Effect of traditional yoga, mindfulness-based cognitive therapy, and cognitive behavioral therapy, on health related quality of life: a randomized controlled trial on patients on sick leave because of burnout

Astrid Grensman, Bikash Dev Acharya, Per Wändell, Gunnar H Nilsson, Torkel Falkenberg, Örjan Sundin, Sigbritt Werner, Astrid Grensman, Bikash Dev Acharya, Per Wändell, Gunnar H Nilsson, Torkel Falkenberg, Örjan Sundin, Sigbritt Werner

Abstract

Background: To explore if health related quality of life(HRQoL) increased after traditional yoga(TY), mindfulness based cognitive therapy(MBCT), or cognitive behavioral therapy(CBT), in patients on sick leave because of burnout.

Methods: Randomized controlled trial, blinded, in ninety-four primary health care patients, block randomized to TY, MBCT or CBT (active control) between September 2007 and November 2009. Patients were living in the Stockholm metropolitan area, Sweden, were aged 18-65 years and were on 50%-100% sick leave. A group treatment for 20 weeks, three hours per week, with homework four hours per week. HRQoL was measured by the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, each with a separate index, and scores from 0 (worse) to 100 (best). SWED-QUAL covers aspects of physical and emotional well-being, cognitive function, sleep, general health and social and sexual functioning. Statistics: Wilcoxon's rank sum and Wilcoxon's sign rank tests, Bonett-Price for medians and confidence intervals, and Cohen's D.

Results: Twenty-six patients in the TY (21 women), and 27 patients in both the MBCT (24 women) and in the CBT (25 women), were analyzed. Ten subscales in TY and seven subscales in MBCT and CBT showed improvements, p < 0.05, in several of the main domains affected in burnout, e.g. emotional well-being, physical well-being, cognitive function and sleep. The median improvement ranged from 0 to 27 points in TY, from 4 to 25 points in CBT and from 0 to 25 points in MBCT. The effect size was mainly medium or large. Comparison of treatments showed no statistical differences, but better effect (small) of both TY and MBCT compared to CBT. When comparing the effect of TY and MBCT, both showed a better effect (small) in two subscales each.

Conclusions: A 20 week group treatment with TY, CBT or MBCT had equal effects on HRQoL, and particularly on main domains affected in burnout. This indicates that TY, MBCT and CBT can be used as both treatment and prevention, to improve HRQoL in patients on sick leave because of burnout, reducing the risk of future morbidity.

Trial registration: July 22, 2012, retrospectively registered. ClinicalTrails.gov NCT01168661 .

Funding: Stockholm County Council, grant 2003-5.

Keywords: Burnout; Cognitive behavioral therapy; Exhaustion syndrome; Integrative medicine; Mind-body therapies; Mindfulness-based cognitive therapy; Randomized controlled trial; Stress-related disorder; Traditional yoga; Work-related stress.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Research Ethics Committee South at KI, Stockholm, Sweden. All procedures performed in studies involving human patients were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual patients included in the study. Trial registration: July 22, 2012, retrospectively registered. ClinicalTrails.gov NCT01168661.

Consent for publication

“Not applicable”

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram
Fig. 2
Fig. 2
Test of treatment effect (post-pre)a in SWED-QUALb median, subscales scores, ranging from 0 (worst) to 100 (best) possible, after 20 weeks treatment with Traditional Yoga (TY), Cognitive Behavioral Therapy (CBT) (control) or Mindfulness-based Cognitive Therapy (MBCT). Significant p-values, P < 0.05, and after Holm-Bonferroni correction are indicated by (*).Legend: a Wilcoxon’s sign-rank test was used for comparisons in each group b Swedish Health related Quality of Life Questionnaire

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