Efficacy of different yoga techniques on negative and cognitive symptoms of schizophrenia – A comparative study

Background: Schizophrenia is often marked by persistent negative symptoms and cognitive impairments that respond poorly to standard pharmacotherapy. Yoga, as a culturally acceptable mind-body intervention, is being explored as an adjunct treatment. Methods: This comparative study evaluated six yoga-based modules – Surya Namaskars, Assorted Asanas, Pranayama, Om Japa, Relaxation Yoga, and Energizer Yoga – alongside an aerobic exercise group and a no-intervention control group. A total of 667 participants with chronic schizophrenia were quasi-randomly assigned to these eight groups. Outcomes were assessed using Negative Symptom Assessment-4 (NSA-4), Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), and Mini-SEA for social cognition. Results: All yoga modules led to significant improvements in social cognition, with effect sizes (Mini-SEA) ranging from 0.42 to 0.61. However, the degree of improvement in negative symptoms varied, with Relaxation Yoga and Surya Namaskars showing the highest impact (NSA-4 effect sizes up to 0.76). Percentage improvements across modules ranged between 18% and 34% on NSA-4 and 22% to 36% on B-CATS scores. Aerobic exercise produced moderate cognitive gains but minimal change in negative symptoms. Conclusion: Yoga-based interventions offer promising adjunctive benefits for negative and cognitive symptoms in schizophrenia. Simpler and more engaging techniques like Relaxation Yoga and Surya Namaskars showed higher compliance and impact, underscoring their practical applicability in routine clinical care. These culturally consonant practices are feasible, low-risk, and cost-effective, making them particularly suitable in the Indian context.