CBT remains first-line anti-anxiety psychotherapy, but Kundalini yoga may help

Kundalini yoga – a popular yoga style involving all traditional yoga components including breathing practices and meditation – was better than stress education but not as effective as the current gold standard, cognitive behavioural therapy (CBT), for managing generalized anxiety disorder (GAD), the GATE* study has shown.

“[Our findings reflect] the anxiolytic effects of [Kundalini] yoga for patients with a primary diagnosis of GAD,” said the researchers. These were seen in the higher post-treatment response rates with Kundalini yoga (54 percent vs 33 percent; odds ratio [OR], 2.46; p=0.03) and CBT (71 percent vs 33 percent; OR, 5.00; p<0.001) compared with stress education.

However, Kundalini yoga was not as effective as CBT (difference, 16.6 percent; p_{noninferiority}=0.42). “[W]e failed to find Kundalini yoga to be noninferior to CBT, although superiority analyses did not conclusively indicate greater short-term CBT efficacy,” they continued. [JAMA Psychiatry 2020;doi:10.1001/jamapsychiatry.2020.2496]

“[These findings support] the effectiveness of group CBT for GAD as a first-line treatment. Although not conclusive, results also suggest that Kundalini yoga may have some short-term anxiolytic efficacy for some individuals, but these effects may be less strong or persistent,” they said.

Filling the gap

“GAD is common, impairing, and undertreated,” noted the researchers. Evidence shows that there is a significant treatment gap in this setting, as only half of patients seek treatment. [JAMA Psychiatry 2017;74:465-475] Moreover, only a third resort to specialty care owing to limited access due to the high cost of treatment, as well as the stigma tied to mental healthcare. [J Clin Psychiatry 2008;69:621-632; Psychol Sci Public Interest 2014;15:37-70]

As such, patients seek more accessible alternatives such as yoga outside the medical system; however, there is insufficient data comparing yoga against first-line treatments for GAD, said the researchers.

The team randomized 226 participants (mean age 33 years, 70 percent female) 2:2:1 to participate in 2‑hour sessions of Kundalini yoga, CBT, or stress education for 12 weeks. The protocols were delivered by two instructors to groups of 4–6 participants, with 20 minutes of daily homework that involved listening to audio files on nutrition, lifestyle, and stress.

“[We found that] Kundalini yoga can reduce anxiety for adults with GAD; [however, it] has less consistent or robust efficacy for GAD vs CBT … [Our] results still support CBT as first-line treatment,” said the researchers.

Why yoga?

Apart from clinical experience, the investigators cited the multicomponent feature of Kundalini yoga as reason for choosing the said yoga protocol. [Int J Yoga Therap 2018;28:97-105; Clin Psychol Psychother 2015;22:364-371] “Hence, it is more likely to be effective as therapy than predominantly physical or postural yoga practices. [However, our findings] may not fully generalize to all yoga types,” they pointed out.

Nonetheless, the results align with data reflecting the promising yet inconclusive anxiolytic effects of yoga. [Depress Anxiety 2018;35:830-843] These imply that Kundalini yoga may still offer help in this setting, noted the researchers.

“Future studies [are thus warranted to] identify individual characteristics that make a patient more prone to respond to yoga vs CBT, including treatment preference and attitudes toward mental healthcare, which could inform how yoga might be integrated into a stepped-care personalized approach to anxiety disorders,” said the researchers.