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A Randomized Control Trial of Cognitive Behavioral Therapy with Yoga in managing Job stress among teachers of children with Autism Spectrum Disorders
Last registered on October 29, 2020

Pre-Trial

Trial Information
General Information
Title
A Randomized Control Trial of Cognitive Behavioral Therapy with Yoga in managing Job stress among teachers of children with Autism Spectrum Disorders
RCT ID
AEARCTR-0006682
Initial registration date
October 28, 2020
Last updated
October 29, 2020 7:21 AM EDT
Location(s)
Region
Primary Investigator
Affiliation
University of Johannesburg
Other Primary Investigator(s)
Additional Trial Information
Status
Completed
Start date
2019-01-10
End date
2019-06-20
Secondary IDs
Abstract
Background/Objective: Job-related stress undermines occupational, personal, and organizational outcomes. Stress symptoms are common among teachers of children with Autism Spectrum Disorders (ASD) and affect the academic progress of the children. This study investigated the effectiveness of Yoga- based cognitive behavioral therapy in reducing occupational stress among teachers of children with autism in Lagos states, Nigeria.
Methods: The current study adopted a group-randomized waitlist control trial design with pretest, post-test, and follow-up assessments. Participants included 75 teachers of children with autism in public and private special schools in Lagos state. Participants were randomly assigned to Y-CBT (N=33) and waitlist control (WLC) (N=32) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments- Demographic Questionnaire, Single Item Stress Questionnaire (SISQ), and Teachers’ Stress Inventory (TSI) were used to collect data. Data were collected at baseline; post-test and follow-up evaluations. Data were analyzed using means, standard deviations, t-test statistics, repeated measures ANOVA, and bar charts.
Results: Results revealed that all dimensions of job stress (perception of stress sources, stress manifestation, and total TSI scores) reduced significantly at post-test and follow-up assessments among the Y-CBT group, compared to the WLC.
Conclusion: It was concluded that Y-CBT modalities could help to minimize the perception of stress sources and stress manifestation as well as Total TSI scores among teachers of children with ASD.
List of Abbreviations: ASD=Autism Spectrum Disorders; Y-CBT=Combined CBT and Yoga; CBT=Cognitive behavioural Therapy; ABCDE=Activating Event, Beliefs, Consequences, Disputation and Effective World View; WLG=Waitlist Group; SISQ = Single-Item Stress Questionnaire; TSI= Teachers’ Stress Inventory; SS= Stress Sources; SM=Stress Manifestation SPSS=Statistical Package for Social Sciences; ANOVA=Analysis of Variance; n=sample; M= mean; SD= standard deviation; Df=Degree of Freedom; t=t-test statistic; p=probability value; CI=Confidence Interval; F =Analysis of variance test statistic; ŋ2=Partial Eta Squared (effect size).
External Link(s)
Registration Citation
Citation
Onyishi, Charity. 2020. "A Randomized Control Trial of Cognitive Behavioral Therapy with Yoga in managing Job stress among teachers of children with Autism Spectrum Disorders." AEA RCT Registry. October 29. https://doi.org/10.1257/rct.6682-1.0.
Experimental Details
Interventions
Intervention(s)
A Yoga-Cognitive behavioural therapy program manual was developed by two of the researchers in collaboration with two experts (one in CBT and the other in Yoga). In developing the manual, CBT strategies were blended with after-session Yoga exercises. The CBT sessions were based on using the “ABCDE” model (Antecedent/Activating event, Beliefs, Consequences, Disputing, and Effective new philosophy) to identify, assess, revalidate and change unhelpful absolutistic and irrational beliefs associated with work experiences. The major aims of Y-CBT were to 1) use ABCDE group therapeutic model (CBT) in “disputing” – challenging and questioning teachers’ work-related irrational and dysfunctional beliefs and to replace them with rather helpful and functional beliefs [84] 2); use yoga to reduce the physiological symptoms of stress and helping the participants oust of the vicious circle of negative thoughts through Yoga “Victory Meditation,” affirmations and physical exercises.[55] This framework helped provide a targeted mind/body approach to stress perceptions, reactions, and symptoms.
The ABCDE formed the basis of explaining the relationships links between activating

(A) events associated with teaching children with ASD, dysfunctional thoughts, beliefs or cognitions arising from those events (B); the emotional and behavioral consequences of the beliefs (C) [84] Then, disputation techniques (D) are used to eliminate the maladaptive, dysfunctional, and self-limiting beliefs and cognitions. [84, 85, 86] Disputation involves challenging and comparing the maladaptive thoughts with more adaptive ones. Ellis [87] theorized that the best way to counter irrational beliefs is by considering realistic and logical ones. Hence as participants become aware of and counteract their dysfunctional beliefs, they come up with more effective world-views (E). This ABCDE model as used in earlier studies formed the basis of activities throughout the intervention (See table 1).
Yoga complementary approaches involved after-session physical/posture exercise and meditation practices. The interaction between cognitions, emotions, and physical symptoms were highlighted and skills were taught to reduce the incongruity between sensation and perception. Traditional Yoga (asanas, breathing exercises, and meditation) exercises were used in maintaining physical, mental, and emotional well-being. The traditional Yoga used in this study was appropriate for beginners, given that it is mild and does not demand too much effort. The Yoga intervention was meant to help participants understand and appreciate the interplay between their bodily sensations and emotional feelings. Ten different asanas posses were used, which are Tadasana (Mountain pose); Vrikshasana (Tree Pose); Adho Mukho Svanasana (Downward Facing Dog Pose); Trikonasana (Triangle Pose); Kursiasana(Chair Pose); Naukasana (Boat Pose); Bhujangasana (Cobra Pose); Paschimottanasana; Child's Pose and Sukhasna. [88]
Breathing exercises focused on basic Breath Awareness; Ujjayi Pranayama (Victorious Breath or Ocean Breath); Kapalabhati Pranayama (Breath of Fire or Skull-Shining Breath); Kumbhaka Pranayama (Breath Retention), Nadi Shodhana Pranayama (Alternate-Nostril Breathing). Meditation involved getting quiet, calm, and focused; mind slows down, relaxation, and staying positive by focusing on something that brings you peace to mind as well as choosing to shed go all the negative thoughts that interfere with health. Meditation also helps you become more mindful of your mind and body.
Hence, in Y-CBT we designed a 12 weeks module of CBT accompanied by traditional yoga exercises as discussed above. Each session of the module includes information, exercises, worksheets, images, examples, homework exercises, and template for progress feedback.
Intervention Start Date
2019-03-12
Intervention End Date
2019-06-20
Primary Outcomes
Primary Outcomes (end points)
Results revealed that all dimensions of job stress (perception of stress sources, stress manifestation, and total TSI scores) reduced significantly at post-test and follow-up assessments among the Y-CBT group, compared to the WLC.
Primary Outcomes (explanation)
Y-CBT modalities could help to minimize the perception of stress sources and stress manifestation as well as Total TSI scores among teachers of children with ASD.
Secondary Outcomes
Secondary Outcomes (end points)
Y-CBT modalities could help to minimize the perception of stress sources and stress manifestation as well as Total TSI scores among teachers of children with ASD.
Secondary Outcomes (explanation)
Y-CBT modalities could help to minimize the perception of stress sources and stress manifestation as well as Total TSI scores among teachers of children with ASD.
Experimental Design
Experimental Design
The current study adopted a group-randomized waitlist control trial design with pretest, post-test, and follow-up assessments. Participants included 75 teachers of children with autism in public and private special schools in Lagos state. Participants were randomly assigned to Y-CBT (N=33) and waitlist control (WLC) (N=32) groups.
Experimental Design Details
The current study adopted a group-randomized waitlist control trial design with pretest, post-test, and follow-up assessments. Participants included 75 teachers of children with autism in public and private special schools in Lagos state. Participants were randomly assigned to Y-CBT (N=33) and waitlist control (WLC) (N=32) groups.
Randomization Method
Participants were asked to pick 1 envelope containing pressure-sensitive paper labeled with either Y-CBT or WLG-Waitlist Group
Randomization Unit
Individuals
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
58 teachers in 2 clusters
Sample size: planned number of observations
58 teachers of children with autism
Sample size (or number of clusters) by treatment arms
29 teachers in Y-CBT and 29 teachers in the control group
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
G-power
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
IRB Approval Date
IRB Approval Number
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is data collection complete?
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports, Papers & Other Materials
Relevant Paper(s)
REPORTS & OTHER MATERIALS