Yoga, CBT Provide Long-term Improvement in Insomnia, Worry

Kelli Whitlock Burton

September 01, 2022

Both yoga and cognitive-behavioral therapy (CBT) provide meaningful improvements in worry, anxiety, and insomnia in older adults that last even 6 months after discontinuing treatment, new research suggests.

The study is the first to compare the long-term effects from the two interventions; and the results offer clinicians and patients two effective choices for reducing worry and anxiety, researchers note.

"Anxiety can be a really big problem for older adults," lead investigator Suzanne Danhauer, PhD, professor of social sciences and health policy at Wake Forest University School of Medicine, Winston-Salem, North Carolina, told Medscape Medical News.

"So to find something they can do that lasts … and has some enduring impact on their quality of life and their mental health, and they're both nonpharmacologic treatments, I think for a lot of older people that's really attractive," Danhauer said.

The findings are published in the September issue of the American Journal of Geriatric Psychiatry.

Long-term Benefits

The two-stage randomized preference trial included 500 community-dwelling individuals over age 60 who scored 26 or above on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), indicating heightened anxiety and worry.

Half the group took part in a randomized controlled trial comparing CBT (n = 125) to yoga (n = 125). The other half participated in a preference trial where they were allowed to choose between CBT (n = 120) and yoga (n = 130).

Participants completed 20 yoga sessions over 10 weeks or 10 weekly CBT calls between May 2017 and November 2018.

Measures used included the PSWQ-A, the Insomnia Severity Index (ISI), the Patient Reported Outcomes Measurement Information System (PROMIS) Short Form v1.0 – Anxiety 8a, and the PROMIS-29 to assess depression, fatigue, physical function, social participation, and pain.

In 2020, the researchers published results at 11 weeks showing improvements from baseline in all areas. The scores for anxiety and worry were similar between the CBT and yoga groups, but CBT yielded significantly higher improvement in insomnia.

At 37 weeks, about 6 months after the interventions had ended, the investigators found even greater improvements from baseline in all areas measured — except physical function.

However, at that point, there were no significant differences between the two interventions in either the randomized controlled trial or the preference trial. There were also no differences in the results between the two trial designs.

"There were some little differences, but by and large we found both interventions to be efficacious," Danhauer said. "This gives clinicians [the] choice to be able to say, 'you can try either one of these and they're probably going to help.'"

Beyond Statistically Significant

The researchers also found the improvements were not just statistically significant, but were also clinically meaningful for worry, anxiety, and insomnia.

Meaningful changes were defined as a decrease of ≥ 5.5 points on the PSWQ-A for worry, a decrease of ≥ 3 points on the PROMIS Anxiety scale for anxiety, and a decrease of ≥ 6 points in the ISI for insomnia.

At long-term follow up, the majority of participants in both the CBT and yoga arms of the RCT demonstrated meaningful change in worry (85.7% and 77.6%, respectively), anxiety (82.1% and 80.8%), and insomnia (52.8% and 44.3%).

The majority of participants also reported meaningful improvements in generalized anxiety symptoms, depressive symptoms, and fatigue, but not for physical function, pain interference, or pain intensity.

"That's the part to me that's particularly notable. The improvements weren't just statistically significant, they were clinically meaningful as well," Danhauer said.

"When it comes right down to people's lives, they want differences they can feel and see and not just what a P value looks like," she added.

Real-World Impact

In an accompanying editorial, Carmen Andreescu, MD, associate professor of psychiatry at the University of Pittsburgh, Pittsburgh, Pennsylvania, agrees that the results have "real-world impact."

"Clinicians can direct their patients toward interventions that may be beneficial, consolidate the results over time and avoid fueling the well-trained worry cognitive loop with concerns related to potential side effects," Andreescu writes.

She adds that interventions such as these "may increase accessibility and provide relief for the immediate suffering of our patients."

The study was funded by the Patient-Centered Outcomes Research Institute Program. Danhauer and Andreescu report no relevant financial relationships.

Am J Geriatr Psychiatry. Published in the September 2022 issue.;30:979−990. Abstract. Editorial.

Kelli Whitlock Burton is a reporter for Medscape Medical News who covers psychiatry and neurology.

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