Yoga — specifically Kundalini yoga — can reduce anxiety in adults with generalized anxiety disorder (GAD). However, it is not as effective as cognitive behavioral therapy (CBT), a new study in JAMA Psychiatry reported.

Although mindfulness-based therapies have been shown to reduce anxiety symptoms, the benefits of yoga — which often incorporates mindfulness and breath control — remain unclear.

To learn more, researchers conducted a randomized, 3-arm, controlled, single-blind (masked raters; unmasked practitioners) clinical trial to determine whether Kundalini yoga and CBT were more effective than the control (stress education) for GAD and whether yoga is superior or inferior to CBT for GAD treatment.

The planned population included 230 adults with a primary Diagnostic and Statistical Manual of Mental Disorders, 5th Edition GAD diagnosis. Exclusions included current posttraumatic stress disorder, substance use disorders, eating disorders, significant suicidal ideation, mental disorder because of a medical or neurocognitive condition, lifetime psychosis, bipolar disorder, and developmental disorders. The study also excluded adults who had completed more than 5 Kundalini yoga or CBT sessions in the past 5 years.


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Treatment was delivered in small cohorts of 3 to 6 participants per group. The yoga group took a program developed by the Guru Ram Das Center for Medicine and Humanology that included yoga postures, breathing exercises, meditation and mindfulness practice, yoga theory, philosophy, and psychology.

The CBT group used an evidence-based GAD protocol with no mindfulness component. The control group received stress education that included lectures about stress, lifestyle behaviors, resilience factors, and the importance of exercise and diet.

The participants engaged in 120-minute sessions once a week for 12 weeks plus 20 minutes of daily homework.

Response rates after treatment were higher in the yoga group (54.2%) than the stress education group (33%). Response rates were also higher in the CBT group (70.8%) compared with the stress education group. At the 6-month follow-up, CBT response rates remained higher (76.7%) than yoga (63.2%) or stress education (48%).

Measuring depression and medication as potential covariates and/or moderators of treatment group differences, the researchers found that neither accounted for differences between the groups.

Although Kundalini yoga was shown to be less effective than CBT for GAD treatment, “Given the increasing costs of health care and barriers to accessing trained mental health care professionals, however, yoga may still have a role to play in GAD,” the researchers concluded. “Future studies should identify individual characteristics that make a patient more prone to respond to yoga vs CBT, including treatment preference and attitudes toward mental health care, which could inform how yoga might be integrated into a stepped-care personalized approach to anxiety disorders.”

Disclosures: Multiple authors declared disclosures. Please see the original reference for a full list of the authors’ disclosures.

Reference

Simon NM, Hofmann SG, Rosenfield D, et al. Efficacy of yoga vs cognitive behavioral therapy vs stress education for the treatment of generalized anxiety disorder: a randomized clinical trial. JAMA Psychiatry. Published online August 12, 2020. doi:10.1001/jamapsychiatry.2020.2496