In a recent study published in JAMA Network Open, a group of researchers evaluated the efficacy of Sudarshan Kriya Yoga (SKY) in reducing psychological distress and enhancing wellness among physicians at risk of burnout.
Study: Sudarshan Kriya Yoga Breathing and a Meditation Program for Burnout Among Physicians. Image Credit: ZephyrMedia/Shutterstock.com
Background
The prevalence of burnout and stress among physicians, exacerbated by the coronavirus disease 2019 (COVID-19) pandemic, presents serious challenges, impacting healthcare professionals, patient care, and the health system.
This situation underscores the need for effective interventions to alleviate psychological symptoms, enhance sleep quality, and prevent burnout. While organizational measures are crucial, individual strategies that complement these are also essential.
Among these, SKY, a comprehensive wellness program encompassing yoga, unique rhythmic breathing, meditation, and stress management techniques, has shown promise.
This program, effective even when conducted online, has been beneficial in various groups, including war veterans, prisoners, and university students, demonstrating improvements in stress, anxiety, depression, and overall wellness.
Further research is needed to explore these interventions' long-term effects and scalability across diverse healthcare settings and populations.
About the study
The present online randomized clinical trial, conducted from November 2021 to March 2022, compared the effects of SKY and stress management education (SME) on physicians from Turkey, Germany, and Dubai.
Endorsed by the Izmir Biomedicine and Genome Center, it involved physicians aged 25 to 65, excluding those with major illnesses or regular mind-body practice.
The study initially attracted 280 physicians, reducing to 129 participants after screening and randomization to either SKY or SME groups.
The SKY group participated in 1.5-hour online sessions for three days, practicing gentle stretches, breathing exercises, meditation, and cognitive coping skills, followed by daily 30-minute practices and weekly sessions for eight weeks. The SME group received similar training focused on psychological distress reduction.
The study assessed stress, insomnia, anxiety, optimism, depression, professional fulfillment, and self-reported errors using Depression, Anxiety, and Stress Scale (DASS-42), Life Orientation Test—Revised (LOT-R), Regensburg Insomnia Scale (RIS), Professional Fulfillment Index (PFI), mixed linear regression and statistical tests.
Despite limited sex-based analysis due to low male participation, sensitivity adjustments for sex were made. The study, adhering to statistical significance at P < .05, was conducted using Stata SE version 17.0.
Study results
In the present study involving 129 participants, predominantly female Turkish physicians from various specialties, the SKY group demonstrated significant improvements compared to the SME control group. The participants were well-distributed across age groups, with most from Turkey's major cities.
The DASS-42 results indicated that the SKY group experienced a notable reduction in stress and depression after the training and at the 8-week post-intervention point. Anxiety levels also significantly decreased in the SKY group at post-intervention.
These findings, supported by moderate to large effect sizes, underline the positive impact of SKY on mental health parameters. However, no significant differences were noted between high and low adherence groups within the SKY participants in additional analyses.
Regarding optimism, as measured by the LOT-R, no significant differences were observed between the SKY and control groups at any point. Interestingly, higher adherence to SKY practice showed a significant positive effect on optimism at post-intervention.
In terms of insomnia, measured by the RIS, there was a noteworthy decrease in symptoms in the SKY group from baseline to post-intervention, suggesting the intervention's effectiveness in improving sleep quality.
However, the effect sizes were very small, and no differences were found between different adherence levels in the SKY group.
PFI outcomes revealed significant improvements in professional fulfillment, interpersonal disengagement, work exhaustion, and overall burnout in the SKY group. These positive changes were consistent from the baseline to the post-test and follow-up periods.
In contrast, the control group reported higher work exhaustion, interpersonal disengagement, and burnout, with lower professional fulfillment, particularly at follow-up. The effect sizes ranged from small to moderate.
For self-reported medical errors, no intervention effect was observed. However, subgroup analysis indicated that higher adherence to SKY practice resulted in fewer reported medical errors than the control group.
Burnout scores, typically presented in dichotomous categories, showed that the SKY group's scores fell below the burnout threshold at follow-up, in contrast to the control group, which remained above this threshold throughout the study.
Similarly, for professional fulfillment, both groups scored below the desired cutoff across all time points. Sensitivity analyses adjusting for sex did not alter these outcomes, underscoring the robustness of the findings across different demographic groups.
These results highlight the potential of SKY as a beneficial practice for improving mental health and reducing burnout among physicians.
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