Abstract
Background
The rise in problematic smartphone use among university students underscores the potential of yoga, with its evidence-based ability to improve problematic behaviours at their core.
Objective
To determine whether a ten-week yoga intervention can reduce the symptoms of problematic smartphone usage in university students.
Materials & methods
One hundred fifty participants aged between 18 and 23 years were randomly divided into a yoga (n=75) and a control group (n=75) with an allocation ratio of 1:1. The yoga group received yoga intervention for ten-weeks, whereas the control group carried out their normal daily routine. Each participant was assessed for the symptoms of problematic smartphone usage at baseline, post intervention and two months follow-up by using a standardized Problematic Use of Mobile Phone (PUMP) scale.
Results
Data were analyzed using SPSS 24.0. Repeated measure analyses of variance (RM-ANOVA) with baseline PUMP score used as a covariate have shown a significant reduction in overall problematic smartphone usage (p<0.001; Bonferroni adjusted post hoc analyses) in the yoga group after ten-week of yoga intervention and at two months follow-up (p<0.001).
Conclusions
The results suggest that regular practice of yoga may act as a useful approach to reduce the problematic smartphone usage and its associated symptoms in university students.
Keywords: Yoga, Problematic use, Smartphone, Students
1. Introduction
The growing dependence on advanced information technology has resulted in excessive reliance on smartphones, leading to digital enslavement [1]. According to the International Telecommunication Union's (ITU) annual Facts and Figures report (2022), approximately 73% of individuals aged 10 and above across the globe own a mobile phone. Among these, an estimated 5.3 billion individuals, which is roughly 66% of the global populace, are active users of the Internet [2]. The continual enhancement of smartphone features, escalating youth infatuation, easy internet accessibility and rapid digitalization pave the way for the potential emergence of problematic smartphone usage as a new and perilous form of behavioural addiction. Although it has not been listed in either the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) or the International Classification of Diseases (ICD-10) [3], a growing consensus within the scientific community has emerged, categorizing problematic smartphone use as a distinct manifestation of addiction. Furthermore, an expanding corpus of research suggests that behavioural addictions have similar trends like substance addictions and both can contribute significantly to the emergence of various physiological and psychological disorders [4]. Previous studies reveal that the addictive use of smartphones not only deteriorates sleep quality [5] but also exacerbates depression and anxiety [6,7], thereby exerting negative impact on well-being [8]. In addition to this, excessive smartphone usage leads to several other psychophysiological issues, such as headache [9], musculoskeletal pain in the upper back and neck [10,11], stiffness in the thumb and wrist [12], detrimental effects on brain function [13] and many more. Poor academic performance [14] and an upsurge in the cases of accidents [15] are some other serious consequences of smartphone addiction.
Studies suggest that the addicted individuals lack adequate control over their cognitive processes [16], resulting in persistent cravings for specific substances or addictive behaviour [17]. This is particularly evident among students, who often lack self-control while using their smartphones, inadvertently getting entangled in the virtual quagmire of smartphone addiction [18]. Despite the availability of interventions such as cognitive behavioural therapy [19], laughter therapy [20], baduanjin (traditional Chinese qigong) & basketball [21] and various other exercises [22] to address the problem, the alarming rate at which problematic smartphone usage is ingraining itself within the younger generation underscores the imperative need for further research and intervention in this domain. In this context, traditional yoga practices, steeped in centuries of wisdom, can be quite efficacious as yoga encompasses a mind-body medicine approach, that promotes holistic well-being [23]. By enhancing self-regulation, mindfulness and emotional stability, yoga effectively mitigates core symptoms like craving, compulsivity and emotional dysregulation, which are common in problematic smartphone usage and other addictions [23,24]. A recent pilot study has reported significant reductions in smartphone addiction among participants after practising a yoga module for six weeks, highlighting the potential of yoga practices as an effective strategy for digital detoxification [25]. Additionally, the non-invasive and cost-effective nature of yoga practices makes it an ideal intervention for university students, a group highly susceptible to problematic smartphone use. With this background, the primary objective of the present study is to determine the effect of a ten-week yoga intervention on the symptoms of problematic smartphone usage in university students.
2. Materials and methods
2.1. Participants
One hundred and fifty participants of both genders (male:female=1:1) aged between 18 and 23 years (group average age±SD, 19.39±1.27) were recruited from H.N.B. Garhwal University located in North India. Recruitment was carried out by oral announcements in the lecture halls. Participants were asked to fill a pre-validated standardized Problematic Use of Mobile Phone (PUMP) scale [26], and the individuals with a score of 55 or higher were categorized as problematic smartphone users. Sample size was not calculated a priori for the present study. However, the post hoc power analyses was carried out using G power program with level of significance (α)=0.05, Cohen's d=1.3(determined from the changes in overall PUMP scores in the yoga group at follow-up state), the present study had power=1.00 [27]. Participation in the study was voluntary with no incentive to the participants. The study was approved by the Board of Studies Committee of the university and was conducted in compliance with the ethical guidelines outlined in the Declaration of Helsinki. Signed informed consent was obtained from each participant. The number of participants at various stages of the study is presented in Fig. 1.
Fig. 1.
Flow chart for eligibility criteria.
2.2. Inclusion/exclusion criteria
The participants were included in the study if they satisfied the required criteria like: (i) undergraduate students enrolled at H.N.B. Garhwal University, (ii) aged between 18 and 23 years and (iii) identified as problematic smartphone users. The exclusion criteria comprise (i) any physical or psychological issues which would have prevented them from practicing yoga intervention, (ii) those on regular medication and (iii) those having previous experience in yoga practices.
2.3. Study design
The present randomized controlled trial with pre, post and follow-up research design was carried out between the months of April and December 2022. This was a single-blind study, in which the assessors responsible for scoring the responses were not involved either in group allocation or intervention process. The participants were randomly allocated to the yoga group or the control group with an allocation ratio of 1:1. Each participant was assigned a serial number ranging from 1 to 150, and a corresponding list of random numbers was generated using an online randomizer (https://www.randomizer.org/). Based on this random sequence, participants were assigned alternately to the two groups by a researcher who had no other role in the study. The yoga group (n=75) was subjected to the yoga intervention for ten-weeks. In contrast, the participants in the control group (n=75) were instructed to follow their normal routines during this period. Baseline assessment of both the groups was carried out a day before commencing the yoga intervention. Post-data and follow-up data were collected immediately after the intervention and two months after that respectively. The PUMP scale was utilized consistently at each of these stages to assess the problematic smartphone usage. The study has been reported according to the standard CONSORT guidelines.
2.4. Assessment
2.4.1. Problematic use of mobile phone (PUMP) scale
It is a predesigned self-administered scale consisting of 20 items, with each set of two items effectively reflecting the 10 symptoms of substance use disorder such as (i) tolerance, (ii) withdrawal, (iii) longer time than intended, (iv) great deal of time spent, (v) craving, (vi) activities given up or reduced, (vii) use despite physical or psychological problems, (viii) failure to fulfill role obligation, (ix) use in physically hazardous situations, (x) use despite social or interpersonal problems. Participants are required to rate each item on a 5-point likert scale, with responses ranging from 1, indicating "strongly disagree," to 5, indicating "strongly agree". The possible scores vary between 20 and 100 with higher scores on the scale corresponding to a greater degree of problematic smartphone usage [26].
2.5. Intervention
2.5.1. Yoga group
The participants in the yoga group were offered a total of 60 yoga sessions, each lasting 60 min, over a period of ten-weeks (six days a week). Of these, all participants attended at least 45 yoga sessions. The yoga intervention included specific yoga postures, breathing techniques, cleansing techniques, guided relaxation, and meditation. The selection of yoga practices was based on the fundamental texts in yoga philosophy and contemporary scientific research, ensuring a well-informed and evidence-based approach [25,[28], [29], [30]]. Surya Namaskar, a dynamic sequence of postures, regulates brain waves, promotes body control, and improves sleep quality, fostering mental alertness [31]. Asanas calm the nervous system, reduce stress, and enhance emotional stability, helping break the cycle of excessive smartphone use by promoting mental clarity [30]. Pranayama reduces anxiety, enhances impulse control, and supports mindful technology usage [32]. Meditation and relaxation techniques further improve emotional control and decision-making, promoting sustained concentration and reducing smartphone dependence [23]. The yoga intervention was administered by an experienced yoga instructor. Details of the yoga intervention are given in Table 1.
Table 1.
Details of yoga intervention.
| Yoga Intervention | Duration (60 min) | ||
|---|---|---|---|
| Prarthana (prayer) | 2 min | ||
| Sookshma Vyayam (micro exercises) | 5 min | ||
| Surya Namaskar (sun salutation) | 10 min | ||
| Aasana (Physical Postures) | |||
| Set 1 | Set 2 | ||
| Standing | Vrikshasana (tree pose) | Garudasan (eagle pose) | 1 min |
| Kati-chakrasana (waist rotating pose) | Trikonasana (triangle pose) | 1 min | |
| Sitting | Vakrasana (spinal twist pose) | Ardh-matsyendrasana (half spinal twist pose) | 1 min |
| Ushtrasana (camel pose) | Paschimottanasana (back stretching pose) | 1 min | |
| Prone | Bhujangasana (cobra pose) | Tiryak-bhujangasana (twisting cobra pose) | 1 min |
| Shalabhasana (locust pose) | Dhanurasana (bow pose) | 1 min | |
| Supine | Pawan-muktasana (leg lock pose) | Naukasana (boat pose) | 1 min |
| Ardh-halasana (half-plough pose) | Halasana (plough pose) | 1 min | |
| Relaxation | Shavasana (corpse pose) | Shavasana (corpse pose) | 2 min |
| Shuddhi Kriya (Purification process) | |||
| Kapalbhati Kriya (frontal brain cleansing) | 3 min | ||
| Pranayama (Breathing exercises) | |||
| Nadishodhan (alternate nostril breath) | 4 min | ||
| Bhramari (humming bee breath) | 3 min | ||
| Ujjayi (psychic breath) | 3 min | ||
| Deep relaxation and meditation | |||
| Yoganidra (yogic sleep) | 10 min | ||
| Pranava Japa (om chanting) | 10 min | ||
| Additional practices | |||
| Trataka (concentrated gazing) | Twice in a week | ||
| Jal Neti (nasal cleansing) | Twice in a week | ||
Note: The Aasanas listed in Set 1 were practiced for initial five weeks, whereas the Aasanas listed in Set 2 were practiced for another five weeks.
2.5.2. Control group
The participants in the control group were instructed to maintain their usual routine activities throughout the study period without receiving any intervention. Due to limited resources and the absence of expertise in other active treatments, a control group with no intervention was chosen for this study.
2.6. Data analyses
Data were analyzed using SPSS Version 24.0. Repeated-measures analyses of variance (RM-ANOVA) were carried out to determine the effect of yoga on problematic smartphone usage. Each ANOVA had one within subjects factor (three levels included: pre, post and follow-up scores of the PUMP scale) and one between subjects factor (two levels included: yoga and control group), while baseline overall PUMP score was used as a co-variate. Assumption for sphericity was checked using Mauchly's test of sphericity. Appropriate corrections (i.e., Huynh-Feldt Epsilon or Greenhouse-Geisser) were applied wherever the assumption for sphericity was not met. Assumptions for normality and homogeneity of variance were not tested in this study, as it has been shown that violations of normality have no influence on the robustness of RM-ANOVA for sufficiently large data sets (i.e., ≥30 samples) [33,34]. Furthermore, it has been reported that the assumption of homogeneity of variance is not a mandatory requirement for RM-ANOVA if the groups are equal and the sample size is large enough [35]. The level of significance was set at 0.05. The Bonferroni adjusted post-hoc analyses were carried out for the variables which showed a significant main effect of groups, states, or interaction of groups and states.
3. Results
Out of one hundred and fifty participants initially enrolled, fifteen participants dropped out from the study. Specifically, six participants did not complete post data assessment, while nine did not complete follow-up data assessment. Possible reasons may include scheduling conflicts, a lack of sustained interest, unavailability or other personal issues. Thus, a total of one hundred and thirty-five participants (mean±SD, 19.46±1.26 years) completed the study. The demographic details of the participants who completed the study are given in Table 2.
Table 2.
Demographic details of the participants.
| S.No. | Variables | Yoga Group (n=67) | Control Group (n=68) |
|---|---|---|---|
| 1 | Male | 29 | 38 |
| 2 | Female | 38 | 30 |
| 3 | Age (mean±SD) | 19.46±1.16 | 19.46±1.37 |
| 4 | Weight (mean±SD) | 55.02±9.32 | 56.86±9.41 |
| 5 | Height (mean±SD) | 162.53±8.92 | 164.14±9.41 |
| 6 | BMI (mean±SD) | 20.80±3.02 | 21.11±3.14 |
BMI: body mass index.
3.1. Frequency analysis for yoga group participants
The details of average based percentage change in frequency of yoga group participants selecting 5 ratings (i.e., strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, strongly agree) on PUMP scale after ten weeks of intervention and at follow up as compared to pre state are presented in Table 3. Out of 67 participants in yoga group, the number of participants who reported highest level of tolerance based on Likert Scale decreased by 41.67% after ten weeks of yoga intervention. Similarly, the number of participants who reported highest levels of withdrawal, longer time than intended, great deal of time spent, activities given up or reduced, use despite physical or psychological problems, failure to fulfill role obligations, use in physically hazardous situations, use despite social or interpersonal problems based on Likert Scale decreased by 37.5%, 80.04%, 81.09%, 69.57%, 81.89%, 20.00%, 53.33%, 40.28% respectively, after ten weeks of yoga intervention. However, the number of participants indicating the highest level of craving on the Likert scale increased by 125% following the yoga intervention.
Table 3.
Average based Percentage Change in participants's frequency on PUMP scale ratings at post and follow-up states vs. pre-state in yoga group.
| Variables | Strongly Disagree (1) |
Somewhat Disagree (2) |
Neither Agree Nor Disagree (3) |
Somewhat Agree (4) |
Strongly Agree (5) |
|||||
|---|---|---|---|---|---|---|---|---|---|---|
| Post vs Pre (%) | Follow-up vs Pre (%) | Post vs Pre (%) | Follow-up vs Pre (%) | Post vs Pre (%) | Follow-up vs Pre (%) | Post vs Pre (%) | Follow-up vs Pre (%) | Post vs Pre (%) | Follow-up vs Pre (%) | |
| Tolerance | 62.82 | −42.12 | 5.00 | 121.67 | 27.20 | 26.92 | −66.44 | −28.24 | −41.67 | −16.67 |
| Withdrawal | 37.83 | −89.13 | 96.88 | 131.25 | −1.36 | 34.24 | −47.10 | 9.96 | −37.50 | −93.75 |
| Longer time than intended | 158.33 | −75.00 | 95.00 | 285.00 | 128.33 | 137.22 | −1.91 | −8.28 | −80.04 | −85.21 |
| Great deal of time spent | 700.00 | 150.00 | 22.92 | 262.50 | 118.18 | 96.75 | 9.09 | 2.27 | −81.09 | −78.36 |
| Craving | 47.16 | −46.02 | 302.50 | 271.25 | −7.29 | 28.13 | −80.67 | −55.85 | 125.00 | 62.50 |
| Activities given up or reduced | 700.00 | 25.00 | 50.00 | 360.00 | −6.06 | 12.12 | −40.76 | −44.09 | −69.57 | −68.48 |
| Use despite physical or psychological problems | 325.00 | −41.67 | 362.50 | 332.50 | 37.78 | 83.33 | −42.07 | −28.99 | −81.89 | −66.83 |
| Failure to fulfill role obligations | 51.59 | −50.79 | 85.86 | 177.78 | 8.37 | 2.94 | −64.84 | −30.42 | −20.00 | −60.00 |
| Use in physically hazardous situations | 87.39 | −31.53 | 32.14 | 233.04 | 21.43 | 15.93 | −44.44 | −28.21 | −53.33 | −80.00 |
| Use despite social or interpersonal problems | 110.06 | −41.56 | 15.63 | 101.14 | −7.21 | 30.05 | −57.50 | −50.00 | −40.28 | −22.22 |
3.2. Repeated-measures analyses of variance (RM-ANOVA)
The F, df, Huynh–Feldt epsilon and p value for groups, states, and groups×states for different variables are provided in Table 4. A significant interaction between the groups and states indicates the interdependence of the two.
Table 4.
RM-ANOVA results for sub-variables of PUMP.
| Variables | Factors | F | df | Huynh-Feldt epsilona | p value |
|---|---|---|---|---|---|
| Tolerance | groups | 64.785 | 1,132 | 0.982 | <0.001∗∗∗ |
| states | 4.294 | 1.964,259.240 | 0.982 | 0.015∗ | |
| groups×states | 2.533 | 1,132×1.964,259.240 | 0.982 | 0.082 | |
| Withdrawal | groups | 11.213 | 1,132 | 0.001∗∗ | |
| states | 10.497 | 2.000,264.000 | <0.001∗∗∗ | ||
| groups×states | 4.031 | 1,132×2.000,264.000 | 0.019∗ | ||
| Longer time than intended | groups | 10.217 | 1,132 | 0.002∗∗ | |
| states | 1.312 | 2.000,264.000 | 0.271 | ||
| groups×states | 1.226 | 1,132×2.000,264.000 | 0.295 | ||
| Great deal of time spent | groups | 4.441 | 1,132 | 0.037∗ | |
| states | 0.204 | 2.000,264.000 | 0.816 | ||
| groups×states | 4.144 | 1,132×2.000,264.000 | 0.017∗ | ||
| Craving | groups | 7.282 | 1,132 | 0.008∗∗ | |
| states | 2.298 | 2.000,264.000 | 0.103 | ||
| groups×states | 13.234 | 1,132×2.000,264.000 | <0.001∗∗∗ | ||
| Activities given up or reduced | groups | 38.494 | 1,132 | <0.001∗∗∗ | |
| states | 0.869 | 2.000,264.000 | 0.421 | ||
| groups×states | 14.670 | 1,132×2.000,264.000 | <0.001∗∗∗ | ||
| Use despite physical or psychological problems | groups | 27.019 | 1,132 | <0.001∗∗∗ | |
| states | 2.769 | 2.000,264.000 | 0.065 | ||
| groups×states | 9.664 | 1,132×2.000,264.000 | <0.001∗∗∗ | ||
| Failure to fulfill role obligations | groups | 3.854 | 1,132 | 0.052 | |
| states | 0.936 | 2.000,264.000 | 0.394 | ||
| groups×states | 9.622 | 1,132×2.000,264.000 | <0.001∗∗∗ | ||
| Use in physically hazardous situations | groups | 11.608 | 1,132 | 0.001∗∗ | |
| states | 2.743 | 2.000,264.000 | 0.066 | ||
| groups×states | 11.813 | 1,132×2.000,264.000 | <0.001∗∗∗ | ||
| Use despite social or interpersonal problems | groups | 23.799 | 1,132 | <0.001∗∗∗ | |
| states | 6.560 | 2.000,264.000 | 0.002∗∗ | ||
| groups×states | 9.790 | 1,132×2.000,264.000 | <0.001∗∗∗ | ||
| Overall PUMP score | groups | 131.163 | 1,132 | 0.950 | <0.001∗∗∗ |
| states | 21.512 | 1.899,250.684 | 0.950 | <0.001∗∗∗ | |
| groups×states | 67.864 | 1,132×1.899,250.684 | 0.950 | <0.001∗∗∗ |
∗∗∗p<0.001, ∗∗p<0.01, ∗p<0.05.
values are provided for the variables that did not fulfil the sphericity assumption.
There was a significant main effect of groups for tolerance, withdrawal, using for longer time than intended, craving, activities given up or reduced, use despite physical or psychological problems, use in physically hazardous situations, use despite social or interpersonal problems and overall PUMP score.
There was a significant main effect of states for tolerance, withdrawal, using for longer time than intended, great deal of time spent, craving, activities given up or reduced, use despite physical or psychological problems, use despite social or interpersonal problems and overall PUMP score.
There was a significant interaction effect of groups and states for withdrawal, great deal of time spent, craving, activities given up or reduced, use despite physical or psychological problems, failure to fulfill role obligations, use in physically hazardous situations, use despite social or interpersonal problems and overall PUMP score.
3.3. Post-hoc analyses
Group mean±SD; median (IQR) and confidence interval of the variables assessed at baseline, post intervention and after two months of follow-up are shown in Table 5.
Table 5.
Mean±SD; median (IQR) and confidence interval of the variables assessed at pre, post and follow-up states.
| Variables | Yoga Group (n=67) |
Control Group (n=68) |
95 % CI [Upper limit, lower limit] a | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Pre | Post | Follow-up | Cohen's d |
Pre | Post | Follow-up | Cohen's d |
||||
| Post vs. Pre | Follow- up vs. Pre | Post vs. Pre | Follow- up vs. Pre | ||||||||
| Tolerance | 5.25±1.93; 5 (3) | 4.22±1.67∗∗; 4 (2) | 4.93±1.41; 5 (2) | −0.57 | −0.19 | 6.19±1.7##; 7 (2) | 5.97±1.42###; 6 (2) | 6.26± 1.42###; 6 (2) |
−0.14 | 0.04 | [-1.300, −2.018] |
| Withdrawal | 5.63±2; 6 (3) | 4.88±1.67∗; 5 (2) | 5.7±1.23; 6 (2) | −0.41 | 0.04 | 5.71±1.81; 5 (2) | 5.97±1.55###; 6 (2) | 6.06± 1.57; 6 (2) |
0.15 | 0.21 | [-0.617, −1.684] |
| Longer time than intended | 7.94±1.57; 8 (2) | 6.4±1.65∗∗∗; 7 (3) | 6.31±1.33∗∗∗; 6 (2) | −0.96 | −1.12 | 8.1±1.38; 8 (2) | 7.04±1.54#∗∗∗; 7 (2) | 6.91± 1.23## ∗∗∗; 7 (2) |
−0.73 | −0.91 | [-0.165, −1.226] |
| Great deal of time spent | 8.03±1.42; 8 (2) | 6.45±1.64∗∗∗; 7 (2) | 6.37±1.55∗∗∗; 6 (2) | −1.03 | −1.12 | 7.79±1.45; 8 (2) | 6.9± 1.6∗∗∗; 7 (2) |
7.04± 1.35## ∗∗; 7 (2) |
−0.58 | −0.54 | [0.049, −1.040] |
| Craving | 6.24±1.68; 7 (2) | 4.73±1.44∗∗∗; 5 (2) | 5.52±1.35∗; 6 (1) | −0.97 | −0.48 | 5.79±2.2; 6 (3) | 6.13±1.75###; 6 (3) | 6.03± 1.58#; 6 (2) |
0.17 | 0.13 | [-0.915, −1.988] |
| Activities given up or reduced | 7.3±1.27; 7 (2) | 5.36±1.64∗∗∗; 5 (3) | 5.55±1.48∗∗∗; 6 (3) | −1.33 | −1.27 | 7.06±1.66; 7.5 (2) | 6.9± 1.58###; 7 (2) |
6.9± 1.37###; 7 (2) |
−0.10 | −0.11 | [-1.045, −2.124] |
| Use despite physical or psychological problems | 7.7±1.58; 8 (2) | 5.48±1.7∗∗∗; 6 (2) | 6.24±1.51∗∗∗; 6 (2) | −1.35 | −0.94 | 7.66±1.53; 8 (2) | 7.04±1.42###∗; 7 (2) | 7.15± 1.45###; 7 (2) |
−0.42 | −0.34 | [-1.027, −2.100] |
| Failure to fulfill role obligations | 5.76±1.78; 5 (3) | 4.69±1.89∗∗∗; 5 (3) | 5.36±1.49; 5 (2) | −0.58 | −0.24 | 5.16±1.82; 5 (2) | 5.71±1.66###; 6 (2) | 5.62± 1.74; 6 (2) |
0.32 | 0.26 | [-0.567, −1.677] |
| Use in physically hazardous situations | 5.64±1.94; 5 (2) | 4.67±1.95∗∗; 5 (3) | 4.84±1.5∗∗; 5 (2) | −0.50 | −0.47 | 5.15±1.73; 5 (2) | 5.76±1.86##; 6 (2) | 6.01± 1.64###∗∗; 6 (2) |
0.34 | 0.51 | [-0.491, −1.780] |
| Use despite social or interpersonal problems | 5.82±2.02; 6 (3) | 4.28±2.14∗∗∗; 4 (4) | 5.33±1.66; 5 (2) | −0.74 | −0.27 | 5.71±1.86; 5 (3) | 6± 1.76###; 6 (3) |
6.21± 1.51##; 6 (2) |
0.16 | 0.30 | [-1.126, −2.432] |
| Overall PUMP score | 65.31±7.43; 64 (12) | 51.16±8.55∗∗∗; 53 (8) | 56.15±6.07∗∗∗; 56 (7) | −1.77 | −1.36 | 64.32±6.67; 62 (10) | 63.43±7.4###; 63 (8) | 64.19±6.34###; 64 (9) | −0.13 | −0.02 | [-10.366, −15.205] |
(∗∗∗p<0.001,∗∗p<0.01,∗p<0.05) Based on Bonferroni adjusted post hoc analysis, when Post and Follow-up states were compared with respective Pre-value.
(###p<0.001,##p<0.01,#p<0.05) Based on Bonferroni adjusted post hoc analysis, when Pre, Post and Follow-up states of the yoga group were compared with the respective states of the control group.
95% confidence interval for between group comparison (yoga post vs. control post).
3.3.1. Between group comparison
Following ten-weeks, at post state the yoga group had significantly lower scores for tolerance (p<0.001), withdrawal (p<0.001), longer time than intended (p<0.05), craving (p<0.001), activities given up or reduced (p<0.001), use despite physical or psychological problems (p<0.001), failure to fulfill role obligations (p<0.01), use in physically hazardous situations (p<0.01), use despite social or interpersonal problems (p<0.001), and overall PUMP scores (p<0.001) as compared to the post state of control group.
Subsequently, the yoga group showed a significantly lower scores for tolerance (p<0.001), longer time than intended (p<0.01), great deal of time spent (p<0.01), craving (p<0.05), activities given up or reduced (p<0.001), use despite physical or psychological problems (p<0.001), use in physically hazardous situations (p<0.001), use despite social or interpersonal problems (p<0.01), and overall PUMP score (p<0.001) in follow-up state compared to the respective state of control group.
Also at baseline, no significant changes were observed on PUMP scale between the two groups except for tolerance score, which was significantly higher in control group (p<0.01) as compared to the yoga group.
3.3.2. Within group comparison
Following ten-weeks, at post state the yoga group showed a significant decrease in tolerance (p<0.01, Cohen's d=-0.57), withdrawal (p<0.05, Cohen's d=-0.41), longer time than intended (p<0.001, Cohen's d=-0.96), great deal of time spent (p<0.001, Cohen's d=-1.03), craving (p<0.001, Cohen's d=-0.97), activities given up or reduced (p<0.001, Cohen's d=-1.33), use despite physical or psychological problems (p<0.001, Cohen's d=-1.35), failure to fulfill role obligations (p<0.001, Cohen's d=-0.58), use in physically hazardous situations (p<0.01, Cohen's d=-0.50), use despite social or interpersonal problems (p<0.001, Cohen's d=-0.74), and overall PUMP score (p<0.001, Cohen's d=-1.77) as compared to baseline scores.
Also, the yoga group showed a significant decrease in longer time than intended (p<0.001, Cohen's d=-1.12), great deal of time spent (p<0.001, Cohen's d=-1.12), craving (p<0.05, Cohen's d=-0.48), activities given up or reduced (p<0.001, Cohen's d=-1.27), use despite physical or psychological problems (p<0.001, Cohen's d=-0.94), use in physically hazardous situations (p<0.01, Cohen's d=-0.47) and overall PUMP score (p<0.001, Cohen's d=-1.36) in follow-up state as compared to the pre state.
4. Discussion
The present study investigated the effect of yoga intervention on the growing issue of problematic smartphone usage in university students. Frequency analysis demonstrated that after ten weeks of yoga intervention, there were significant reductions in the number of participants reporting the highest levels of tolerance, withdrawal and other negative behaviours related to problematic smartphone use, as measured on the Likert Scale. Also, the results of the study revealed a significant reduction in overall problematic smartphone usage among participants in the yoga group following ten-week intervention and during the two-month follow-up period, as observed in both within-group and between-group comparisons (Fig. 2).
Fig. 2.
Graphical representation showing within-group and between-group comparisons of overall problematic use of mobile phone (PUMP) scores for yoga and control groups across pre, post and follow-up states.
Also, a significant reduction in all the symptoms of problematic smartphone usage within the yoga group was observed when baseline scores were compared with post-intervention and follow-up scores.
Although research in this specialized domain remains relatively limited, the finding of the present study resonate strongly with those of previous studies [24,25], suggesting consistency in the observed results. However, the findings of these studies were limited by small sample size, absence of control group and there were no follow-up assessments. The findings from Billieux et al.'s study suggest that the tendency to experience strong impulses may contribute significantly to problematic smartphone usage [36]. Conversely, a study on Swedish samples revealed that yoga interventions exert a positive influence on impulsivity [37]. Drawing from these studies, we can infer that the participants undergoing yoga intervention likely experienced a positive change in their impulsive tendencies. As a result, post intervention they may have experienced a reduction in the urge to use their smartphones excessively, leading to a significant reduction in problematic smartphone usage. Another key factor associated with addictive behaviours is decision-making through a weak emotional state [38,39]. As yoga intervention has been proven scientifically to enhance emotional intelligence [40,41], there may be a possibility that yoga practice has effectively redirected the emotions that drag the students towards problematic smartphone usage in a positive direction, allowing them to creatively focus on their work. A review study also suggested yoga and meditation as an effective tool for digital detoxification [30]. In addition, problematic smartphone usage among students is often linked to stress and escapism, stemming from academic pressures and personal challenges [42]. Conversely, yoga serves as a mindfulness practice, fostering consciousness and enhancing mental resilience to confront unfavourable circumstances [43]. However, the present study is limited by the lack of direct measurement of factors like impulsivity or stress, the overall findings still highlight the effectiveness of yoga as a promising strategy to mitigate problematic smartphone usage in university students.
4.1. Strengths of the study
To the best of our knowledge, this is the first randomized controlled trial to rigorously assess the impact of yoga as an intervention for addressing problematic smartphone use, with a follow-up assessment to gauge its sustained effects. The study focuses on university student population that is particularly vulnerable to the excessive smartphone use. Furthermore, the utilization of a randomized controlled trial design enhances the robustness of the findings by minimizing potential confounding variables. Also, the longitudinal approach not only examines the effects of yoga intervention on problematic smartphone use at post intervention state but also provides insights into the sustainability of these effects over time.
4.2. Limitations of the study
It is pertinent to acknowledge that in this study, the assessment of problematic smartphone use was conducted through a psychological scale administered prior to and following the intervention. Also, the absence of sample size calculation a priori is a notable limitation of this study potentially impacting the statistical power. Another key limitation of this study is the absence of an active control group, which restricts direct comparison of the effectiveness of yoga intervention with other standard treatments.
4.3. Recommendations for future study
The present study encourages further exploration and application of yoga-based interventions in context of digital well-being and smartphone addiction management. Future researches are suggested to have an active control group and it should be focused on actual smartphone screen time as a potential approach. Also, it is imperative to delve deeper into the underlying mechanisms through which yoga exerts its influence on problematic smartphone usage. Additionally, future studies should explore whether yoga interventions produce similar outcomes in other demographic groups, such as adolescents, working professionals or other subgroups.
5. Conclusion
The findings of this study are promising, indicating the potential efficacy of a ten-week yoga intervention comprised of specific yoga postures, breathing techniques and guided relaxation for managing the symptoms of problematic smartphone usage in university students. Educational institutions and mental health professionals must encourage students to incorporate yoga into their daily routines as a proactive strategy to address problematic smartphone use. In this regard, policymakers should focus on allocating resources to implement these interventions on a larger scale, ensuring wider access and greater impact.
Sources of Funding
The authors received no financial support for the research.
Author Contributions
VT – Methodology, Investigation, Writing – original draft, Writing – review and editing, Visualization; JK – Investigation, Resources, Writing – review and editing; GST – Conceptualization, Methodology, Formal analysis, Writing – review and editing, Supervision
Declaration of generative AI in scientific writing
The authors acknowledge the use of ChatGPT for language correction in the manuscript and confirm that the content was thoroughly reviewed and edited as needed. No generative AI or AI-assisted tools were employed for data analysis,interpretation, or generation of scientific content. The authors take full responsibility for the integrity and originality of the manuscript.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
The authors gratefully acknowledge Dr. Sachin Kumar Sharma, Scientist C, Patanjali Research Foundation, Uttarakhand (India), for his insightful contribution to the statistical analysis of the study.
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