By Ellen Feldman, MD
Altru Health System, Grand Forks, ND
SYNOPSIS: A randomized controlled study of 129 physicians demonstrated that a two-month regimen of sudarshan kriya yoga, incorporating stretching, breathing, and meditation, is associated with reduced stress, anxiety, and depressive symptoms when compared to conventional stress management training.
SOURCE: Korkmaz A, Bernhardsen GP, Cirit B, et al. Sudarshan kriya yoga breathing and a meditation program for burnout among physicians: A randomized clinical trial. JAMA Netw Open 2024;7:e2353978.
Sir William Osler (1849-1919) cautioned, “We doctors do not ‘take stock’ often enough. In no relationship is the physician more often derelict than in his duty to himself …”1
This observation resonates profoundly today, as evidenced by the 2020 International Classification of Diseases (11th revision) classification of burnout as a syndrome resulting from chronic workplace stress impacting an estimated 50% of practicing healthcare providers worldwide.2,3
First identified in 1974 by psychologist Herbert Freudenberger, burnout describes the severe stress condition leading to physical and emotional exhaustion, often experienced by professionals in high-stress environments.4
This phenomenon poses a significant risk to physicians and other healthcare workers at every stage of their careers. Multiple studies underscore that burnout among medical providers not only compromises their well-being but is linked to suboptimal patient outcomes. Consequently, there is growing emphasis on strategies to understand, address, and prevent burnout as early as possible in the professional lifecycle of healthcare workers.5
Numerous studies have underscored the importance of robust organizational measures and support coupled with personal wellness initiatives as the most effective strategy to mitigate burnout among healthcare providers.5,6 In this context, Kormaz et al explored the potential of sudarshan kriya yoga (SKY), a specialized yoga program previously noted for its beneficial effects on stress and anxiety in other high-risk groups.7
SKY involves gentle stretching, unique breathing techniques, meditation, and cognitive behavioral interventions aimed at enhancing coping skills.6 For this study, the program was administered online to a small group for 1.5 hours over three consecutive days followed by instructions to practice about 30 minutes daily and participate in weekly hourlong group practice sessions for the eight-week follow-up period.
Conversely, participants randomized into the control group were trained in generic stress management education (SME) following a similar schedule. They also were asked to practice daily and attend weekly hourlong group discussions during the eight-week follow-up period.
This study recruited practicing physicians aged 25 to 65 years from various provinces across Turkey and from select regions in Dubai and Germany. Physicians who regularly practiced mind-body activities, such as yoga or meditation, or who had major mental or physical illness were excluded.
Out of the 238 physicians who qualified, 129 enrolled, all of whom completed the eight-week study. Notably, 89% of this final group were female.
Self-report, validated scales were used to gauge levels of anxiety, depressive symptoms, stress, burnout, and insomnia. Self-reported medical errors were measured as well. The effectiveness of the interventions was measured using Cohen’s d to determine effect sizes paired with statistical significance of the result (P value).
At the end of the eight weeks, physicians in the intervention group reported significantly lower levels of stress (P = 0.03), depressive symptoms (P < 0.001), and anxiety (P = 0.02), with effect sizes from medium to large. While statistically significant insomnia improvement and burnout reduction were reported in this group (P = 0.01), the effect sizes were much smaller. There was no significant improvement in self-reported medical errors.
Commentary
This randomized study of physicians offers clinically pertinent insights into the ongoing research on stress and burnout among medical care providers. While numerous studies have pointed to the need for organizational measures (such as reducing the burden of documentation) to alleviate these issues, the contribution of personal efforts at optimizing wellness remains underexplored.4,5
The participants in the SKY active intervention group reported significant reductions in stress, depressive symptoms, and anxiety over the eight-week period. Although the effect on burnout and sleep was less pronounced, it still was significant.
The modest impact on burnout level may relate to findings from other studies, which suggest that successful interventions toward healthcare provider burnout require both organizational and individual efforts toward wellness.
Drawing clear conclusions from this study about the efficacy of SKY compared to other forms of yoga or other mind-body programs (guided meditation, etc.) is challenging. This is because the control group only used generic stress reduction techniques. To make firm recommendations and perhaps provide individual guidance, further research is needed to explore the mechanisms and overall effectiveness of various mind-body interventions.
It is noteworthy that 238 physicians showed initial interest in the study, yet only 129 enrolled. This attrition could be attributed to scheduling conflicts, but it might reflect a broader disinterest in mind-body exercises among some physicians. Additionally, the predominately female composition of the final participant group suggests a gender bias in those who opted to continue, emphasizing the need for future studies designed to attract a more diverse group of participants.
Likewise, extending the studies across a wider geographic pool may help to ultimately generalize these results and provide firm recommendations for all healthcare providers.
The self-report nature of the outcome surveys may be seen as an additional limitation of this study. Incorporating objective measures, such as wearable tracking devices for sleep and practice adherence, and blood tests for inflammatory markers, could bolster the credibility and generalizability of future research.
Despite these limitations, the study’s findings are invaluable. They underscore the potential of targeted mind-body interventions to reduce stress indicators and enhance well-being of physicians. Ongoing research should continue to refine these approaches, ensuring they are accessible and effective for all healthcare workers, regardless of the specific circumstances or practice setting.
References
- Faculty of Medicine. Father of medicine: Sir William Osler and his inspirational words. Published July 10, 2017. https://forum.facmedicine.com/threads/father-of-medicine-sir-william-osler-and-his-inspirational-words.31013/#google_vignette
- World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. Published May 28, 2019. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
- Naji L, Singh B, Shah A, et al. Global prevalence of burnout among postgraduate medical trainees: A systematic review and meta-regression. CMAJ Open 2021;9:E189-E200.
- Freudenberger HJ. Staff burn-out. J Soc Issues 1974;30:159-165.
- Maresca G, Corallo F, Catanese, et al. Coping strategies of healthcare professionals with burnout syndrome: A systematic review. Medicina (Kaunas) 2022;58:327.
- Cohen C, Pignata S, Bezak E, et al. Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: A systematic review. BMJ Open 2023;13:e071203.
- Hamilton-West K, Pellatt-Higgins T, Sharief F. Evaluation of a sudarshan kriya yoga (SKY) based breath intervention for patients with mild-to-moderate depression and anxiety disorders. Prim Health Care Res Dev 2019;20:e73.
A randomized controlled study of 129 physicians demonstrated that a two-month regimen of sudarshan kriya yoga, incorporating stretching, breathing, and meditation, is associated with reduced stress, anxiety, and depressive symptoms when compared to conventional stress management training.
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