Background
A | Physical and mental symptoms of exhaustion with minimum 2 weeks duration. The symptoms have developed in response to one or more identifiable stressors which have been present for at least 6 months | |
B | Markedly reduced mental energy which is manifested by reduced initiative, lack of endurance, or increase of time needed for recovery after mental efforts | |
C | At least four of the following symptoms have been present most of the day, nearly every day, during the same 2 week period: | |
1 | Persistent complaints of impaired memory | |
2 | Markedly reduced capacity to tolerate demands or to work under time pressure | |
3 | Emotional instability or irritability | |
4 | Insomnia or hypersomnia | |
5 | Persistent complaints of physical weakness or fatigue | |
6 | Physical symptoms such as muscular pain, chest pain, palpitations, gastrointestinal problems, vertigo or increased sensitivity to sounds | |
D | The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning | |
E | The symptoms are not due to the direct physiological effects of a substance (e.g. abuse of a drug, a medication) or a general medical condition (e.g. hypothyroidism, diabetes, infectious disease) | |
F | The stress-related disorder does not meet the criteria for major depressive disorder, dysthymic disorder or generalized anxiety disorder |
Rehabilitation for burnout
Yoga in health care
Mindfulness–based cognitive therapy
Aims
Methods
Settings and participants
Inclusion critera: • Aged 18 through 65 years • Being on at least 50% sick-leave at the interview. Sick-leave for a maximum of one year if on full-time sick leave at the interview, or for a maximum of three years if on part-time sick leave at the interview • Body mass index (BMI) of between 18 and 26 • Meets the diagnostic criteria for Exhaustion Syndrome from the Swedish National Board of Health and Welfare, ICD 10 code; F43.8A | |
Exclusion criteria: • Having other diseases that could give similar symptoms or hamper recovery • Not speaking Swedish well enough and not being well enough to participate in the study interventions • Using medication, including medication containing glucocorticoids. Exceptions: antidepressants, sedatives, contraceptives and hormone replacement therapy. The patients were asked to take the same prescribed doses at both assessment times. |
Dropouts
Interventions
Traditional yoga
Exercises Name in Sanskrit (Name in English) | Weeks 1–5 | Weeks 6–20 |
---|---|---|
Padahastasana (Standing forward bend) | X | X |
Supta pawanmuktasana (Knee-lock pose) | X | X |
Bhujangasana (Cobra pose) | X | X |
Ardha Salambhasana (Half grasshopper pose) | X | X |
Digapranam (Salutation) | X | X |
Vajrasana (Diamond pose) | X | |
Breathing exercise | X | X |
Vipareet Karan Mudra (Inverted pose) | X | |
Matsyasana (Fish) | X | |
Yoga Mudra (Sitting, forward bend) | X | |
Tadasana (Mountain pose) | X | |
Kapal Bati (Bellow breathing) | X | |
Chakki Chalanasana (Grind grain) | X | |
Meditation | X | X |
Mindfulness–based cognitive therapy
Cognitive behavioral therapy
Assessment
Subscale | No. of items | Description | |
---|---|---|---|
Physical wellbeing | |||
Physical functioning | 7 | Extent to which health interferes with ability to perform physical activities (e.g., heavy manual work, sports, climbing stairs, dressing) | |
Satisfaction with physical functioning | 1 | Satisfaction with physical ability to do what wanted | |
Pain, frequency and intensity | 6 | Pain frequency, intensity and interference with activities of daily life (ADL), sleep and mood | |
Role limitation due to physical health | 3 | Extent to which physical problems interfere with ADL | |
Emotional wellbeing | |||
Role limitation due to emotional health | 3 | Extent to which emotional problems interfere with ADL | |
Positive affect | 6 | Is a happy person, felt liked, emotionally in harmony, much to look forward to | |
Negative affect | 6 | Felt nervous, tense, down, sad, impatient, annoyed | |
Cognitive function | 6 | Concentration, memory, capacity to take decisions, confusion | |
Sleep | 7 | Problems with sleep initiation and maintenance, sleep adequacy and somnolence | |
General Health perceptions | 8 | Health: prior and current, overall rating of health, immune defense, health worries | |
Satisfaction with family functioning | 4 | Satisfaction with family life in terms of cohesiveness, amount of support and understanding, amount of talking things over, overall happiness with family life | |
Satisfaction with partner functioning | 6 | Relation to spouse (or person felt closest to) in terms of saying anything wanted, sharing feelings, feeling close, being supportive | |
Sexual functioning | 5 | Interest in sex, capability to enjoy sex, having orgasm(w), getting and keeping erection(m) |
Statistical methods
Results
Treatment group | Swedish populationa | |||
---|---|---|---|---|
TY | MBCT | CBT | ||
Sociodemografic data, n | All [men] n = 26[5] | All [men] n = 27[3] | All [men] n = 27[2] | All |
Age, years, means ± SEM | 43.4 ± 1.7 [43.6 ± 4.6] | 41.3 ± 1.7 [45 ± 6.7] | 47.2 ± 1.5 [44.0 ± 3.0] | |
Sick-leave % ± SD | 88.3 ± 21.0 [83.3 ± 25.8] | 85.5 ± 19.1 [75.0 ± 25.0] | 78.2 ± 23.9 [50.0 ± 0.0] | |
Body mass index (BMI) ± SD | 22.6 ± 2.4 [23.9 ± 3.0] | 22.4 ± 2.0 [23.2 ± 2.9] | 22.9 ± 1.9 [24.4 ± 1.4] | |
Education, years, n (%) | (%) | |||
≤ 9 years | 0(0) | 1(4) | 1(4) | (17) |
> 9–12 years | 9(35) | 9(33) | 5(18) | (46) |
> 12 years |
17(65)
|
17(63)
|
21(78)
| (36) |
Having a partner, n (%) | 17(65) | 16(59) | 16(59) | |
Medicationb, psychotropic drugs prescribed, n | 7 | 11 | 12 | ~ (10) |
Effects of treatment
Traditional yoga
Mindfulness–based cognitive therapy
Cognitive behavioral therapy
Comparison of the treatments
Subscale | TY - CBT | MBCT - CBT | TY - MBCT | |||
---|---|---|---|---|---|---|
P-value | ES | P-value | ES | P-value | ES | |
Physical functioning | 0.28 | 0.09 | 0.13 |
0.44 M
| 0.70 |
0.29 M
|
Satisfaction with physical functioning | 0.82 | 0.06 | 0.89 | −0.08 | 0.71 | 0.06 |
Pain | 0.39 | 0.18 | 0.38 | −0.07 | 0.66 | 0.13 |
Role limitation due to physical health | 0.76 | −0.02 | 0.47 |
0.33 M
| 0.75 | 0.04 |
Role limitation due to emotional health | 0.25 |
0.39 Y
| 0.36 |
0.32 M
| 0.95 | 0.1 |
Positive affect | 0.94 | 0.07 | 0.52 | −0.17 | 0.70 |
0.23 Y
|
Negative affect | 0.09 |
0.43 Y
| 0.19 |
0.37 M
| 0.65 | 0.09 |
Cognitive function | 1.0 | 0.01 | 0.38 |
0.32 M
| 0.35 |
0.28 M
|
Sleep | 0.40 | 0.16 | 0.16 |
0.36 M
| 0.66 | 0.16 |
General health | 0.41 |
0.26 Y
| 0.88 | 0.04 | 0.69 |
0.20 Y
|
Satisfaction with family functioning | 0.14 |
0.22 Y
| 0.32 | 0.15 | 0.46 | 0.07 |
Satisfaction with partner functioning | 0.60 | 0.05 | 0.47 | 0.01 | 0.87 | 0.04 |
Sexual functioning | 0.39 |
0.31 Y
| 0.48 |
0.30 M
| 0.91 | 0.09 |