Rehabilitation through yoga: Mental health and the right to dignity in prison

Abstract

Prison environments in Latin America are overpopulated, and current policies restrict more interns’ rights, which in turn leads to high rates of violence and mental health issues. All this goes against social justice in terms of equal rights, equal opportunity, and equal treatment. Following the trend of a more positive criminology, a yoga program was designed for prisoners in a penitentiary center in Valparaiso, Chile. Results of the program were measured before and after the workshop in terms of mental health and aggression. Despite no significant differences being observed in the analysis, a trend was identified in terms of stress, anxiety and aggression reduction. To conclude, longer programs with a gender perspective are suggested for future designs.

Keywords

Prisoners mental health aggressiveness yoga

Introduction

Social justice encompasses mental health and well-being, and it opposes violence. It is widely understood as equity in various social rights, services and goods, all aimed at people's well-being. For there to be social well-being, there must be individual well-being first,¹ and thus mental health.² In the context of most prisons in the world, these rights are nullified. This leads to an increase in violence and aggression, impairing well-being and mental health.³ With these concerns, the research presented here has its main objective to measure the impact of a yoga program on prisoners’ psychological well-being and aggression in a Chilean prison.

Currently, prisons are overpopulated, and policies restrict increasingly internś rights.⁴ In Latin America, this situation is no exception, with Chile presenting high rates of overpopulation and violence and lack of resources.⁵ To contribute to the interns’ well-being, a yoga program was designed for prisoners at the Addiction Treatment Center in a penitentiary center in Valparaiso, Chile. Following the trend of a more positive criminology, a yoga program was considered appropriate due to its studied benefits in such settings.^{6,7,8,9,10,11} Results of the program measured before and after the workshop are presented below.

Theoretical framework

Social justice is not an unequivocal term. However, various definitions coincide in three aspects: equal rights, equal opportunity, and equal treatment.¹² By being incarcerated, people have these rights nullified. Mitchelli, Jacowobitz, Campo and Jahnsen (2023) defined social justice in relation to the contested concept of democracy and the UN 2030 sustainable development goals, as the distribution of goods and the pursuit of equity. Moreover, social justice refers to equality of opportunities, that is equitable distribution of resources in a society, seeking to reduce economic, social and cultural inequalities.¹³ It is based on respect for human rights and the need for the State to guarantee decent conditions for all, especially for the most disadvantaged.¹⁴ This concept has evolved from the Fabian socialism of the nineteenth century to include elements such as human dignity and affirmative actions to promote equity.^15,16 Prisons in Latin America lack these perspectives in their operations.

Prisons are longer-term facilities run by the state government that typically hold felons and people with sentences of more than one year.¹⁷ In this context, prisoners are restricted in their rights and freedom and subjected to rules and regulations established by the correctional institution and limited to social justice. These conditions significantly impact overall well-being and mental health.^3,18 Prisoners normally suffer up to seven times more mental health-related problems than the general population.¹⁸ There are high rates of somatic complaints in prisoners such as dizziness, headache, chest pain, nausea, difficulty breathing, and body numbness.⁸ In general, the prison population experiences high levels of aggression, impulsivity, anti-social behavior, and psychiatric problems, with frequent fights that can lead to death.^19,20

Latin American prisons are the most violent in the world, and this was exacerbated during the pandemic²¹ as well as overcrowding, violence, lack of access to basic needs such as health care and to rehabilitation programs.²² The lack of aid and security provided to prisoners lead to rebellions and elevated violence rates.²³ According to the Prison Insider database (2020), prison occupancy in Chile stands at more than one hundred percent.^4,24 This is due to the punitive anti-crime policies that increase the rates of incarceration and the time spent in prison. This results in overcrowding, violence and recidivism.^25,26 There are serious irregularities in prisons, mainly related to infrastructure, health and living conditions.²⁶ This reflects both the lack of resources in Chilean prisons, as well as the fact that prisons (and prisoners) have low priority for governments and politicians. Prison reinforces social exclusion and lack of social justice in Chile.²⁵ In relation to prisoners’ mental health in Chile, prevalence of stress, somatic complaints, anxiety and depression have been revealed.^27,28,5

In recent years, some countries have adopted a more positive criminology, focusing on the holistic study of crime considering victims, police forces, the judicial system and programs for the inclusion and reintegration of offenders. Over time, the purpose of correctional institutions in countries such as Sweden and Israel, has experienced a substantial change, shifting from isolation and punishment to prevention of relapse by using different treatment programs.^29,30,8,31 Among these programs, yoga has become popular in many correctional institutions as a complementary rehabilitation tool offered to prison inmates.

Yoga is a holistic health discipline designed to bring balance in all the dimensions of the individual, recognized as a form of mind-body medicine.^32,33 Yoga has integral health benefits that go beyond simple physical conditioning. Previous studies have shown that yoga improves mood, stress and verbal aggression.¹¹ Moreover, it helps to reduce symptoms in prisoners with depression and post-traumatic stress disorder (PTSD),^9,7 helping with somatization and social interactions and decreasing anxiety and obsession.⁸ Regular yoga practice is associated with increased levels of impulse control, reduced aggression, and antisocial behaviors,⁹ variables related to criminal behavior.

A study by Kerekes (2019) showed that a 10-week-long yoga practice intervention among male inmates in Swedish correctional facilities increased inmates’ character maturity, and also improved their capability to take responsibility, feel more purposeful, and to be more self-acceptant.³⁴ Studies in Israel and North Carolina found lower rates of recidivism for those who practiced yoga while incarcerated.⁶ Some studies show that inmates continue the practice of Yoga throughout their lives, even outside of prison, which shows that they are making a permanent change with this practice.⁷ Also, yoga fosters compassion, understanding and the desire for personal growth, all very important factors in the rehabilitation of inmates.¹⁰

Yoga leads to neurobiological changes related to the sympathetic and parasympathetic functions of the autonomic nervous system, as well as on the regulation of the hypothalamus-pituitary-adrenal (HPA) axis.^35,36,37 Regular yoga exercise can reduce the levels of cortisol and catecholamines (adrenaline and noradrenaline) increasing serotonin, melatonin, brain-derived neurotrophic factor (BDNF) and gamma-amino butyric acid (GABA), which are key for the regulation of mental health.³⁸ Reductions in sympathetic activity such as heart rate are associated with improved self-esteem and mental and emotional states as well as with better memory and concentration capacities,³⁹ better sleep and reduced aggression.⁴⁰

One of the factors determining relapses of inmates is mental health issues and violence levels,⁴¹ and so this should be the focus in correctional institutions. Prison environments normally address basic physical needs, ignoring higher order mental, spiritual, relationship or connectedness needs,⁴² and thus ignoring social justice.

Following the trend of a more positive criminology, the aim of the present study was to apply a yoga program to a population of interns at the Valparaiso prison in Chile, considered as one of the most violent and dangerous in the country. The first objective of the study was to establish the effects of yoga practice on aggressiveness and aggression, and the second objective was to determine the effects of yoga on stress, anxiety and depression in prisoners. Methodology and results of the program measured are presented below.

Methods

Study design and procedure

The research reported here was a non-experimental, cross-sectional, descriptive and relational design, using quantitative techniques. The quantitative universe is the entire population of the studied penitentiary center is approximately 2600 people, from which a sample of 13 interns was obtained for this pilot study, with a non-parametric stratified random sampling. The studied group belongs to the Addiction Treatment Center (ATC), which is specialized in people with alcohol and/or drug use problems within the male penal unit. Established in 2003, it hosts up to 20 users, who share rooms for 2–3 people in an intervention module. The treatment program has a duration of up to 12 months. In this study, the total number of 13 Participants at ATC was invited to four weeks of a Trauma Sensitive Yoga workshop, composed of 4 sessions of one hour each. Each session consisted of a practice of meditation practice for 15 min, a set of asanas (postures) and pranayama (breath control) practice for 30 min and a final relaxation practice for 10 min. A certified teacher was in charge in each session. Participants were contacted through professionals responsible for the unit. Their participation was compulsory, and it provided them with behavioral benefits. No one refused to participate. Participants came from different cities in Chile, and one person came from Venezuela.

Instruments

PAMA and DASS-21 scales were used to collect data, since both have been previously used in studies with prisoners,^9,5 along with a sociodemographic questionnaire including questions about their age, nationality, time in prison, violence exposition and drug intake, among others.

Dass-21: The abbreviated DASS-21 scale, validated in Chile,⁴³ was also used to measure depression, anxiety and stress. This instrument is composed of 21 statements, seven for each dimension, with a response scale ranging from 0 to 3, where 0 represents “does not apply to me at all,” and 3 “applies to me most of the time.” A lower score (close to 0) on the DASS-21 indicates a normal or minimal level of symptoms, suggesting little to no current impact of depression, anxiety, or stress on the person. A higher score indicates more severe symptoms: for depression, scores range from normal (0–9) up to extremely severe (28+). In the case of anxiety, scores range from normal (0–7) up to extremely severe (20+), and for stress from normal (0–14) up to extremely severe (34+). The DASS-21 scores are multiplied by 2 to calculate the final score. For data analysis, both descriptive and inferential statistical analysis techniques were used, assisted by the Jamovi software.

PAMA: Prison Adjusted Measure of Aggression (PAMA) Prison Adjusted Measure of Aggression is an 11-item instrument used to measure the frequency of prison inmates’ aggressive and antisocial behavior during the past month. It is an adapted version of the Life History of Aggression (LHA) scale. Adaptations were made by the Forensic Psychiatry Group at the Sahlgrenska Academy and included the time frame and wordings of certain items. Whereas the LHA measures aggressive and antisocial behavior since age 13 (trait aggression), PAMA focuses on past month's aggressive and antisocial behavior (and has the capacity to detect changes in aggressive behavior). The format of PAMA remains the same as that for LHA, with 11 items distributed over three subscales. These subscales are as follows: (1) a five-item aggression subscale (which measures overt aggression and includes items on temper tantrums, verbal and indirect aggression, nonspecific fighting, and physical assault against people), (2) a two-item, self-directed aggression subscale (which includes items on self-injurious behavior and suicide attempts), and (3) a four-item antisocial behavior subscale (which measures antisocial behavior and its consequences with items on disciplinary problems in the correctional facility, problems with supervisors, and antisocial behavior resulting in or not resulting in correctional officers involvement). Items are rated on a 6-point scale based on the total amount of occurrences during the last month: 0 = no occurrences, 1 = 1 event, 2 = 2 or 3 events, 3 = 4–9 events, 4 = 10 or more events, and 5 = more events than can be counted. In a validation study, the psychometric properties of PAMA were examined, where the subscales and the total scale showed an acceptable level of intern consistency reliability,^9,44 the psychometric properties of PAMA were examined, where the subscales and the total scale showed an acceptable level of intern consistency reliability. Lower scores indicate lower levels of aggression across these dimensions, suggesting less aggressive behavior and attitudes. Higher scores reflect higher levels of aggression, with significant associations to more prison sentences and violent offenses. Inmates with previous sentences and violent crime convictions tend to score higher on both the short and long versions of the aggression scale.

Data analysis

Descriptive and inferential statistical techniques were used to process quantitative data. Measures of central tendency, dispersion, and concentration were applied. Descriptive statistics were used to characterize the studied population and to measure the effects of yoga in each scale of each test. Moreover, variables were also cross-referenced to establish relationships. Due to the sample size a T Student statistics was used. Analysis was assisted with the Jamovi software.

Quality and ethical criteria

Rigor and ethical criteria were applied throughout all the research. First, the reliability and validity of the used scales were considered. Likewise, ethical approval was obtained from the Ethical Committee of Adolfo Ibáñez University prior to data acquisition. Moreover, ethical criteria were followed and respected through the study, which also ensured the quality of this research. Data collection was performed in 2025 in the Valparaíso prison. The battery of questionnaires was disseminated in person. At the beginning of the project, participants received a document with the aims and scope of the research, along with an informed consent form to agree to participate and to be under study. Participants also received information on the confidentiality of the study and their rights prior to data collection. An informed consent document was signed by participants. They were also informed that they could withdraw at any time without giving any reason for doing so. Consideration was also given to retribution to participants and the studied institution, through the delivery of a final research report to them.

Regarding data analysis, descriptive statistics were used to characterize the studied population and to measure the effects of yoga in each variable. Moreover, the T student test was used to determine the significance of these impacts.

Results

The present study included 13 men, 12 Chilean and one Venezuelan, whose average age was between 30 and 35 years. The majority (62%) had been a user in the study center for between one and two years. In terms of gender, they all defined themselves as men. The majority declared to be single (50%) and married (27.7%). Generally, their education level was basic (66.6%) to high school (16.6%), and most of them did not work previously (55.5%). The majority had a family network (83.3%), composed of partners, children and extended family. Most participants declared not to have suffered violence during their childhood (66.6%) and adulthood (77.7%), not even in the last few months (94.4%) within the prison. Regarding details by specific objectives, firstly, to establish the effects of yoga practice on aggressiveness and aggression, the PAMA scale was used. Reliability scores for PAMA and for Dass-21 were calculated. Cronbach's alpha for Dass21 was 0.95, suggesting high reliability. In the case of PAMA, a score of 0.86 also suggested high reliability. Regarding aggression, participants post yoga scored a median of three, suggesting lower levels of aggression. For the Dass21 dimensions, the median scores were: for stress 6 (normal), in depression 0 (normal), and in anxiety 1 (normal). To prove the hypothesis of average differences, a T Student for non-parametric and related samples was used, assisted by Jamovi, and using de test F, no significant changes were found in these aspects when comparing answers before and after the Trauma Sensitive Yoga workshop. Also, the Wilcoxon Signed Rank test was calculated, as shown in Table 1.

Table 1.

Student T-test for aggressiveness (PAMA) pre and post yoga.

T-test for paired samples
			Statistic	p		Effect size
Total aggressiveness PRE	Total aggressiveness POST	Wilcoxon W	16.0^a	0.262	Biserial correlation of ranks	−0.418
Descriptives

		N	Average	Median	DE	EE
Total aggressiveness PRE		13	3.31	1	7.36	2.04
Total aggressiveness POST		13	7.15	3	9.56	2.65

Note. Figure by authors.

^aValues p < .05 were considered significant.

As this table shows, there are changes in antisocial behavior and self-directed aggression after the implementation of the yoga workshop. However, these cannot be considered significant.

To answer the objective of determining the effects of yoga on stress, anxiety and depression in prisoners, the DASS 21 scales were used. Here, no significant changes were established when comparing averages results before and after, as shown in Tables 2, 3 and 4.

Table 2.

Student T-test for stress Dass21 pre and post yoga.

T-test for paired samples
			Statistic	p		Effect size
STRESS PRE	STRESS POST	Wilcoxon W	67.5	0.132	Biserial correlation of ranks	0.484

Descriptives
	N	Average	Median	DE	EE
STRESS PRE	13	5.92	6	3.28	0.909
STRESS POST	13	3.77	1	5.97	1.657

Table 3.

Student T-test for depression Dass21 pre and post yoga.

T-test for paired samples
			Statistic	p		Effect size
DEPRESSION PRE	DEPRESSION POST	Wilcoxon W	55.5^a	.050	Biserial correlation of ranks	0.682
Descriptives

		N	Average	Median	DE	EE
DEPRESSION PRE		13	5.46	5	4.29	1.19
DEPRESSION POST		13	2.38	0	4.54	1.26

Note: Figure by authors.

^aValues p < .05 were considered significant.

Table 4.

Student T-test for anxiety Dass21 pre and post yoga.

T-test for paired samples
			Statistic	p		Effect size
ANXIETY PRE	ANXIETY POST	Wilcoxon W	40.5^a	.202	Biserial correlation of ranks	0.473
Descriptives

		N	Average	Median	DE	EE
ANXIETY PRE		13	4.92	4	3.50	0.970
ANXIETY POST		13	3.23	1	5.09	1.410

Note: Figure by authors.

^aValues p < .05 were considered significant.

Tables 2, 3 and 4 show that there is a reduction on each of the three dimensions, stress, anxiety and depression, after the yoga program. Nevertheless, none of these transformations are significant.

Discussion

Statement of principal findings

Results of the yoga program were measured before and after the workshop in terms of mental health and aggression using previously tested instruments; Dass21 and PAMA, respectively. The results of the study showed that, although some changes in averages were identified per scale, these changes were not statistically significant. More specifically, aggression rates were not decreased after the program, which is consistent with previous findings that also noted modest changes in verbal aggressiveness with yoga. This indicates that the effects of yoga on aggression may vary based on individual factors and the specific yoga practices undertaken.⁴⁹

On the other hand, the Dass21 instrument, applied before and after the yoga program to measure mental health, showed a trend towards lower levels of stress, anxiety and depression. This is consistent with previous studies by the groups of Kerekes^9,34 and Sfendla⁸ in which prisoners reported decreased stress levels, and improved performance in tasks assessing impulsivity and attention. Another study by Uebelacker et al.,⁵⁰ reported high participant satisfaction after a 10-week yoga program, and observed trends toward decreased anger, depression, and anxiety.

Weaknesses of the study

In relation to the limitations of the study, it should be noted that the answers obtained with the instruments depend on the victim's participant's report, which is biased by its interpretation, along with the fear of the consequences of the answers, and distrust in authorities. Together with this, and as already mentioned, cultural beliefs in Latin America are strongly affected by the masculine idea of a “macho” as strong and aggressive. This can lead to altered (unrealistic) values in relation to aggressiveness, anxiety, stress or depression levels. As an alternative to data collected through surveys, it is proposed to conduct qualitative research by means of interviews. The use of structured or semi-structured interviews makes it possible to generate detailed information on the state of mental health, aggressiveness or subjective well-being in prison before and after a yoga program.

Another limitation is the number of inmates participating in the research, along with the fact that it was carried out in only one penitentiary center in Chile. Also, participants were only male. However, despite limitations, the research allows us to obtain information about the reality of mental health and aggressiveness before and after application of a yoga program, which is a contribution, due to the scarceness of these programs in the country. In addition, this research shows the need to design and implement specific yoga programs for prisoners, exploring a more positive criminology in Chilean prisons.

Strengths

To our knowledge, this is the first study conducted in a Chilean prison applying a yoga program to test for mental health and aggressiveness. The results presented here continue to point to the relevance of studying the mental health of prisoners, to make progress in respecting human rights as democratic and diverse societies, and in terms of ethical aspects linked to research of this type. Offering this relatively cheap and simple option of a yoga program, might have multiple benefits for prisoners’ wellbeing, helping in managing mental health problems and regulating aggressiveness. Working according to these other variables could help to reduce aggressiveness and improve mental health amongst prisoners, increasing their health and wellbeing, and thus their access to social justice.

Strengths and weaknesses in relation to other studies

Prison environments impact the well-being and mental health of prisoners, who normally suffer up to seven times more mental health-related problems than the general population.^3,18 In general, the prison population experiences high levels of aggression, impulsive, anti-social behavior, and psychiatric problems.²⁷ The state of the art on social justice in prisons addresses the inclusion of cultural and artistic programs as tools for resocialization, such as yoga. It is recognized that access to culture is a right of inmates, promoting their rehabilitation and social reintegration.⁴⁵

However, there are challenges such as overcrowding and lack of resources in prison systems.^46,47 In Chile, intersectoral policies focused on human rights and social reintegration have been developed, encompassing education, work and health.⁴⁸ These approaches seek to transform the prison experience into opportunities for personal development. Following the trend of a more positive criminology, this study analyzed the effects of a yoga program in a penitentiary center in Valparaiso, Chile.

The prison environment is marked by stressful situations, violence, and injustice. There are several possible explanations for the high levels of aggression, stress, anxiety and depression at baseline. In terms of mental health, prisoners normally suffer up to seven times more mental health-related problems than the general population.¹⁸ This is explained by overcrowding, violence, and lack of access to basic needs such as health care and to rehabilitation programs.²² In terms of aggression, we observed an increase in antisocial behavior and aggressiveness after the yoga program: this can be due to either withdrawal symptoms from drug use (the center's users are in the process of detoxification) or to having to participate in yoga activities on a mandatory basis. This added to the fact of being in a place full of rules and limitations, can generate more aggression. The friction and arguments between inmates due to overcrowding and lack of space could also lead to higher levels of aggression.

Finally, it should be emphasized that the room for the improvement of inmates does not depend solely on having activities in which they can freely participate, but also requires a commitment from the institution, both in terms of funding to enable the implementation of these workshops and the infrastructure to carry them out. Chile still has a punitive prison system, where people deprived of their liberty must “pay” for their crimes. In this context, a shift towards a more human paradigm that allows for personal well-being and growth is necessary, especially in terms of reintegration.

In relation to the absence of significant results after the application of the yoga program, different possibilities arise; one is the need to design new methodologies to isolate variables that could influence aggression and mental health. Another is the option of contrasting this intervention with one which is more focused on traditional physical activity, since yoga could generate a certain degree of rejection in a reality where hegemonic masculinity prevails.⁵¹ Inmates tend to willingly participate in various workshops and activities within the center, which are normally mandatory, as they help them earn behavior points. In this specific case, given the characteristics of the program and the fact that yoga is still sometimes considered a more “feminine” activity,⁵² making the program mandatory may be counterproductive in terms of users participating consciously and wholeheartedly. For future interventions, it is necessary to reconsider this and allow free and voluntary participation.

Meaning of the study: Possible mechanisms and implications for clinicians or policymakers

It is important not to discredit the results from these findings. On the contrary, they indicate that there is a need to explore further on this and to determine which variables improve mental health and reduce aggressiveness in a prison setting. In this sense, the authors suggest designing yoga programs that last longer and are applied more frequently (2–3 times a week) to obtain more significant results. Moreover, a gender perspective is also essential in these programs; masculinity present in Latin American countries (and prisons) may require yoga programs adapted to these socio-cultural aspects. Also, mental health aspects and needs are different between men and female prisoners,⁵³ with women suffering (or reporting) more depression, anxiety and self-injuries.²⁷

Unanswered questions and future research

Some of the questions for future research which arise from this study are: What are the appropriate research methodologies and strategies to study this type of population? As mentioned above, the responses obtained using the PAMA and Dass21 instruments depend on a structured and limited measurement, and furthermore, the questions are not always easy to understand. It is proposed to use personalized interviews as a complement, where inmates can express themselves more freely. This will provide richer and more detailed information regarding their state of health and psychological well-being. New validated instruments for prison environment are also to be considered as future research opportunities.

In addition, future research will focus on the application of this same program to women to see the impact it has on their mental health and levels of aggression. As part of prison life, men may prefer high-impact physical activities such as soccer or rugby, and so it is possible that yoga programs yield better results in women. Investigating the impact of yoga on interoception would also be of interest, given that many female inmates arrive at prison with post-traumatic stress and, therefore, with serious dysfunctions in terms of connecting with their own bodies and regulate emotions, among others.

Finally, implementing other types of programs such as physical conditioning or art therapy could also contribute to reducing stress and anxiety levels and regulating aggression. This is being considered for the future as part of the program of activities with inmates.

Footnotes

ORCID iD

Isabel Benjumeda Wynhoven

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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