and bhastrika pranayama ¹² that are highly recommended by yoga professionals treating patients with depression, have demonstrated positive effects on mood and have been used in many research trials on yoga for depression^{11, 13} have been completely omitted from the proposed module.

We recommend that authors thoroughly search the literature from ancient texts, contemporary yoga texts and research evidence before developing and standardising yoga therapy modules for any disorder. Also, it is essential to consider the expertise of senior yoga professionals/researchers in the respective field to validate the yoga modules.