Led by researchers at NYU Grossman School of Medicine, a new study found that yoga was significantly more effective for generalized anxiety disorder than standard education on stress management, but not effective as cognitive behavioral therapy (CBT), the gold standard form of structured talk therapy that helps patients identify negative thinking for better responses to challenges.
“Generalized anxiety disorder is a very common condition, yet many are not willing or able to access evidence-based treatments,” says lead study author Naomi M. Simon, MD, a professor in the Department of Psychiatry at NYU Langone Health. “Our findings demonstrate that yoga, which is safe and widely available, can improve symptoms for some people with this disorder and could be a valuable tool in an overall treatment plan.”
For the study, publishing online Aug. 12 in JAMA Psychiatry, 226 men and women with generalized anxiety disorder were randomly assigned to three groups — either CBT, Kundalini yoga, or stress-management education, a standardized control technique.
After three months, both CBT and yoga were found to be significantly more effective for anxiety than stress management. Specifically, 54 percent of those who practiced yoga met response criteria for meaningfully improved symptoms compared to 33 percent in the stress-education group. Of those treated with CBT, 71 percent met these symptom improvement criteria.
However, after six months of follow-up, the CBT response remained significantly better than stress education (the control therapy), while yoga was no longer significantly better, suggesting CBT may have more robust, longer-lasting anxiety-reducing effects.
The study involved an evidence-based protocol for CBT treatment of generalized anxiety disorder, including psychoeducation, cognitive interventions (focused on identifying and adapting maladaptive thoughts and worrying), and muscle relaxation techniques.
Kundalini yoga included physical postures, breathing techniques, relaxation exercises, yoga theory, and meditation/mindfulness practice.
The stress-management education control group received lectures about the physiological, psychological and medical effects of stress, as well as the antianxiety effects of lifestyle behaviors, such as reducing alcohol and smoking, and the importance of exercise and a healthy diet. Homework consisted of listening to educational material about stress, nutrition, and lifestyle.
Each treatment was administered in groups of three to six participants, over weekly two-hour sessions for 12 weeks with 20 minutes of daily homework assigned.
Can Yoga Help Treat Anxiety?
According to researchers, generalized anxiety disorder is a common, impairing, and undertreated condition, currently affecting an estimated 6.8 million Americans. While most people feel anxious from time to time, it is considered a disorder when worrying becomes excessive and interferes with day-to-day life. CBT is considered the gold standard first-line treatment. Medications, including antidepressants and sometimes benzodiazepines, may also be used. Yet, not everyone is willing to take medication which can have adverse side effects and there are challenges with accessing CBT for many, including lack of access to trained therapists and long waitlists.
“Many people already seek complementary and alternative interventions, including yoga, to treat anxiety,” says Dr. Simon. “This study suggests that at least short-term there is significant value for people with generalized anxiety disorder to give yoga a try to see if it works for them. Yoga is well-tolerated, easily accessible, and has a number of health benefits.”
According to Dr. Simon, future research should aim to understand who is most likely to benefit from yoga for generalized anxiety disorder to help providers better personalize treatment recommendations.
“We need more options to treat anxiety because different people will respond to different interventions, and having more options can help overcome barriers to care,” she says. “Having a range of effective treatments can increase the likelihood people with anxiety will be willing to engage in evidence-based care.”
Naomi M. Simon, Stefan G. Hofmann, David Rosenfield et al. Efficacy of Yoga vs Cognitive Behavioral Therapy vs Stress Education for the Treatment of Generalized Anxiety DisorderA Randomized Clinical Trial. JAMA Psychiatry, 2020 DOI: 10.1001/jamapsychiatry.2020.2496