Stress Reduction by Yoga versus Mindfulness Training in Adults Suffering from Distress: A Three-Armed Randomized Controlled Trial including Qualitative Interviews (RELAX Study)

Abstract

Distress is a growing public health concern. In this three-armed randomized controlled trial, n = 102 adults with elevated stress levels and stress-related symptoms were randomly assigned to (1) “integrative” yoga classes which combined physical exercises, mindfulness training, and ethical/philosophical aspects of traditional yoga; to (2) Iyengar yoga classes which entailed primarily physical exercises; or to (3) mindfulness training without physical training. We hypothesized the synergistic effects of physical yoga exercises, mindfulness, and ethical/philosophical aspects. The primary outcome was the group difference on Cohen’s Perceived Stress Scale (PSS) after 12 weeks. Secondary outcomes included burnout, quality of life, physical complaints, depression, anxiety, mindfulness, interoceptive awareness, self-regulation, spirituality, mysticism, and posttraumatic stress. All outcomes were evaluated at baseline (V0), after 12 weeks (V1), and after 24 weeks (V2). A subset of participants took part in qualitative interviews. A lasting and clinically relevant stress reduction was observed within all groups (PSS ΔV0–V1Integrative Yoga = −6.69 ± 6.19; ΔV0–V1Iyengar Yoga = −6.00 ± 7.37; ΔV0–V1Mindfulness = −9.74 ± 7.80; all p < 0.00). Effect sizes were also statistically large at the end of the follow-up period (Cohen’s d Integrative Yoga = 1.41; d Iyengar Yoga = 1.37; d Mindfulness = 1.23). There were no significant group differences or evidence of relevant synergistic effects from combining mindfulness and physical yoga exercises. All three interventions were found to be equally effective methods of stress reduction. Their use in practice should be based on availability and patient preference.

Interoceptive interventions for posttraumatic stress: A systematic review of treatment and interoception outcomes.

“…Nine studies involved integrative exercise (Bryant et al, 2023; Chopin et al, 2020; Fetzner & Asmundson, 2015; Fischer et al, 2022; King et al, 2014; Mehling et al, 2018; Neukirch et al, 2019; Shivakumar et al, 2017; van der Kolk et al, 2014). The intervention types within this group were diverse, with five of the studies exploring trauma-focused yoga, three exploring aerobic exercise, and one a combination of yoga and aerobic exercise.…”

“…The intervention types within this group were diverse, with five of the studies exploring trauma-focused yoga, three exploring aerobic exercise, and one a combination of yoga and aerobic exercise. Five studies were RCTs (Bryant et al, 2023; Fetzner & Asmundson, 2015; Fischer et al, 2022; Mehling et al, 2018; van der Kolk et al, 2014). The remaining four studies were pre–post outcome studies with one (Neukirch et al, 2019) being a mixed-design case study.…”

“…The RCTs examining the efficacy of trauma-focused yoga interventions also demonstrated favorable results in treating PTS. Fischer et al (2022) conducted a three-armed RCT examining the efficacy of: (a) integrative yoga, which combined physical exercises, mindfulness training, and ethical/philosophical aspects of traditional yoga; (b) Iyengar yoga, which entailed primarily physical exercises; and (c) mindfulness training without physical training. The results showed that PTS improved across all three groups with medium effect sizes reported: d = 0.49 for integrative yoga, d = 0.56 for Iyengar yoga, and d = 0.73 for mindfulness, suggesting that the two integrative exercise conditions and present-focused observation (mindfulness) are all equally efficacious in treating PTSD symptomology, with moderate treatment effect sizes.…”

“…Fischer et al (2022) conducted a three-armed RCT examining the efficacy of: (a) integrative yoga, which combined physical exercises, mindfulness training, and ethical/philosophical aspects of traditional yoga; (b) Iyengar yoga, which entailed primarily physical exercises; and (c) mindfulness training without physical training. The results…”

Effects of Prolonged Fasting During Inpatient Multimodal Treatment on Pain and Functional Parameters in Knee and Hip Osteoarthritis: A Prospective Exploratory Observational Study

“…The Department of IMNT at the Immanuel Hospital Berlin is one of the leading institutions regarding the application of NB and traditional medicinal approaches (17)(18)(19)(20)(21)(22) including TEM (23)(24)(25)(26)(27)(28)(29). It is especially experienced in applying prolonged fasting as a therapeutic intervention in diverse disease entities (6,16,.…”