Special Interest Section Quarterly

Sensory Integration
Sponsored in part by The Psychological Corporation
Volume 31, Number 3 • September 2008
Published by The American Occupational Therapy Association, Inc.

The Use of Kripalu Yoga To Decrease Sensory

Overresponsivity: A Pilot Study
■ Kimberly Mollo, MS, OTR/L, Roseann Schaaf, PhD, OTR/L, Yoga as a Possible Treatment for SOR
FAOTA, and Teal Benevides, MS, OTR/L
Hatha yoga was created more than 3,000 years ago as a spiritual dis-
cipline to unify body, mind, and spirit in preparation for transcen-
yres (1989) defined sensory integration as “the neurological

A process that organizes sensations from one’s body and from

the environment and makes it possible to use the body effec-
tively in the environment” (p. 22). Accordingly, persons with sensory
integrative dysfunction have difficulty processing and integrating
sensory information, which has an impact on their ability to partic-
ipate in everyday activities (Schaaf & Smith-Roley, 2006). Several
subtypes of sensory integrative dysfunction have been proposed
(Ayres, 1989; Miller, Anzalone, Lane, Cermak, & Osten, 2007), and
this article focuses specifically on one sensory modulation disorder:
adults with sensory overresponsivity (SOR).
SOR is an exaggerated response to stimuli that generally is con-
sidered harmless or nonirritating (Kinnealey, Oliver, & Wilbarger,
1995). Persons with SOR respond to typical levels of sensation more
quickly, more intensively, and for a longer duration than is usual
(Miller et al., 2007). Studies show that SOR can have a significant
negative impact on participation in daily life activities for adults
affected by this condition (Kinnealey et al., 1995; Kinnealey &
Fuiek, 1999; Pfeiffer, 2002). SOR also has been linked to mental
health disorders such as anxiety and depression (Kinnealey & Fuiek,
1999).
Participation in occupational therapy using a sensory integra-
tive approach is one method used to treat children and adults with
SOR. Treatment for adults with SOR focuses on increased self-aware-
ness of reactions to sensory input, the development of coping
strategies to manage sensory stimuli, and participation in activities
rich in proprioceptive input to help modulate overresponsivity to
stimuli (Blanche & Schaaf, 2001; Henry, Wheeler, & Sava, 2004;
Pfeiffer & Kinnealey, 2003).
Self-initiated proprioceptive input is used to help individuals
“increase body awareness, improve motor coordination, help mod-
ulate arousal level, and aid in the processing of sensation through
other sensory systems” (Blanche & Schaaf, 2001, p. 109). Activities
rich in proprioception are thought to improve self-regulation and
decrease SOR (Blanche & Schaaf, 2001; Pfeiffer & Kinnealey, 2003).
The neurological mechanisms responsible for the impact of proprio-
ception on decreasing SOR are not known; however, plausible
explanations exist. For example, perhaps participation in proprio-
ceptive-rich activities reduces SOR by decreasing sympathetic over-
arousal and enhancing the parasympathetic nervous system’s
(PsNS’s) activity or perhaps the increase in deep breathing that
occurs during heavy work may enhance parasympathetic activation
and, thus, homeostasis.
dence of the human condition (Feuerstein, 1998). The practice of
hatha yoga can improve strength, flexibility, and balance; decrease
blood pressure; help control respiration and heart rate; and improve
metabolic rate; and may relieve symptoms associated with chronic
pain, epilepsy, headache, asthma, insomnia, anxiety, and depres-
sion (Kirkwood, Rampes, Tuffrey, Richardson, & Pilkington, 2005;
Raub, 2002; Riley, 2004; Saper, Eisenberg, Davis, Culpepper, &
Phillips, 2004; Woolery, Myers, Sternlieb, & Zeltzer, 2004). Regular
hatha yoga practitioners demonstrate reduced breathing rates and
this yogic breathing may normalize autonomic nervous system
activity by increasing PsNS tone (Brown & Gerbarg, 2005a; Malathi
& Damodaran, 1999). Kripalu yoga, which involves heavy work,
deep breathing, and intense attention, therefore may be an effective
treatment for persons with SOR.
A Pilot Study of Kripalu Yoga as an Intervention for SOR
The primary purpose of this study was to examine the effectiveness
of kripalu yoga on decreasing SOR in adults with sensory defensive-
ness. Secondary aims were to explore whether changes in parasym-
pathetic activity (vagal tone) occurred after the use of kripalu yoga
Meet the New Chairperson
Renee Watling, PhD, OTR/L, the new Chairperson of the
Sensory Integration Special Interest Section, has been a pediatric
occupational therapist in Washington State since 1992 and has
worked in clinic, school, and private practice settings. Dr.
Watling has lectured extensively at state, regional, and national
conferences on the topics of sensory processing, sensory-based
occupational therapy intervention, and issues related to services
for children with autism. Her publications include both research
and theoretical papers and book chapters. Dr. Watling received
her bachelor’s and master’s degrees in occupational therapy
from the School of Medicine at the University of Washington
and her doctorate from the College of Education at the
University of Washington. Her research focuses on understand-
ing the relationship between sensory processing and behavior,
especially among children with autism spectrum disorders. She
currently holds faculty appointments at the University of
Washington and the University of Puget Sound. ■
 —2—
intervention, whether persons with SOR rated themselves as having
anxiety, and whether any relationships existed among SOR, anxi-
ety, and vagal tone in this population.
Method
This pilot study involved a quantitative preexperimental pretest–
posttest design to evaluate the differences in sensory reactivity, per-
ceived anxiety, and parasympathetic functions in adults with SOR
before and after kripalu yoga intervention. The study was approved
by the university Institutional Review Board. A convenience sample
of adults was recruited at the university and affiliated hospital
through flyers and broadcast e-mail messages.
Participants
Interested persons were screened to determine whether they met
eligibility requirements (n = 128). Inclusion criteria were older than
21 years of age; demonstrated SOR as measured by the Adult
Sensory Profile (a score of > 41 on the sensory-sensitive or sensory-
avoiding quadrants [Brown, Tollefson, Dunn, Cromwell, & Filion,
2001]); not taking any medications that affected cardiac activity; no
physical (including pregnancy) or mental conditions that affected
the person’s ability to participate in the yoga postures in a safe and
controlled manner, that affected heart rate or sweat response, or
that negatively affected the participation of others; and a willing-
ness to participate in a minimum of six 90-minute yoga sessions.
Procedure
After consent, participants completed the Sensory Challenge
Protocol (SCP; McIntosh, Miller, Shyu, & Hagerman, 1999) and the
State/Trait Anxiety Inventory (Knight, Waal-Manning, & Spears,
1983). The intervention phase consisted of six 90-minute kripalu
yoga sessions held at the university (described in more detail later
in the Intervention section). After the intervention, the participants
completed the Adult Sensory Profile (Brown et al., 2001), the
State/Trait Anxiety Inventory, and the SCP. Posttesting took place
within 2 weeks of completion of the intervention.
Instruments
The SCP was used to evaluate autonomic nervous system activity at
baseline and in response to sensory stimuli and involves the admin-
istration of 48 sensory stimuli, 8 in each of the six sensory domains,
with a pseudo-random interval of 13 to 17 seconds between stimuli.
(For a complete description of the SCP, see Miller, Reisman,
McIntosh, & Simon, 2001.)
The State/Trait Anxiety Inventory is a 40-item self-report ques-
tionnaire that assesses the temporary condition of “state anxiety”
and the more general and long-standing quality of “trait anxiety.”
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Adequate psychometric properties of this tool have been established
in the literature: the State/Trait Anxiety Inventory has good internal
consistency and reliability as demonstrated by a Cronbach’s alpha of
0.93 for state anxiety and 0.87 for trait anxiety (Knight et al., 1983).
The Adult Sensory Profile, a trait measure of sensory processing,
is a 60-item self-report questionnaire about behavioral responses to
sensation during daily life activities. Studies of the Adult Sensory
Profile demonstrate that the assessment has good construct validity
as measured by comparing constructs of self-reported sensory avoid-
ing, sensory sensitivity, low registration, and sensory seeking with
physiological measures (Brown et al., 2001). In addition, the assess-
ment has good internal consistency and reliability of subscale
items, with Cronbach’s alpha ranging from 0.77 to 0.82 for four
subdomains, after item analysis and revision (Brown et al., 2001).
Intervention
The kripalu yoga intervention was delivered over a 3-week, six-session
period by a certified kripalu yoga instructor and a student in the
graduate occupational therapy program. The first and last 5 minutes
of each intervention session was spent in open dialogue between
the instructor and the participants to check in and ask questions.
The intervention itself consisted of centering (5 minutes), warm-up
(20 minutes), asana series (yoga postures, 30 minutes), pranayma
(breathing; 5 minutes), final relaxation (15 minutes), and closing
meditation (5 minutes). Three-stage diaphragmatic breathing was
used throughout the yoga sessions. This format not only is a tradi-
tional kripalu yoga class, but also incorporates all components of
hatha yoga practice as suggested by Kirkwood et al. (2005).
Analysis
Each participant’s characteristics were summarized with appropriate
statistics (frequency counts and proportions for categorical variables;
range, median, mean, and standard deviation for continuous vari-
ables). Study outcomes (vagal tone, State/Trait Anxiety Inventory)
were similarly summarized by group and condition. The main analy-
sis used t tests to compare group differences between pretest and
posttest intervention on each measure. In addition, cardiac vagal
tone at baseline, during sensory stimuli, and during the recovery
phases were examined to compare trajectories of each participant
over the three conditions (i.e., group-by-condition interaction) both
preintervention and postintervention. For exploratory purposes,
yoga intervention participant data were compared to a data set of
adults with typical development to examine similarities and differ-
ences preintervention.
Results
Nine (8 women) participants were enrolled in the study. Two partic-
ipants (both women) were lost due to scheduling conflicts. The
final sample, therefore, included 6 women and 1 man between 26
and 53 years of age with educational levels ranging from complet-
ing high school to postgraduate work. One participant had clinical
depression and anxiety but was not currently taking medication. Six
of the 7 participants had taken some form of yoga previously, 1 was
actively taking yoga at the gym, and none had ever participated in a
kripalu yoga class.
Participants demonstrated a significant increase in their cardiac
baseline vagal tone score postintervention (t [5] = -1.046; p = .002),
demonstrating increased PsNS activity. Additionally, vagal tone
increased during the prolonged auditory challenge postintervention
(t [5] = -1.010; p = .079). In addition, a significant decrease in state
anxiety scores postintervention (t [6] = 3.552; p = .012) was found,
indicating a perceived decrease in anxiety level; and the trait anxiety
posttest scores decreased (t [6] = 2.321; p = .059). The participants
demonstrated lower “low registration” scores posttest than pretest
 —3—
scores on the Adult Sensory Profile (t [6] = 2.159; p = .022), possibly
suggesting that sensory defensiveness decreased. Interestingly, the
yoga participants demonstrated significantly lower cardiac baseline
vagal tone (i.e., decreased PsNS activity) than the comparison data
set of adults with typical development (t [48] = -2.9; p = .006) prein-
tervention. Additionally, the yoga participants had higher Adult
Sensory Profile scores preintervention in three of the four quadrants
(low registration, p = .001; sensitivity, p = .001; avoiding, p = .001)
than the comparison group.
Discussion
The results indicate that the participants demonstrated a signifi-
cant increase in baseline vagal tone after the yoga intervention.
This finding supports that yoga practice can increase PsNS activity
and, thus, enhance homeostasis. Participants also demonstrated a
significant decrease in their perceived current anxiety level after
the yoga intervention as measured by the State/Trait Anxiety
Inventory. This finding supports the emerging body of literature
showing that participation in hatha yoga may be a useful practice
to decrease anxiety and enhance well-being, mood, attention,
mental focus, and stress tolerance (Brown & Gerbarg, 2005a,
2005b, 2005c).
The unique data that this study adds are evidence that
enhanced PsNS activity may be the physiological basis for these
improved feelings of well-being. Two findings support this idea.
First, participants had lower baseline (i.e., resting) vagal tone than
the comparison group at preintervention, suggesting poorer PsNS
activity at rest. Given that the PsNS is an important factor in self-
regulation, this finding suggests that persons with SOR may not be
using their PsNS effectively to help regulate and modulate their
responses to typical levels of environmental stimuli. In terms of
implications for occupational therapy, this finding points to the
need for occupational therapy practitioners to incorporate strategies
that facilitate PsNS activity and, thus, enhance self-regulation.
Perhaps heavy work activities improve the PsNS response, a hypoth-
esis that requires further testing but is interesting and supports
anecdotal findings in the literature (Blanche & Schaaf, 2001).
Equally compelling is the finding that baseline vagal tone increased
in the yoga participants, which supports the previously given argu-
ment that participation in proprioceptive-rich activities may
enhance self-regulation (in this case, overresponsivity to sensory
stimuli) through enhanced parasympathetic activity. Thus, occupa-
tional therapy practitioners may want to continue to offer activities
that are rich in proprioception as part of their intervention pro-
grams for SOR and closely monitor the results.
It is also possible that the differences in vagal tone were due to
enhancements in breathing rather than enhanced proprioceptive
input. The literature suggests that diaphragmatic breathing can
enhance PsNS activity and increase vagal tone (Brown & Gerbarg,
2005a). This viable hypothesis requires further testing. Currently,
occupational therapy practitioners who are working with clients with
SOR may find that attending to the breathing patterns and using
diaphragmatic breathing patterns that are part of a yoga program
could be an effective therapeutic strategy (Brown & Gerbarg, 2005a).
In future studies it would be important to include a pretest and
posttest measure of SOR to determine whether changes in SOR are
concomitant with changes in vagal tone and anxiety ratings.
Schoen and Miller are standardizing a new SOR scale that may be
useful in this regard (Schoen, Miller, & Green, 2008). Other limita-
tions include a small experimental sample size, lack of control
group, and lack of randomization. Further, not all participants were
able to attend all six yoga sessions. Thus, future studies would be
strengthened by a longer, more consistent intervention that uses a
more rigorous methodology.
Conclusion
This study provides preliminary support for the hypothesis that
proprioceptive-rich activities can enhance self-regulation and
decrease SOR (Blanche & Schaaf, 2001). Further, it supports the idea
that enhanced PsNS activity may be one mechanism that underlies
this observed response (Brown & Gerbarg, 2005a; Schaaf, Miller,
Seawell, & O’Keefe, 2003). However, these findings are only prelimi-
nary and must be considered in the context of their limitations. ■
Acknowledgments
We thank the participants who gave willingly of their time to par-
ticipate in the study and Susan Toth-Cohen, PhD, OTR/L, who
helped to conceptualize the project and provided design consulta-
tion. We also thank the graduate assistants in the Department of
Occupational Therapy at Thomas Jefferson University—Christina
Chin, Gina Outten, and Ashley Holst—who helped to administer
the SCP to the participants.
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Kimberly Mollo, MS, OTR/L, is Adjunct Faculty, Department of Occupational

Therapy, Thomas Jefferson University, 130 South 9th Street, Edison 810, Philadelphia,
Pennsylvania 19107; Kimberly.Mollo@jefferson.edu
Roseann Schaaf, PhD, OTR/L, FAOTA, is Associate Professor and Vice
Chairman, Department of Occupational Therapy, Thomas Jefferson University,
Philadelphia; roseann.schaaf@jefferson.edu
Teal Benevides, MS, OTR/L, is Instructor and Sensory Integration Lab
Coordinator, Department of Occupational Therapy, Thomas Jefferson University,
Philadelphia.

Mollo, K., Schaaf, R., & Benevides, T. (2008, September). The use of kripalu
yoga to decrease sensory overresponsivity: A pilot study. Sensory Integration
Special Interest Section Quarterly, 31(3), 1–4.

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