Burnout: Can yoga help you cope?

In the “ThemenCheck Medizin” procedure offered by the German Institute for Quality and Efficiency in Health Care (IQWiG), interested members of the public can submit proposals for the assessment of medical procedures and technologies. On behalf of IQWiG, an interdisciplinary team of researchers led by the Protestant Hospital (“Evangelische Kliniken”) Essen-Mitte investigated whether yoga helps people with burnout. The main question was whether yoga could reduce the severity of burnout, depressive symptoms or stress and improve quality of life.

The research question about yoga for burnout cannot be answered based on the available study results. The comparison of yoga with no treatment provides a hint that yoga may reduce the stress experienced. However, for all other outcomes, such as severity of burnout, quality of life, or side effects, no conclusions can be drawn about the benefits or harms of yoga.

The ThemenCheck report therefore highlights a fundamental research gap. The researchers conclude that there is a need for studies that examine yoga as a therapeutic approach over a sufficiently long period of time. However, two basic requirements need to be met: First, there needs to be a consistent definition and standards for diagnosing burnout. And second, for yoga to be considered as a therapeutic approach, the quality of the yoga course needs to be defined by clear criteria for its content and the yoga teacher’s skills.

A question from a member of the public was the starting point for the ThemenCheck report

Burnout can occur in highly stressful life situations, such as prolonged high levels of stress at work, family conflicts, caring for relatives or high demands on oneself. However, researchers have not clearly defined what burnout exactly is and what symptoms can be used to diagnose it. Different definitions of burnout essentially mean that people affected feel "burnt out", exhausted, overworked and less productive. Physical symptoms such as pain and gastrointestinal problems can also occur, and people find it difficult to cope with everyday life.

Treating people with burnout usually involves a combination of treatments, such as medication and psychotherapy. Complementary therapies such as exercise, relaxation and mindfulness techniques, and art therapy are also used. As yoga also aims to reduce stress, there are approaches to treating burnout with yoga.

Yoga, which is based on a 3000-year-old teaching from India, involves a wide range of exercises, including physical exercises, breathing exercises, meditation, body cleansing techniques, and concentration and lifestyle exercises. In Western countries, yoga postures (asanas), breathing and meditation techniques are particularly well known. In Germany, yoga programmes are not regulated and may include a wide range of yoga variations. The job title "yoga teacher" is not protected.

Results of scientific studies are inconsistent

The external researchers commissioned by IQWiG systematically searched for studies that compared yoga for people with burnout with "no treatment" or other treatments. The results of five studies were analysed for the ThemenCheck report, but they all have their weaknesses and are not easy to compare: For example, participants were selected using different criteria and different forms of yoga were used. It is therefore not possible to say whether or how well yoga helps with burnout. Two of the five studies compared yoga with no treatment.

In one study, yoga was added to standard care and compared with standard care alone. The other two studies compared yoga with other treatments (cognitive behavioural therapy and group fitness classes).

The results only suggest that yoga could reduce the stress experienced compared with no treatment or standard treatment (without yoga as an add-on). The studies did not show any other effects of yoga, for example on depressive symptoms or quality of life. Data on the side effects of yoga were missing or could not be analysed.

The “ThemenCheck Medizin” procedure

In a two-stage selection process, which also involves members of the public, up to five new topics are selected each year from all the proposals submitted. According to the legal mandate, these should be topics of particular importance for patient care. The ThemenCheck reports are not written by IQWiG itself, but by external experts. Their assessment is published together with an easy-to-understand summary and a publisher’s comment by IQWiG.

The Institute published the preliminary results of the (German-language) HTA report "Burnout: Can yoga help you cope?" in January 2023 as a preliminary ThemenCheck report and put it up for discussion. After the end of the commenting procedure, the report was revised and published in its final version in July 2023. The English translation of the report was published in April 2024.