Stress Reduction by Yoga versus Mindfulness Training in Adults Suffering from Distress: A Three-Armed Randomized Controlled Trial including Qualitative Interviews (RELAX Study).
Jan Moritz Fischer, Farid-Ihab Kandil, Christian S Kessler, Lucas Nayeri, Laura Sophie Zager, Theresa Rocabado Hennhöfer, Nico Steckhan, Daniela A Koppold-Liebscher, Holger C Bringmann, Thomas Schäfer, Andreas Michalsen, Michael Jeitler
Journal of Clinical Medicine September 26, 2022 DOI: 10.3390/jcm11195680 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Qualitative Peer reviewed |
|---|---|
| Sample size | 102 |
| Population | Adults with elevated stress levels and stress-related symptoms |
| Interventions | Integrative yoga Iyengar yoga Mindfulness training |
| Duration | 12-week intervention with follow-up to 24 weeks |
| Measures | Cohen's Perceived Stress Scale (PSS) |
| Topics | Meditation |
| Keywords | Iyengar yoga Mixed methods Stress reduction |
| Key findings | All three interventions produced lasting, clinically relevant stress reduction, with Perceived Stress Scale decreases of 6.69 points for integrative yoga, 6.00 for Iyengar yoga, and 9.74 for mindfulness at 12 weeks and large effect sizes at 24 weeks. The authors report no significant group differences and no evidence of synergistic effects from combining mindfulness with physical yoga exercises, concluding the three methods were equally effective. |
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.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 5
- A meta-analysis of the effects of mindfulness meditation training on self-reported interoception Scientific Reports November 6, 2025
- The Combined Effect of Mindfulness and Physical Activity on Stress: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Behavioral Sciences September 11, 2026
- Yoga and guided meditation in emergency medicine: Impact on stress, anxiety, and well-being. The National medical journal of India 2026
- Minding the Body: A Meta-analysis of the Effects of Mindfulness Meditation Training on Self-reported Interoception. Research Square June 4, 2025
- Strengthening the Leader Within: A Deep Dive into Impact of Yoga on Various Leadership Traits - A Narrative Review. Indian Journal of Community Medicine 2026
Cites 15
- Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology Science and Practice 2003
- Mechanisms of mindfulness Journal of Clinical Psychology December 29, 2005
- Mindfulness-based cognitive therapy for depression August 21, 2006
- Effects of Mindfulness-Based Stress Reduction Intervention on Psychological Well-being and Quality of Life: Is Increased Mindfulness Indeed the Mechanism? Annals of Behavioral Medicine June 1, 2008
- Mindfulness-Based Stress Reduction as a Stress Management Intervention for Healthy Individuals Journal of Evidence-Based Complementary & Alternative Medicine July 22, 2014
and 10 more in the library