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Executive Summary A. AIM The aim of this study is to examine the impact of heated yoga on expanding one’s perception box (i.e., improvements in mindfulness and rumination), as well as explore other secondary outcomes, compared to non-heated yoga, heat alone, and a no yoga/no heat control. B. CONTEXT/BACKGROUND Preliminary research shows that an 8-week, heated yoga intervention for depression (N=64) was feasible and acceptable as well as improved mindfulness (assessed by The Five Facet Mindfulness Questionnaire [FFMQ]), and decreased rumination (assessed by Ruminative Response Scale [RRS]) compared to a control for depressed participants (2–5). We will extend this work to a distressed (i.e., having difficulty with mindfulness), but non-clinical sample. C. IMPORTANCE OF PROJECT This project examines whether heated yoga improves proxies for the perception box compared to non-heated yoga, heat alone, and a no yoga/no heat control. We expect that the heated yoga group will be particularly useful for mindfulness and rumination given that a heated environment, with the mindful movement of yoga, forces an individual into the present moment instead of focused on one’s own internal thoughts or distress. D. HYPOTHESES: 1. Heated yoga will improve mindfulness (i.e., FFMQ total score; primary outcome) and rumination (i.e., RRS total score) compared to non-heated yoga, heat alone, and a no yoga/no heat control. 2. (Exploratory) Heated yoga will improve secondary outcomes (i.e., wellbeing, depression, physical function, fatigue, pain interference, anxiety, social function, sleep disturbance) more so than non-heated yoga, heat alone, and a no yoga/no heat control. E. PROJECT ACTIVITIES Participants will be randomized to an 8-week heated yoga intervention (delivered in a state-of-the-art heated dome), to non-heated yoga, heat alone, and a no yoga/no heat control. The heated (i.e., ~105°F with 40% humidity) and non-heated (i.e., warm, 75°F with no humidifier) yoga will be a standardized 90-minute protocol used in two prior studies of heated yoga (2,3,6–8). The heat only group will be exposed to the same heat environment of the heated yoga group (in the domes). To standardize the two non-yoga groups, the heat only and no heat/no yoga control will be given health education materials utilized in previous control conditions for yoga trials (9,10). Eligible participants will be adults not regularly practicing yoga or meditation, with no contraindications to heated yoga, but experiencing low levels of mindfulness. Participants will complete assessments via REDCap, a secure data capture system, at baseline (Week 0), post-treatment (8 weeks), and after follow-up (12 weeks). We will enroll 5 participants/month over 24-months (allowing 6-months for study start-up, treatment follow-up and dissemination of results which is consistent with recruitment timelines in our previous studies) to obtain a well-powered sample (N=120) compared to a no heat/no yoga control. F&G. OUTPUTS AND IMPACT Heated yoga has great potential to shift one’s perception box. This study will also examine the active component of heated yoga by comparing it to non-heated yoga, heat alone, and a no yoga/no heat control. This study will also allow for effect size estimations for the active comparators.

Additional file 2: Supplementary Table. The association betweensexual minority status/sexual orientation groups and PHQ-9 scores, NHANES 2005to 2014.

Additional file 1. Directed acyclic graph for the study.