Burnout is characterized by the gradual draining of emotional resources required to cope work-related stress (1, 2). Without proper management, burnout can evolve into a chronic condition, leading to physiological changes (3, 4). Over time, it can result in a steady decline in engagement, self-efficacy, and effectiveness, transitioning from enthusiasm to emptiness (5, 6). Moreover, burnout’s impact extends beyond the individual, negatively affecting the entire organization (7). Burnout diminishes employee motivation, reduces productivity, and fosters an unfavorable work environment marked by contagious negativity (8). The consequences are be severe, including higher absenteeism, reduced efficiency, and increased counterproductive behavior (9, 10).

Several factors contribute to burnout. Personality traits, particularly a Type A personality (11–13), and specific sociodemographic factors such as being young, single or unmarried, or a woman, increase susceptibility to burnout (14–16). Organizational factors such as low organizational commitment, job insecurity, excessive workload, role conflicts and ambiguities, limited support from supervisors and peers, and poor working conditions also contribute to burnout (17–19).

Given the demand and dedication required in their profession (20–22), burnout is reportedly more prevalent among educators (5, 6, 23, 24) than among other professionals. With the rapid increase in the prevalence of stress in recent years (25–27), the reported prevalence of perceived extreme stress (burnout) among educators has also risen (25, 28, 29). Nearly one-third of these stress levels may lead to clinical impairment (30). Therefore, to prevent further deterioration, it is necessary to identify early signs of stress and properly manage burnout among teachers (31). Burnout can be averted before it manifests and can also be effectively addressed in its early stages (21).

A recent scoping review (31) based on 40 articles published between 2018 and 2022 revealed that mindfulness interventions were associated reduced stress and burnout among educators. Similarly, our systematic review and meta-analysis (32) of 26 articles found that MB-CBT interventions effectively reduced teacher burnout. Hagermoser et al.’s (33) systematic review studied 18 articles published between 1987 to 2016 which identified meditation and mindfulness-based practices are the most commonly evaluated interventions for reducing teacher stress and burnout. Another study conclusively demonstrated that a brief mindfulness-based intervention effectively alleviated stress and burnout among teachers (34). Von der Embse et al.’s (35) systematic review which examined 24 articles published between 1998 and 2017, aligned with these findings and affirmed the effectiveness of mindfulness and cognitive behavioral interventions. These reviews collectively confirm that mindfulness-based CBT is an effective intervention for mitigating occupational stress and burnout among educators.

We aimed to test whether such interventions could also reduce burnout among community schoolteacher in the culturally and socio-economically different context of Nepal. The present study evaluated the effect of a mindfulness-based cognitive behavior therapy (MB-CBT) intervention on occupational burnout among school teachers in Nepal in a one month follow-up. We hypothesized that MB-CBT intervention would significantly reduce the occupational burnout among school teachers.

The present study is a single-blind cluster randomized controlled trial, including two arms (treatment and control) to assess the impact of a four-week MB-CBT on burnout among school teachers in government-supported community schools in the Kathmandu district of Nepal.

The study protocol was registered in clinical trials (ClinicalTrials.gov ID: NCT05626543), and the ethical committee of Nepal Health Research Council (225/2022) granted ethical approval to conduct the study. Additional permission was obtained from the concerned schools and the Education Development and Coordination Unit in Kathmandu district.

Table 1 shows the baseline characteristics of the study participants by study group. Of the 218 participants who replied to the baseline questionnaire, 116 were in the control, and the remaining 102 were in the treatment group. There was no statistically significant difference between the study groups in the baseline characteristics. Most of the participants were aged ≥40, male, married, had master’s degree qualifications, and had a monthly income exceeding 50,000 Nepali rupees. Most of the participants reported good self-rated health, no comorbidities, and had moderate to very good work ability. Among behavioral and lifestyle factors, most of the respondents had good sleep quality, were physically active, non-smokers, and non-alcohol drinkers. Most were teaching at least five hours/day and in classrooms with a higher number of students.

Figure 3 presents the mean with their 95% CIs of all three dimensions of occupational burnout of school teachers at baseline and post-test by the study groups. At baseline, the mean EE and PA in the treatment group were higher than the controls. At the post-test, the mean EE and DP decreased in the treatment group and controls. However, a sharper decrease was found in DP in the controls. The PA was increased within the treatment and the controls at the post-test. The mean scores for within-group change ( Table 2 ) show a significant decrease in EE (-1.71, -3.24 to -0.18), DP (-1.97, -2.78 to -1.16), and an increase in PA (1.53, 0.35 to 2.70) in the control group. In the treatment group, decreased mean levels in EE (-0.93, 95% CI -2.56 to 0.70), and increased PA (1.04, -0.21 to 2.30) were found, which were not statistically significant while, decrease in DP (-0.12, -0.98 to -0.75) was statistically significant. Similarly, the changes between the study groups show an increased mean difference in EE and DP and decreased difference in PA from the baseline to the post-test. The interaction between the study group and time (baseline and post-test) was found to be significant for DP only.

Figure 4 shows the change in the distribution of prevalence of occupational burnout (high EE, high DP, and low PA) with their 95% CIs among school teachers at baseline and post-test by study groups. The prevalence of high EE and low PA was decreased in both arms. However, the prevalence of high DP was constant in the treatment arm and sharply decreased in the control arm.

This single-blinded cluster randomized controlled trial showed a modest positive impact of virtual MB-CBT on reducing occupational burnout among school teachers in Nepal; however, the reduction in occupational burnout was also observed among controls.

Baseline characteristics were comparable between the control and treatment groups, ensuring that observed post-test burnout differences could be attributed to the intervention rather than baseline disparities (46). The mean EE, DP and PA were comparable at baseline, with mean EE and PA were little higher in the control group. Post-test results showed a decrease in EE and DP in both groups, with a sharper decline in DP in the control group. PA increased in both groups, but not significantly. Overall, although not statistically significant we found positive changes in mean EE and PA, but this was also observed in the control group. A recent systematic review study shows that the effectiveness of mindfulness-based interventions may reduce certain dimensions of burnout, such as PA (47).

Overall, our findings indicate a positive effect of the MB-CBT intervention in reducing burnout among school teachers; however, the findings were not significant. We found a decrease in mean levels of burnout within the treatment arm. Many of the previous studies show the beneficial impact of MB-CBT in reducing burnout among teachers (31, 34, 48–55) and in other occupational groups (56–60). We used a virtual approach to deliver MB-CBT intervention for a month; a previous study reported this technique as effective (61). Our findings regarding the modest impact align with the findings of a meta-analysis of intervention studies, which suggested that mindfulness interventions lasting less than one month could have modest effects (62). We utilized a four-week MB-CBT for school teachers, targeting to reduce EE and DP and increase PA—all three dimensions of burnout (63).

Our findings contradict the generally expected outcome where the treatment group was anticipated to show a more significant improvement than the controls. Several reasons could explain this unexpected finding. First, the external factors or passage of time may lead to a natural reduction in burnout—even if it is not expected in a short time—across both groups. Second, the study participants may have been influenced by the awareness of being part of a study, leading to improved outcomes—the so-called Hawthorne effect (64, 65). Third, those in the control group may have realized that they were not part of the intervention group by the time the second survey was conducted, which was not explicitly communicated to them. However, it is possible that their awareness of not being part of the intervention could have influenced their response in the second survey. This may also explain the observed reduction in burnout within the control group, potentially due to compensatory rivalry or other related factors.

The major strength of this study is its design (two arms, single-blinded, cluster randomized), which establishes a strong internal validity framework (66), promoting confident causal inferences about the effects of the MB-CBT intervention. Digital surveys and virtual interventions were utilized to represent a cost-efficient and time-conserving approach (67, 68). The intervention was developed based on contemporary literature and the findings of a recent systematic review on the effectiveness of interventions in reducing stress and burnout among school teachers (32), strengthening its reliability and reproducibility. We used the Maslach Burnout Inventory (MBI-ES) tool, which is widely recognized for its robustness and accuracy in measuring occupational burnout (37), and the survey questionnaire was sent to both groups simultaneously avoiding chance of possible bias due to measurement instrument and timing of assessment. The study participants were balanced at baseline, and the sensitivity analysis contributed to the overall robustness of the findings.

However, the diverse backgrounds of participants and self-reported data pose challenges to eliminating bias compared to controlled laboratory clinical trials. Online delivery of MB-CBT may also raise concerns about participant engagement and consistency of intervention fidelity. The intervention was delivered quite late in the evening (8-9 pm) when most teachers are tired already which might also affect their willingness to accept and utilize the intervention properly. However, this was the only suitable time for most teachers especially the female teachers who also have lots of household responsibilities to be completed before they can join the intervention session. Generalizability may be limited to low-resource settings. The non-significant differences in the intervention in burnout dimensions suggest avenues for further exploration. More research is required to compare the effectiveness of MB-CBT interventions in virtual and physical formats. For future research, incorporating objective measurements, such as cortisol assessments besides self-reported data, is advisable. This dual approach can provide a more comprehensive understanding by combining subjective self-assessments with objective physiological measurements. The study’s focus on a specific group of teachers in Nepal may limit the generalizability of the findings to other similar populations or cultural contexts. The time constraints teachers face, and the challenges of adapting these programs to different contexts require careful consideration.

In conclusion, the study indicates a moderate impact of virtual MB-CBT on reducing occupational burnout among school teachers in a one-month follow-up. The intervention had statistically no significant impact on occupational burnout. However, a reduction in burnout was found in both groups, with a sharper reduction in the control group, warranting further studies and explanation.