Yoga-based intervention for caregivers of outpatients with psychosis: A randomized controlled pilot study

Abstract

Purpose of the study

The use of yoga as an intervention for caregivers of patients with psychosis has been poorly studied. The current study aimed to test the efficacy of a brief yoga program as an intervention in caregivers of outpatients with functional psychotic disorders using a randomized controlled research design.

Materials and methods

Caregivers who agreed to participate in the study (n = 29) were randomized into yoga (n = 15) or wait-list group (n = 14). They were assessed at baseline and at the end of 3 months. Patients who were randomized into the yoga group were offered supervised yoga training thrice a week for 4 weeks, after which they were instructed to practice at home for the next 2 months. Due to the small sample size and some variables not being normally distributed, non-parametric statistical analysis was used.

Results

Results showed significantly reduced burden scores and improved quality of life scores in the yoga group as compared to the wait-list group at the end of 3 months. There were no significant changes in anxiety and depression scores in caregivers, or psychopathology scores in patients.

Conclusion

In caregivers of outpatients with functional psychosis, 4 weeks of training followed by 3 months of home practice of a yoga module offered significant advantage over waitlist. Yoga can be offered as an intervention for caregivers of patients with severe mental disorders. Methods of providing yoga intervention closer to the community or use of flexible modules at hospitals needs further study.

Introduction

The prevalence of psychosis (including schizophrenia) is consistently reported to be more than 1% throughout the world. As well as the strain on financial and health care resources, psychosis leads to social and psychological anguish for patients and their families, which is difficult to measure. Caregivers of patients with any illness have been found to have higher levels of stress and depression, and more likely to have lower levels of subjective well-being, physical health, and self-efficacy than non-caregivers (Pinquart and Sorensen, 2003). Among chronic diseases, caregivers of patients with schizophrenia have been reported to have higher subjective and objective burden than caregivers of patients with physical illnesses, particularly in families with poor social support (Magliano et al., 2005). This highlights the need for interventions for these caregivers.

Yoga has been found to be useful in many physical and mental disorders, particularly those associated with stress, and specific yoga modules have been designed for stress reduction and depression (Naveen et al., 2010). Yoga has been shown to be an effective treatment for dysthymia (Janakiramaiah et al., 1998) and major depression (Janakiramaiah et al., 2000).

Several studies have looked at yoga as a stress-relief package for caregivers of patients with dementia. A pilot study of yoga and meditation intervention for dementia caregiver stress (Waelde et al., 2004) found pre/post comparisons leading to statistically significant reductions in depression and anxiety and improvements in perceived self-efficacy. Another feasibility study of the effect of yoga on the physical health and coping of informal caregivers randomized 17 caregivers of patients with disabilities into yoga or control group (Van Puymbroeck et al., 2007). The study found that yoga training was feasible but required testing in a larger sample for its efficacy. However, these studies were not specific to patients with psychosis, and the needs of these caregivers may be quite different. Jagannathan et al. conducted a randomized controlled trial of yoga as an intervention for caregivers of inpatients with schizophrenia (Jagannathan, 2010). This methodologically sound study randomized consenting caregivers into four interventional groups; a brief yoga program, psychosocial intervention, combined yoga and psychosocial intervention, and waitlist. The results did not show any significant differences in the reduction of burden and improvement of coping among the caregivers in the four study groups. However, the inpatient population in this study may not represent the majority of patients with psychosis. We are not aware of any study specifically looking at yoga intervention in caregivers of outpatients with psychosis.

In this context, we studied the effects of a structured yoga module for caregivers of outpatients with psychosis on their burden, depression, anxiety, and quality of life.