Efficacy of Yoga vs Cognitive Behavioral Therapy vs Stress Education for the Treatment of Generalized Anxiety Disorder

Abstract

IMPORTANCE Generalized anxiety disorder (GAD) is common, impairing, and undertreated. Although many patients with GAD seek complementary and alternative interventions, including yoga, data supporting yoga's efficacy or how it compares to first-line treatments are lacking.OBJECTIVES To assess whether yoga (Kundalini yoga) and cognitive behavioral therapy (CBT) for GAD are each more effective than a control condition (stress education) and whether yoga is noninferior to CBT for the treatment of GAD.DESIGN, SETTING, AND PARTICIPANTS For this randomized, 3-arm, controlled, single-blind (masked independent raters) clinical trial, participants were recruited from 2 specialty academic centers starting December 1, 2013, with assessment ending October 25, 2019. Primary analyses, completed by February 12, 2020, included superiority testing of Kundalini yoga and CBT vs stress education and noninferiority testing of Kundalini yoga vs CBT.INTERVENTIONS Participants were randomized to Kundalini yoga (n = 93), CBT for GAD (n = 90), or stress education (n = 43), which were each delivered to groups of 4 to 6 participants by 2 instructors during twelve 120-minute sessions with 20 minutes of daily homework. MAIN OUTCOMES AND MEASURESThe primary intention-to-treat outcome was acute GAD response (Clinical Global Impression-Improvement Scale score of much or very much improved) after 12 weeks as assessed by trained independent raters. RESULTSOf 538 participants who provided consent and were evaluated, 226 (mean [SD] age, 33.4 [13.5] years; 158 [69.9%] female) with a primary diagnosis of GAD were included in the trial. A total of 155 participants (68.6%) completed the posttreatment assessment. Completion rates did not differ (Kundalini yoga, 60 [64.5%]; CBT, 67 [74.4%]; and stress education, 28 [65.1%]: χ 2 = 2.39, df = 2, P = .30). Response rates were higher in the Kundalini yoga group (54.2%) than in the stress education group (33.%) (odds ratio [OR], 2.46 [95% CI, 1.12-5.42]; P = .03; number needed to treat, 4.59 [95% CI,) and in the CBT group (70.8%) compared with the stress education group (33.0%) (OR, 5.00 [95% CI, 2.12-11.82]; P < .001; number needed to treat, 2.62 [95% CI, 1.91-5.68]). However, the noninferiority test did not find Kundalini yoga to be as effective as CBT (difference, 16.6%; P = .42 for noninferiority). CONCLUSIONS AND RELEVANCEIn this trial, Kundalini yoga was efficacious for GAD, but the results support CBT remaining first-line treatment.

Nutritional and Behavioral Approaches to Body Composition and Low-Grade Chronic Inflammation Management for Older Adults in the Ordinary and COVID-19 Times

“…Physical activity and exercise are now becoming a major issue, when gyms are closed and even some usual and habitual everyday activities are reduced. For older adults, any type of activity, including household chores, is considered beneficial [ 96 ], as well as alternate activities such as yoga, tai chi, or even ballroom dancing [ 97 , 98 ].…”

“…Additionally, exercise such as yoga, Pilates, and tai chi have shown similar benefits but perhaps to a slighter degree, when considering body composition outcomes [ 95 ]. These types of activities are safe and popular as stress and anxiety reduction strategies, as shown recently for yoga [ 97 ]. Similarly, a recent meta-analysis found an over 30% reduction in falls and fall risk in older individuals who were engaged in dance-based mind–motor activities [ 98 ].…”

Effects of Different Components of Yoga: A Meta-Synthesis

“…Yet, in this study, this could be ascribed to higher dosage and exercise time in the combined treatment. Interestingly, customized treatments such as cognitive-behavioral therapy for a generalized anxiety disorder or self-hypnosis for cancer patients were more effective than combined yoga treatments [45,46].…”

Efficacy of Yoga Nidra vs Supine Relaxation Technique on Depression, Anxiety, Insomnia in frontline COVID-19 Health Care Workers: A Randomized Controlled Trial

“…(range 0-21) was interpreted as Normal/minimal (0-4), Mild (5-9), Moderate (10-14), Severe (15)(16)(17)(18)(19)(20)(21) anxiety. ISI scale (range 0-28) was interpreted as no clinically signi cant insomnia (0-7), Subthreshold insomnia (8-14), Moderate severity clinical insomnia (15)(16)(17)(18)(19)(20)(21), and Severe clinical insomnia (22)(23)(24)(25)(26)(27)(28). The Cut off scores for detecting symptoms of major depression, anxiety, insomnia were 10, 7, and 15 respectively.…”

“…general wellbeing in various patient populations [19,20,21,22,23,24]. Yoga therapy as an alternative form of therapy for behavioral modi cation is safer without any known complications directly related to it [25].…”