Comparison of cognitive‐behavioral therapy and yoga for the treatment of late‐life worry: A randomized preference trial

Abstract

Background: The purpose of this study was to compare the effects of cognitivebehavioral therapy (CBT) and yoga on late-life worry, anxiety, and sleep; and examine preference and selection effects on these outcomes. Methods: A randomized preference trial of CBT and yoga was conducted in community-dwelling adults 60 years or older, who scored 26 or above on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A). CBT consisted of 10 weekly telephone sessions. Yoga consisted of 20 biweekly group yoga classes. The primary outcome was worry (PSWQ-A); the secondary outcomes were anxiety (PROMIS-Anxiety) and sleep (Insomnia Severity Index [ISI]). We examined both preference effects (average effect for those who received their preferred intervention [regardless of whether it was CBT or yoga] minus the average for those who did not receive their preferred intervention [regardless of the intervention]) and selection effect (which addresses the question of whether there is a benefit to getting to select one intervention over the other, and measures the effect on outcomes of selfselection to a specific intervention). Results: Five hundred older adults were randomized to the randomized trial (125 each in CBT and yoga) or the preference trial (120 chose CBT; 130 chose yoga). In the randomized trial, the intervention effect of yoga compared with CBT adjusted for baseline psychotropic medication use, gender, and race was 1.6 (−0.2, 3.3), p = .08 for the PSWQ-A. Similar results were observed with PROMIS-Anxiety (adjusted intervention effect: 0.3 [−1.5, 2.2], p = .71). Participants randomized to CBT experienced a greater reduction in the ISI compared with yoga (adjusted intervention effect: 2.4 [1.2, 3.7], p < .01]). Estimated in the combined data set (N = 500), the preference and selection effects were not significant for the PSWQ-A, PROMIS-Anxiety, and ISI. Of the 52 adverse events, only two were possibly related to the intervention. None of the 26 serious adverse events were related to the study interventions. Conclusions: CBT and yoga were both effective at reducing late-life worry and anxiety. However, a greater impact was seen for CBT compared with yoga for improving sleep. Neither preference nor selection effects was found.

The Impact of Cognitive-Behavioral Interventions on Sleep Disturbance in Depressed and Anxious Community-dwelling Older Adults: A Systematic Review

“…It was reported that symptoms of insomnia declined, on average, among participants in both interventions; however, those in the CBT intervention demonstrated a significantly greater improvement in sleep than NST over a 12-month follow-up period. A later, large randomized preference trial by Brenes et al (2020) extended these findings in a trial comparing CBT-T with yoga for the treatment of worry in older adults. Study findings suggest that CBT-T was significantly superior to yoga in reducing scores on the ISI, although both interventions did produce improvements in insomnia symptoms, worry and anxiety.…”

“…Three trials examined the effects of telephone CBT (CBT-T) on sleep disturbance in participants with late-life GAD (Brenes et al, 2016(Brenes et al, , 2020(Brenes et al, , 2012. In the Brenes et al (2012) study, scores on the ISI suggested greater improvements in insomnia severity in the CBT-T group post-intervention, relative to the information-only control condition, but in a similar trend to other clinical measures, this differential treatment effect was not maintained at the 6-month follow-up period.…”

Relax into Yoga for Seniors: An Evidence-Informed Update for Enhancing Yoga Practice Benefits by Reducing Risk in a Uniquely Vulnerable Age Group

“…The first outcomes evidence on the efficacy of the Relax into Yoga program found that it was effective for improving worry, anxiety and sleep among worried older adults. [22] With safety principles at the heart of our approach, the word "relax" is explicitly used in the title to highlight an important distinction about initiating and sustaining yoga practice that is particularly relevant to seniors. A key characteristic that differentiates this ancient approach to wholeness from modern exercise is the importance of moving to a point of challenge, but not strain.…”

A Randomized Preference Trial Comparing Cognitive-Behavioral Therapy and Yoga for the Treatment of Late-Life Worry: Examination of Impact on Depression, Generalized Anxiety, Fatigue, Pain, Social Participation, and Physical Function

“…Findings from previously published analyses of primary and secondary outcomes showed that CBT and yoga were both effective at reducing worry and anxiety, and a greater impact was seen for CBT compared with yoga for improving sleep. 8 The focus of this investigation is on a variety of prevalent and interrelated symptoms commonly reported by older adults with substantial worry: depressive symptoms, generalized anxiety symptoms, fatigue, and pain.…”

“…As reported above, findings for the primary outcome (worry) and secondary outcomes (anxiety, sleep) have been published elsewhere. 8 In this secondary data analysis using data from the randomized arm (N = 250), we compared the effects of CBT and yoga on several exploratory outcomes: depressive symptoms, generalized anxiety symptoms, fatigue, pain interference, pain intensity, physical function, and social participation. Using data from both the randomized and preference trial arms (N = 500), we examined the effects of preference (i.e., an effect on outcome from having a choice in treatments compared with being randomized) and selection (i.e., an effect on outcomes by making a specific treatment choice ) on depressive symptoms, generalized anxiety symptoms, fatigue, pain interference, pain intensity, physical function, and social participation.…”