A new study suggests that integrating yoga practice into cognitive behavioral therapy (CBT) might be an especially effective treatment for generalized anxiety disorder (GAD). The findings were published in Clinical Psychology & Psychotherapy.
GAD is a relatively common mental health diagnosis, and people who meet the criteria often present with additional psychological disorders. While CBT has been established as an effective treatment for GAD, many sufferers simply do not respond to it. There has been great interest, therefore, in uncovering ways to improve upon traditional CBT.
A research team led by Manjit K. Khalsa wondered whether yoga-enhanced cognitive behavioral therapy (Y-CBT) might be especially effective. Evidence suggests that yoga and meditation can improve mood and reduce anxiety, and by targeting both the physiological (yoga) and cognitive (CBT) aspects of anxiety, the researchers proposed that such an intervention may be particularly beneficial.
A group of 32 adults with GAD was recruited from an outpatient clinic and assigned to take part in a Y-CBT intervention. The sample had an average age of 43, and all participants had co-morbid diagnoses — the two most common being major depression (56%) and mood disorders (75%). The patients were considered treatment-resistant since they had been treated at the clinic for an average of 2.79 years and were still meeting the criteria for GAD.
The intervention took place over six weeks and consisted of weekly, one and a half hour group sessions. Each session included a mix of yoga/meditation, CBT, and group discussion. The yoga component followed Kundalini yoga — a style of yoga focused on awakening energy that is centered at the base of the spine while incorporating breathing techniques, physical postures, and mantras to provoke mindfulness and relaxation. The CBT component revolved around the awareness of automatic thoughts and the practice of replacing these thoughts with new ones.
The results of the Y-CBT intervention were overall, very positive. Patients showed significant improvements in both state anxiety (anxiety felt in a given moment) and trait anxiety (a general tendency toward anxiety). They also showed reduce symptoms of depression, panic, suicidality, and sleep disturbance, and improvements in sexual function and quality of life.
Khalsa and colleagues say that the Y-CBT intervention may be particularly effective because it addresses both cognitive and physiological processes at once. The researchers say, “both work together very effectively because while yoga reduces the physiological causes of anxiety, thereby reducing the tendency for negative thoughts to arise, CBT focuses on altering the content of negative thoughts as they arise (“I can’t,” shifted to “I can.”).”
Moreover, while traditional CBT teaches patients to replace maladaptive thoughts, the addition of yoga may prevent these thoughts from appearing at all. The awareness that is practiced in yoga slows down activity in the default mode network (DMN) — a network of brain structures that is active when the brain is not focused on any type of mental activity — possibly preventing dysfunctional thoughts from arising in the first place.
The authors address the need to replicate these findings among a larger, controlled sample, especially given their study’s high drop-out rate (31%). It will also be important to decipher what portion of the positive results can be attributed to the yoga versus the CBT aspect of the treatment.
The study, “Yoga-Enhanced Cognitive Behavioral Therapy (Y-CBT) for Anxiety Management: A Pilot Study”, was authored by Manjit K. Khalsa, Julie M. Greiner-Ferris, Stefan G. Hofmann, and Sat Bir S. Khalsa.
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