CBT more effective than yoga for treating generalized anxiety disorder

Kundalini yoga (KY) has less consistent or robust efficacy compared with cognitive behavioural therapy (CBT) for adults with generalized anxiety disorder (GAD), results of a randomized clinical trial have shown.

“Our study’s results support CBT to remain as first-line treatment for adults with GAD. Future research is needed to better understand individual differences in the heterogenicity of response to KY and CBT,” concluded the researchers. [JAMA Psychiatry 2020, doi: 10.1001/jamapsychiatry.2020.2496]

In the study, 226 participants (mean age, 33.4 years; female, 69.9 percent) with a primary diagnosis of GAD were randomized to receive KY (n=93), CBT (n=90) or stress education (SE; n=43). The interventions were each delivered to groups of 4–6 participants by 2 instructors during twelve 120-minute sessions, with 20 minutes of daily homework.

Post-treatment assessment was completed in 68.1 percent of all patients, without any significant difference in completion rates across treatments (KY, 64.5 percent; CBT, 74.4 percent; SE, 65.1 percent; p=0.30). Participants who dropped out tended to be younger compared with participants who completed the study (31.1 years vs 35.7 years; p=0.07).

Response rates, assessed by Clinical Global Impression-Improvement (CGI-I) Scale score of 1 or 2 (ie, much improved or very much improved), at the post-treatment assessment were significantly higher with KY vs SE (54.2 percent vs 33.0 percent; odds ratio [OR], 2.46; 95 percent confidence interval [CI], 1.12 to 5.42; p=0.03; number needed to treat [NNT], 4.59) and in the CBT group vs the SE group (70.8 percent vs 33.0 percent; OR, 5.00; 95 percent CI, 2.12 to 11.82; p<0.001; NNT, 2.62). The noninferiority test did not find KY to be as effective as CBT (difference, 16.6 percent; p=0.42 for noninferiority).

At 6-month follow-up, response rates remained higher with CBT vs SE (76.7 percent vs 48.0 percent; OR, 3.56; 95 percent 1.08 to 11.70; p=0.04; NNT, 3.51), and were similar between the KY and SE groups (63.2 percent vs 48.0 percent; OR, 1.86; 95 percent CI, 0.52 to 6.69; p=0.34).

Neither differences in rates of depression at baseline (25.6 percent vs 12.9 percent) nor medication use during follow-up (24.4 percent vs 3.2 percent) accounted for the differences between the CBT group and the KY group, or moderated outcomes at the post-treatment or follow-up assessment.