Adding Yoga to group CBT for depression and anxiety improved outcome (study)

 



Evidence supports the use of Cognitive Behavioral Therapy (CBT) as treatment for anxiety and depression (1). Cognitive Behavioral Therapy uses strategies to address unhelpful thoughts and patterns of behavior to enable mechanisms that help to make a shift in the conditions that trigger and exacerbate symptoms of depression and anxiety.

 Even though CBT is considered an effective therapy, fifty percent of adults who complete CBT continue to have symptoms (2). Therefore, adding strategies to augment the effectiveness of CBT is a path that warrants attention and research.

 Incorporating mindfulness into CBT has shown promising results. Yoga is an ancient practice that integrates mindfulness and physical exercise through the combination of breathing, gentle movements and physical postures. Research has shown that yoga as a mind-body discipline has multiple benefits on health and wellbeing (3). Also, small studies have indicated that the practice of yoga may be beneficial to relieve symptoms of depression and anxiety (4).  However, no previous study was done to compare the benefits of the use of CBT with and without yoga, so the study done by Melissa O’Shea and colleagues in Australia is the first one. 

 The study was published in 2022 by the Journal of Affective Disorders (5). The purpose of the research was to compare the effects of using CBT in one group of clients with the combination of CBT plus yoga in another group. The study was designed to answer the question on whether adding yoga would help to augment the effects of CBT to treat anxiety and depression

 To answer this question the primary outcome was measured through the use of the Depression Anxiety Stress Scale-21 (DASS-21). This score includes three subscales that measure the intensity of depression, anxiety and stress. The DASS-21 was measured in both groups at baseline, after completing treatment and three months post-treatment.

 A total of 59 participants were recruited. Seventy-one percent of the participants were women. 27 participants belonged to the CBT group (Control group), and 32 participants completed the CBT plus Yoga treatment (Intervention group).

  The control group only received the CBT group program, which was delivered weekly for two hours during the eight-week period. The program provided support through the use of strategies to understand the symptoms, practical management, and it also “encouraged practice within and outside the group to maintain skills and prevent relapse.”

 The intervention group had the Therapeutic Yoga Program added to the delivery of CBT. This Yoga program involved weekly group sessions that lasted sixty minutes, as well as a personalized home practice that was developed to suit each person’s limitations, considering safety and motivations. The home practice had to be performed at least three times a week for 15 to 30 minutes. A practice log had to be documented weekly by the participant.

 The yoga practice combined relaxation, breathing, gentle physical postures and movements suitable for all levels of experience.

  Both groups responded well to the therapies. Both the control and the intervention group had their scores reduced, but the CBT plus Yoga group showed significantly lower DASS total scores and depressive symptoms compared to the CBT alone after treatment and three months post-treatment. The intervention group also had fewer anxiety and stress symptoms after the treatment.

The results of the study suggest that yoga may be considered as an added therapy to CBT to enhance the beneficial effects of CBT and to accomplish sustainable improvements of depression and anxiety.

Participants that included yoga as part of their management of depression and anxiety reported feeling more receptive to their CBT therapy. They reported feeling more empowered to respond to the therapy; they also expressed they had better levels of energy and better quality of sleep.

 The promising results of this study with a limited number of participants indicates the need to research this field further. Adding yoga as an adjunct of therapy may be a cost-effective strategy with multiple potential benefits. This study suggests that adding yoga to CBT can improve the outcome.

 

 References:

1)     1) Carpenter, J.K., Andrews, L.A., Witcraft, S.M., Powers, M.B., Smits, J.A.J., Hofmann, S. G., 2018. Cognitive behavioral therapy for anxiety and related disorders: a metaanalysis of randomized placebo-controlled trials. Depress. Anxiety 35 (6), 502–514. https://doi.org/10.1002/da.22728.

2)    2)  Santoft, F., Axelsson, E., Ost, L.G., Hedman-Lagerlof, M., Fust, J., Hedman-Lagerlof, E., 2019.

Cognitive behaviour therapy for depression in primary care: systematic review and meta-analysis. Psychol. Med. 49 (8), 1266–1274. https://doi.org/10.1017/ S0033291718004208.

 

3)    3)  https://formative.jmir.org/2022/5/e37876/

4)      4) Khalsa, M.K., Greiner-Ferris, J.M., Hofmann, S.G., Khalsa, S.B.S., 2015. Yoga-enhanced cognitive behavioural therapy (Y-CBT) for anxiety management: a pilot study. Clin. Psychol. Psychother. 22 (4), 364–371. https://doi.org/10.1002/cpp.1902.

5)     5)  O’Sheall, M., Capon, H., Skvare, D., Evans, S., McIvry, S., Harris, J., Houston, E., Berk, M.,2022. A pragmatic preference trial of therapeutic yoga as an adjunct to group cognitive behavioral therapy versus group CBT alone for depression and anxiety: a pilot study. Journal of Affective Disorders 307 (2022) 1-10

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