The feelings of fear are normal emotions felt when the brain senses an impending danger or stress. Anxiety is the body's natural response to stress. In some people, however, they experience constant and overwhelming anxiety and fear, impeding their normal activities.
General anxiety disorder (GAD) is a common condition associated with significant distress and impairment, but only half of the affected people seek medical care. Of these, about one-third were seen in specialty mental health settings, hinting a significant treatment gap.
The first line of treatment for GAD is cognitive-behavioral therapy (CBT), which has been dubbed as effective. Yet, many patients do not receive CBT because of its cost, stigma, and other logistic reasons. Further, some patients may not opt to get pharmacotherapy since it is not accessible, it is ineffective for them, or they cannot tolerate it.
Now, with all these problems revolving around treating anxiety in patients, a team of researchers suggests that yoga can help improve symptoms of GAD. The researchers conducted a randomized clinical trial that looked to answer the question, "are yoga and cognitive behavioral therapy (CBT) each more efficacious than a psychological control condition, and is yoga non-inferior to CBT for the treatment of generalized anxiety disorder?". Their research is published in the journal JAMA Psychiatry.
What is the general anxiety disorder?
Anxiety disorders are an umbrella term for a group of mental health disorders characterized by feelings of fear and anxiety. These include generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, phobias, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).
The symptoms of GAD may range from mild to severe, wherein the duration of the symptoms makes it more a chronic condition that an episodic disorder.
In 2015, the estimated proportion of the global population with anxiety disorders was 3.6 percent, accounting for 264 million people. The condition is more common in women than in men, and the number of people with the disorder has increased by 14.9 percent from 2005 to 2015.
Yoga offers a multitude of health benefits. First, it helps improve general wellness by relieving stress and improving mental health, balance, and sleep. It also helps relieve low-back pain, neck pain, and menopause symptoms.
For people with anxiety and depressive symptoms, yoga can help manage the symptoms tied to difficult life situations. It offers an accessible and promising intervention for anxiety.
To arrive at the study findings, the team from NYU Grossman School of Medicine aimed to assess whether yoga, particularly Kundalini yoga, which included postures, relaxation exercises, breathing techniques, meditation, and yoga theory, and cognitive-behavioral therapy (CBT) for GAD are each more effective than a control condition, called stress education.
The team also planned to determine if yoga is a better option than CBT. The study participants were recruited from specialty academic centers since December 2013, with the evaluation ending in October 2019.
The team has found that yoga was significantly more effective for generalized anxiety disorder than standard education on stress management, but not as effective as cognitive-behavioral therapy (CBT), which is the gold standard form of structured talk therapy to help patients determine and identify negative thinking for a better response to challenges.
"Generalized anxiety disorder is a prevalent condition, yet many are not willing or able to access evidence-based treatments. 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," Dr. Naomi M. Simon, a professor in the Department of Psychiatry at NYU Langone Health, said.
The study involved 226 men and women with GAD who were randomly assigned to three groups – CBT, Kundalini yoga, or stress-management education. From there, the team determined if yoga is a better treatment alternative. They found that after three months, both CBT and yoga were more effective for anxiety than stress management.
About 54 percent of those who performed yoga met response criteria for meaningfully improved symptoms, compared to 33 percent in the stress management group. Also, of those who had CBT, an estimated 71 percent met the symptom improvement criteria.
"Many people already seek complementary and alternative interventions, including yoga, to treat anxiety. This study suggests that at least short-term, there is significant value for people with a 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," Dr. Simon explained.
- 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, https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2769486