1  524 160 COMPARISON OF COGNITIVE-BEHAVIORAL THERAPY AND YOGA FOR THE TREATMENT OF LATE-LIFE WORRY: A RANDOMIZED PREFERENCE TRIAL. BACKGROUND: THE PURPOSE OF THIS STUDY WAS TO COMPARE THE EFFECTS OF COGNITIVE-BEHAVIORAL THERAPY (CBT) AND YOGA ON LATE-LIFE WORRY, ANXIETY, AND SLEEP; AND EXAMINE PREFERENCE AND SELECTION EFFECTS ON THESE OUTCOMES. METHODS: A RANDOMIZED PREFERENCE TRIAL OF CBT AND YOGA WAS CONDUCTED IN COMMUNITY-DWELLING ADULTS 60 YEARS OR OLDER, WHO SCORED 26 OR ABOVE ON THE PENN STATE WORRY QUESTIONNAIRE-ABBREVIATED (PSWQ-A). CBT CONSISTED OF 10 WEEKLY TELEPHONE SESSIONS. YOGA CONSISTED OF 20 BIWEEKLY GROUP YOGA CLASSES. THE PRIMARY OUTCOME WAS WORRY (PSWQ-A); THE SECONDARY OUTCOMES WERE ANXIETY (PROMIS-ANXIETY) AND SLEEP (INSOMNIA SEVERITY INDEX [ISI]). WE EXAMINED BOTH PREFERENCE EFFECTS (AVERAGE EFFECT FOR THOSE WHO RECEIVED THEIR PREFERRED INTERVENTION [REGARDLESS OF WHETHER IT WAS CBT OR YOGA] MINUS THE AVERAGE FOR THOSE WHO DID NOT RECEIVE THEIR PREFERRED INTERVENTION [REGARDLESS OF THE INTERVENTION]) AND SELECTION EFFECT (WHICH ADDRESSES THE QUESTION OF WHETHER THERE IS A BENEFIT TO GETTING TO SELECT ONE INTERVENTION OVER THE OTHER, AND MEASURES THE EFFECT ON OUTCOMES OF SELF-SELECTION TO A SPECIFIC INTERVENTION). RESULTS: FIVE HUNDRED OLDER ADULTS WERE RANDOMIZED TO THE RANDOMIZED TRIAL (125 EACH IN CBT AND YOGA) OR THE PREFERENCE TRIAL (120 CHOSE CBT; 130 CHOSE YOGA). IN THE RANDOMIZED TRIAL, THE INTERVENTION EFFECT OF YOGA COMPARED WITH CBT ADJUSTED FOR BASELINE PSYCHOTROPIC MEDICATION USE, GENDER, AND RACE WAS 1.6 (-0.2, 3.3), P = .08 FOR THE PSWQ-A. SIMILAR RESULTS WERE OBSERVED WITH PROMIS-ANXIETY (ADJUSTED INTERVENTION EFFECT: 0.3 [-1.5, 2.2], P = .71). PARTICIPANTS RANDOMIZED TO CBT EXPERIENCED A GREATER REDUCTION IN THE ISI COMPARED WITH YOGA (ADJUSTED INTERVENTION EFFECT: 2.4 [1.2, 3.7], P < .01]). ESTIMATED IN THE COMBINED DATA SET (N = 500), THE PREFERENCE AND SELECTION EFFECTS WERE NOT SIGNIFICANT FOR THE PSWQ-A, PROMIS-ANXIETY, AND ISI. OF THE 52 ADVERSE EVENTS, ONLY TWO WERE POSSIBLY RELATED TO THE INTERVENTION. NONE OF THE 26 SERIOUS ADVERSE EVENTS WERE RELATED TO THE STUDY INTERVENTIONS. CONCLUSIONS: CBT AND YOGA WERE BOTH EFFECTIVE AT REDUCING LATE-LIFE WORRY AND ANXIETY. HOWEVER, A GREATER IMPACT WAS SEEN FOR CBT COMPARED WITH YOGA FOR IMPROVING SLEEP. NEITHER PREFERENCE NOR SELECTION EFFECTS WAS FOUND.	2020	
                                                                                                                                                                                                                                                                                                                                                                                    
2 1557  63 LONG-TERM EFFECTS OF COGNITIVE-BEHAVIORAL THERAPY AND YOGA FOR WORRIED OLDER ADULTS. OBJECTIVES: COGNITIVE-BEHAVIORAL THERAPY (CBT) AND YOGA DECREASE WORRY AND ANXIETY. THERE ARE NO LONG-TERM DATA COMPARING CBT AND YOGA FOR WORRY, ANXIETY, AND SLEEP IN OLDER ADULTS. THE IMPACT OF PREFERENCE AND SELECTION ON THESE OUTCOMES IS UNKNOWN. IN THIS SECONDARY DATA ANALYSIS, WE COMPARED LONG-TERM EFFECTS OF CBT BY TELEPHONE AND YOGA ON WORRY, ANXIETY, SLEEP, DEPRESSIVE SYMPTOMS, FATIGUE, PHYSICAL FUNCTION, SOCIAL PARTICIPATION, AND PAIN; AND EXAMINED PREFERENCE AND SELECTION EFFECTS. DESIGN: IN THIS RANDOMIZED PREFERENCE TRIAL, PARTICIPANTS (N = 500) WERE RANDOMIZED TO A: 1) RANDOMIZED CONTROLLED TRIAL (RCT) OF CBT OR YOGA (N = 250); OR 2) PREFERENCE TRIAL (SELECTED CBT OR YOGA; N = 250). OUTCOMES WERE MEASURED AT BASELINE AND WEEK 37. SETTING: COMMUNITY. PARTICIPANTS: COMMUNITY-DWELLING OLDER ADULTS (AGE 60+ YEARS). INTERVENTIONS: CBT (BY TELEPHONE) AND YOGA (IN-PERSON GROUP CLASSES). MEASUREMENTS: PENN STATE WORRY QUESTIONNAIRE - ABBREVIATED (WORRY);(1)(,)(2) INSOMNIA SEVERITY INDEX (SLEEP);(3) PROMIS ANXIETY SHORT FORM V1.0 (ANXIETY);(4)(,)(5) GENERALIZED ANXIETY DISORDER SCREENER (GENERALIZED ANXIETY);(6)(,)(7) AND PROMIS-29 (DEPRESSION, FATIGUE, PHYSICAL FUNCTION, SOCIAL PARTICIPATION, PAIN).(8)(,)(9) RESULTS: SIX MONTHS AFTER INTERVENTION COMPLETION, CBT AND YOGA RCT PARTICIPANTS REPORTED SUSTAINED IMPROVEMENTS FROM BASELINE IN WORRY, ANXIETY, SLEEP, DEPRESSIVE SYMPTOMS, FATIGUE, AND SOCIAL PARTICIPATION (NO SIGNIFICANT BETWEEN-GROUP DIFFERENCES). USING DATA COMBINED FROM THE RANDOMIZED AND PREFERENCE TRIALS, THERE WERE NO SIGNIFICANT PREFERENCE OR SELECTION EFFECTS. LONG-TERM INTERVENTION EFFECTS WERE OBSERVED AT CLINICALLY MEANINGFUL LEVELS FOR MOST OF THE STUDY OUTCOMES. CONCLUSIONS: CBT AND YOGA BOTH DEMONSTRATED MAINTAINED IMPROVEMENTS FROM BASELINE ON MULTIPLE OUTCOMES SIX MONTHS AFTER INTERVENTION COMPLETION IN A LARGE SAMPLE OF OLDER ADULTS. TRIAL REGISTRATION: WWW. CLINICALTRIALS: GOV IDENTIFIER NCT02968238.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
3  133  49 A PRAGMATIC PREFERENCE TRIAL OF THERAPEUTIC YOGA AS AN ADJUNCT TO GROUP COGNITIVE BEHAVIOUR THERAPY VERSUS GROUP CBT ALONE FOR DEPRESSION AND ANXIETY. BACKGROUND: YOGA HAS SEVERAL MECHANISMS THAT MAKE IT A PROMISING TREATMENT FOR DEPRESSION AND ANXIETY, INCLUDING PHYSICAL ACTIVITY, BEHAVIOURAL ACTIVATION, AND MINDFULNESS. FOLLOWING POSITIVE OUTCOMES FROM ADAPTED CBT INTERVENTIONS INCORPORATING MINDFULNESS-BASED PRACTICES, THIS STUDY EXPLORED THE EFFECTS OF A THERAPEUTIC YOGA PROGRAM AS AN ADJUNCT TO GROUP-BASED CBT FOR DEPRESSION OR ANXIETY. METHODS: THIS WAS A PRAGMATIC PREFERENCE TRIAL INVOLVING ADULTS DIAGNOSED WITH DEPRESSION OR ANXIETY IN A REGIONAL PRIMARY MENTAL HEALTHCARE SERVICE (N = 59), COMPARING TRANSDIAGNOSTIC GROUP CBT (N = 27) WITH TRANSDIAGNOSTIC GROUP CBT COMBINED WITH AN ADJUNCT THERAPEUTIC YOGA PROGRAM (N = 32). A PREFERENCE RECRUITMENT DESIGN ALLOWED ELIGIBLE PARTICIPANTS (N = 35) TO SELF-SELECT INTO THE ADJUNCT PROGRAM. THE DEPRESSION ANXIETY STRESS SCALE-21 (DASS) WAS ASSESSED AT BASELINE, POST-INTERVENTION, AND THREE-MONTHS FOLLOW UP. RESULTS: CBT + YOGA WAS AN ACCEPTABLE ALTERNATIVE TO CBT ALONE. SIGNIFICANT REDUCTIONS WERE OBSERVED IN TOTAL DASS SCORES AND THE 3 SUBSCALES OF THE DASS FOR BOTH GROUPS, HOWEVER CBT + YOGA SHOWED SIGNIFICANTLY LOWER DEPRESSIVE AND ANXIETY SYMPTOMS POST-INTERVENTION, COMPARED TO CBT ALONE. CBT + YOGA ALSO SHOWED SUSTAINED REDUCTIONS IN DEPRESSIVE SYMPTOMS OVER THREE-MONTHS, AND MORE RAPID REDUCTIONS IN DEPRESSIVE SYMPTOMS, COMPARED TO CBT ALONE. LIMITATIONS: THESE FINDINGS SHOULD BE CONSIDERED PRELIMINARY DUE TO THE MODERATE SAMPLE SIZE, WITH A RIGOROUS RANDOMISED CONTROL TRIAL NECESSARY TO DEFINITIVELY SUPPORT THE INTEGRATION OF YOGA WITHIN MENTAL HEALTH CARE TO AUGMENT THE BENEFITS AND UPTAKE OF TRANSDIAGNOSTIC CBT FOR DEPRESSION AND ANXIETY. CONCLUSIONS: COMPLEMENTING OTHER MINDFULNESS-BASED PRACTICES, THERAPEUTIC YOGA SHOWS PROMISE AS AN ADJUNCT TO TRANSDIAGNOSTIC CBT.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
4 1140  50 EFFICACY OF YOGA VS COGNITIVE BEHAVIORAL THERAPY VS STRESS EDUCATION FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER: A RANDOMIZED CLINICAL TRIAL. IMPORTANCE: GENERALIZED ANXIETY DISORDER (GAD) IS COMMON, IMPAIRING, AND UNDERTREATED. ALTHOUGH MANY PATIENTS WITH GAD SEEK COMPLEMENTARY AND ALTERNATIVE INTERVENTIONS, INCLUDING YOGA, DATA SUPPORTING YOGA'S EFFICACY OR HOW IT COMPARES TO FIRST-LINE TREATMENTS ARE LACKING. OBJECTIVES: TO ASSESS WHETHER YOGA (KUNDALINI YOGA) AND COGNITIVE BEHAVIORAL THERAPY (CBT) FOR GAD ARE EACH MORE EFFECTIVE THAN A CONTROL CONDITION (STRESS EDUCATION) AND WHETHER YOGA IS NONINFERIOR TO CBT FOR THE TREATMENT OF GAD. DESIGN, SETTING, AND PARTICIPANTS: FOR THIS RANDOMIZED, 3-ARM, CONTROLLED, SINGLE-BLIND (MASKED INDEPENDENT RATERS) CLINICAL TRIAL, PARTICIPANTS WERE RECRUITED FROM 2 SPECIALTY ACADEMIC CENTERS STARTING DECEMBER 1, 2013, WITH ASSESSMENT ENDING OCTOBER 25, 2019. PRIMARY ANALYSES, COMPLETED BY FEBRUARY 12, 2020, INCLUDED SUPERIORITY TESTING OF KUNDALINI YOGA AND CBT VS STRESS EDUCATION AND NONINFERIORITY TESTING OF KUNDALINI YOGA VS CBT. INTERVENTIONS: PARTICIPANTS WERE RANDOMIZED TO KUNDALINI YOGA (N = 93), CBT FOR GAD (N = 90), OR STRESS EDUCATION (N = 43), WHICH WERE EACH DELIVERED TO GROUPS OF 4 TO 6 PARTICIPANTS BY 2 INSTRUCTORS DURING TWELVE 120-MINUTE SESSIONS WITH 20 MINUTES OF DAILY HOMEWORK. MAIN OUTCOMES AND MEASURES: THE PRIMARY INTENTION-TO-TREAT OUTCOME WAS ACUTE GAD RESPONSE (CLINICAL GLOBAL IMPRESSION-IMPROVEMENT SCALE SCORE OF MUCH OR VERY MUCH IMPROVED) AFTER 12 WEEKS AS ASSESSED BY TRAINED INDEPENDENT RATERS. RESULTS: OF 538 PARTICIPANTS WHO PROVIDED CONSENT AND WERE EVALUATED, 226 (MEAN [SD] AGE, 33.4 [13.5] YEARS; 158 [69.9%] FEMALE) WITH A PRIMARY DIAGNOSIS OF GAD WERE INCLUDED IN THE TRIAL. A TOTAL OF 155 PARTICIPANTS (68.6%) COMPLETED THE POSTTREATMENT ASSESSMENT. COMPLETION RATES DID NOT DIFFER (KUNDALINI YOGA, 60 [64.5%]; CBT, 67 [74.4%]; AND STRESS EDUCATION, 28 [65.1%]: CHI2 = 2.39, DF = 2, P = .30). RESPONSE RATES WERE HIGHER IN THE KUNDALINI YOGA GROUP (54.2%) THAN IN THE STRESS EDUCATION GROUP (33.%) (ODDS RATIO [OR], 2.46 [95% CI, 1.12-5.42]; P = .03; NUMBER NEEDED TO TREAT, 4.59 [95% CI, 2.52-46.19]) AND IN THE CBT GROUP (70.8%) COMPARED WITH THE STRESS EDUCATION GROUP (33.0%) (OR, 5.00 [95% CI, 2.12-11.82]; P < .001; NUMBER NEEDED TO TREAT, 2.62 [95% CI, 1.91-5.68]). HOWEVER, THE NONINFERIORITY TEST DID NOT FIND KUNDALINI YOGA TO BE AS EFFECTIVE AS CBT (DIFFERENCE, 16.6%; P = .42 FOR NONINFERIORITY). CONCLUSIONS AND RELEVANCE: IN THIS TRIAL, KUNDALINI YOGA WAS EFFICACIOUS FOR GAD, BUT THE RESULTS SUPPORT CBT REMAINING FIRST-LINE TREATMENT. TRIAL REGISTRATION: CLINICALTRIALS.GOV IDENTIFIER: NCT01912287.	2021	
                       
5  187  79 A RANDOMIZED PREFERENCE TRIAL COMPARING COGNITIVE-BEHAVIORAL THERAPY AND YOGA FOR THE TREATMENT OF LATE-LIFE WORRY: EXAMINATION OF IMPACT ON DEPRESSION, GENERALIZED ANXIETY, FATIGUE, PAIN, SOCIAL PARTICIPATION, AND PHYSICAL FUNCTION. BACKGROUND: DEPRESSION, GENERALIZED ANXIETY, FATIGUE, DIMINISHED PHYSICAL FUNCTION, REDUCED SOCIAL PARTICIPATION, AND PAIN ARE COMMON FOR MANY OLDER ADULTS AND NEGATIVELY IMPACT QUALITY OF LIFE. THE PURPOSE OF THE OVERALL TRIAL WAS TO COMPARE THE EFFECTS OF COGNITIVE-BEHAVIORAL THERAPY (CBT) AND YOGA ON LATE-LIFE WORRY, ANXIETY, AND SLEEP; AND EXAMINE PREFERENCE AND SELECTION EFFECTS ON THESE OUTCOMES. OBJECTIVE: THE PRESENT ANALYSES COMPARED EFFECTS OF THE 2 INTERVENTIONS ON ADDITIONAL OUTCOMES (DEPRESSIVE SYMPTOMS, GENERALIZED ANXIETY SYMPTOMS, FATIGUE, PAIN INTERFERENCE/INTENSITY, PHYSICAL FUNCTION, SOCIAL PARTICIPATION); AND EXAMINED WHETHER THERE ARE PREFERENCE AND SELECTION EFFECTS FOR THESE TREATMENTS. METHODS: A RANDOMIZED PREFERENCE TRIAL OF CBT AND YOGA WAS CONDUCTED IN ADULTS >/=60 YEARS WHO SCORED >/=26 ON THE PENN STATE WORRY QUESTIONNAIRE-ABBREVIATED (PSWQ-A), RECRUITED FROM OUTPATIENT MEDICAL CLINICS, MAILINGS, AND ADVERTISEMENTS. COGNITIVE-BEHAVIORAL THERAPY CONSISTED OF 10 WEEKLY TELEPHONE SESSIONS. YOGA CONSISTED OF 20 BI-WEEKLY GROUP YOGA CLASSES. PARTICIPANTS WERE RANDOMIZED TO(1): A RANDOMIZED CONTROLLED TRIAL (RCT) OF CBT OR YOGA (N = 250); OR (2) A PREFERENCE TRIAL IN WHICH THEY SELECTED THEIR TREATMENT (CBT OR YOGA; N = 250). OUTCOMES WERE MEASURED AT BASELINE AND POST-INTERVENTION. RESULTS: WITHIN THE RCT, THERE WERE SIGNIFICANT BETWEEN-GROUP DIFFERENCES FOR BOTH PAIN INTERFERENCE AND INTENSITY. THE PAIN INTERFERENCE SCORE IMPROVED MORE FOR THE CBT GROUP COMPARED WITH THE YOGA GROUP [INTERVENTION EFFECT OF (MEAN (95% CI) = 2.5 (.5, 4.6), P = .02]. FOR THE PAIN INTENSITY SCORE, THE INTERVENTION EFFECT ALSO FAVORED CBT OVER YOGA [.7 (.2, 1.3), P < .01]. DEPRESSIVE SYMPTOMS, GENERALIZED ANXIETY, AND FATIGUE SHOWED CLINICALLY MEANINGFUL WITHIN-GROUP CHANGES IN BOTH GROUPS. THERE WERE NO CHANGES IN OR DIFFERENCE BETWEEN PHYSICAL FUNCTION OR SOCIAL PARTICIPATION FOR EITHER GROUP. NO PREFERENCE OR SELECTION EFFECTS WERE FOUND. CONCLUSION: BOTH CBT AND YOGA MAY BE USEFUL FOR OLDER ADULTS FOR IMPROVING PSYCHOLOGICAL SYMPTOMS AND FATIGUE. COGNITIVE-BEHAVIORAL THERAPY MAY OFFER EVEN GREATER BENEFIT THAN YOGA FOR DECREASING PAIN.	2022	
                                                                                                                                                                                                                                                                                                                                             
6  188  61 A RANDOMIZED PREFERENCE TRIAL OF COGNITIVE-BEHAVIORAL THERAPY AND YOGA FOR THE TREATMENT OF WORRY IN ANXIOUS OLDER ADULTS. BACKGROUND: WORRY IS A COMMON PROBLEM AMONG OLDER ADULTS. COGNITIVE-BEHAVIORAL THERAPY IS THE MOST STUDIED NONPHARMACOLOGICAL INTERVENTION AND IT HAS DEMONSTRATED EFFICACY IN REDUCING LATE-LIFE WORRY AND ANXIETY. ALTHOUGH THE EVIDENCE-BASE IS SMALLER, YOGA HAS BEEN SHOWN TO REDUCE ANXIETY AND STRESS. HOWEVER, LITTLE IS KNOWN ABOUT THE RELATIVE EFFECTIVENESS OF THESE TWO NONPHARMACOLOGICAL INTERVENTIONS. FURTHER, THE IMPACT OF PATIENT PREFERENCE ON OUTCOMES IS UNKNOWN.PURPOSE: THE PURPOSE TO THIS STUDY IS TO COMPARE THE EFFECTIVENESS OF COGNITIVE-BEHAVIORAL THERAPY (CBT) WITH YOGA FOR IMPROVING LATE-LIFE WORRY, ANXIETY, AND SLEEP. WE WILL ALSO EXAMINE THE EFFECTS OF PREFERENCE AND SELECTION ON OUTCOMES, ADHERENCE, AND ATTRITION. METHODS: WE ARE CONDUCTING A TWO-STAGE RANDOMIZED PREFERENCE TRIAL COMPARING CBT AND YOGA FOR THE REDUCTION OF WORRY IN A SAMPLE OF ANXIOUS OLDER ADULTS. FIVE HUNDRED PARTICIPANTS WILL BE RANDOMIZED TO EITHER THE PREFERENCE TRIAL (PARTICIPANTS CHOOSE THE INTERVENTION; N=250) OR TO THE RANDOMIZED TRIAL (PARTICIPANTS ARE RANDOMIZED TO ONE OF THE TWO INTERVENTIONS; N=250) WITH EQUAL PROBABILITY. CBT CONSISTS OF 10 TELEPHONE-BASED SESSIONS WITH AN ACCOMPANYING WORKBOOK. YOGA CONSISTS OF 10 WEEKS OF GROUP YOGA CLASSES (TWICE A WEEK) THAT IS MODIFIED FOR USE WITH OLDER ADULTS. CONCLUSIONS: THE STUDY DESIGN IS BASED ON FEEDBACK FROM ANXIOUS OLDER ADULTS WHO WANTED MORE NONPHARMACOLOGICAL OPTIONS FOR INTERVENTION AS WELL AS MORE INPUT INTO THE INTERVENTION THEY RECEIVE. IT IS THE FIRST HEAD-TO-HEAD COMPARISON OF CBT AND YOGA FOR REDUCING LATE-LIFE WORRY AND ANXIETY. IT WILL ALSO PROVIDE INFORMATION ABOUT HOW INTERVENTION PREFERENCE AFFECTS OUTCOMES. TRIAL REGISTRATION: CLINICALTRIALS.GOV NCT02968238.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
7 2577  40 YOGA FOR GENERALIZED ANXIETY DISORDER: DESIGN OF A RANDOMIZED CONTROLLED CLINICAL TRIAL. GENERALIZED ANXIETY DISORDER (GAD) IS A COMMON DISORDER ASSOCIATED WITH SIGNIFICANT DISTRESS AND INTERFERENCE. ALTHOUGH COGNITIVE BEHAVIORAL THERAPY (CBT) HAS BEEN SHOWN TO BE THE MOST EFFECTIVE FORM OF PSYCHOTHERAPY, FEW PATIENTS RECEIVE OR HAVE ACCESS TO THIS INTERVENTION. YOGA THERAPY OFFERS ANOTHER PROMISING, YET UNDER-RESEARCHED, INTERVENTION THAT IS GAINING INCREASING POPULARITY IN THE GENERAL PUBLIC, AS AN ANXIETY REDUCTION INTERVENTION. THE PURPOSE OF THIS INNOVATIVE CLINICAL TRIAL PROTOCOL IS TO INVESTIGATE THE EFFICACY OF A KUNDALINI YOGA INTERVENTION, RELATIVE TO CBT AND A CONTROL CONDITION. KUNDALINI YOGA AND CBT ARE COMPARED WITH EACH OTHER IN A NONINFERIORITY TEST AND BOTH TREATMENTS ARE COMPARED TO STRESS EDUCATION TRAINING, AN ATTENTION CONTROL INTERVENTION, IN SUPERIORITY TESTS. THE SAMPLE WILL CONSIST OF 230 INDIVIDUALS WITH A PRIMARY DSM-5 DIAGNOSIS OF GAD. THIS RANDOMIZED CONTROLLED TRIAL WILL COMPARE YOGA (N=95) TO BOTH CBT FOR GAD (N=95) AND STRESS EDUCATION (N=40), A COMMONLY USED CONTROL CONDITION. ALL THREE TREATMENTS WILL BE ADMINISTERED BY TWO INSTRUCTORS IN A GROUP FORMAT OVER 12 WEEKLY SESSIONS WITH FOUR TO SIX PATIENTS PER GROUP. GROUPS WILL BE RANDOMIZED USING PERMUTED BLOCK RANDOMIZATION, WHICH WILL BE STRATIFIED BY SITE. TREATMENT OUTCOME WILL BE EVALUATED BI-WEEKLY AND AT 6MONTH FOLLOW-UP. FURTHERMORE, POTENTIAL MEDIATORS OF TREATMENT OUTCOME WILL BE INVESTIGATED. GIVEN THE INDIVIDUAL AND ECONOMIC BURDEN ASSOCIATED WITH GAD, IDENTIFYING ACCESSIBLE ALTERNATIVE BEHAVIORAL TREATMENTS WILL HAVE SUBSTANTIVE PUBLIC HEALTH IMPLICATIONS.	2015	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
8 2872  34 YOGA-ENHANCED COGNITIVE BEHAVIOURAL THERAPY (Y-CBT) FOR ANXIETY MANAGEMENT: A PILOT STUDY. COGNITIVE BEHAVIOURAL THERAPY (CBT) IS AN EFFECTIVE TREATMENT FOR GENERALIZED ANXIETY DISORDER, BUT THERE IS STILL ROOM FOR IMPROVEMENT. THE AIM OF THE PRESENT STUDY WAS TO EXAMINE THE POTENTIAL BENEFIT OF ENRICHING CBT WITH KUNDALINI YOGA (Y-CBT). PARTICIPANTS CONSISTED OF TREATMENT RESISTANT CLIENTS AT A COMMUNITY MENTAL HEALTH CLINIC. A TOTAL OF 32 PARTICIPANTS ENROLLED IN THE STUDY AND 22 COMPLETED THE PROGRAMME. AFTER THE Y-CBT INTERVENTION, PRE-POST COMPARISONS SHOWED STATISTICALLY SIGNIFICANT IMPROVEMENTS IN STATE AND TRAIT ANXIETY, DEPRESSION, PANIC, SLEEP AND QUALITY OF LIFE. RESULTS FROM THIS PRELIMINARY STUDY SUGGEST THAT Y-CBT MAY HAVE POTENTIAL AS A PROMISING TREATMENT FOR THOSE SUFFERING FROM GENERALIZED ANXIETY DISORDER. KEY PRACTITIONER MESSAGES: YOGA-ENHANCED COGNITIVE BEHAVIOURAL THERAPY (Y-CBT) MAY BE A PROMISING NEW TREATMENT FOR THOSE SUFFERING FROM GENERALIZED ANXIETY DISORDER. Y-CBT MAY ALSO REDUCE DEPRESSION IN THOSE SUFFERING FROM GENERALIZED ANXIETY. Y-CBT MAY REDUCE DEPRESSION AND ANXIETY IN A CLINIC POPULATION WHERE CLIENTS SUFFER FROM MULTIPLE DIAGNOSES INCLUDING GENERALIZED ANXIETY DISORDER.	2015	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
9 1784  54 PREDICTORS OF PREFERENCE FOR COGNITIVE-BEHAVIORAL THERAPY (CBT) AND YOGA INTERVENTIONS AMONG OLDER ADULTS. THE PURPOSE OF THIS STUDY WAS TO EXAMINE FACTORS THAT INFLUENCE A PERSON'S CHOICE OF COGNITIVE-BEHAVIORAL THERAPY (CBT) OR YOGA, THE STABILITY OF THESE PREFERENCES, AND THE IMPACT OF PREFERENCE ON ENGAGEMENT AND PROCESS MEASURES. WE CONDUCTED A RANDOMIZED PREFERENCE TRIAL OF CBT AND YOGA IN 500 ADULTS >/=60 YEARS WITH SYMPTOMS OF WORRY. PARTICIPANTS REPORTED THEIR INTERVENTION PREFERENCE, STRENGTH OF PREFERENCE, AND FACTORS IMPACTING PREFERENCE. ENGAGEMENT IN THE INTERVENTION (SESSION COMPLETION AND DROPOUT RATES) WAS ASSESSED. PROCESS MEASURES INCLUDED SATISFACTION WITH THE INTERVENTION, THERAPEUTIC ALLIANCE, AND INTERVENTION EXPECTANCY. NEITHER INTERVENTION PREFERENCE (48% AND 52% CHOSE CBT AND YOGA, RESPECTIVELY) NOR STRENGTH OF PREFERENCE DIFFERED SIGNIFICANTLY BETWEEN THE TWO PREFERENCE TRIAL GROUPS. INTERVENTION EXPECTANCIES AT BASELINE AMONG THOSE IN THE PREFERENCE TRIAL WERE APPROXIMATELY 4.5 UNITS (40-POINT SCALE) HIGHER FOR THEIR PREFERRED INTERVENTION (P < .0001 WITHIN EACH GROUP). A PRINCIPAL COMPONENT ANALYSIS OF FACTORS INFLUENCING PREFERENCE IDENTIFIED THREE CONSTRUCTS. USING LOGISTIC REGRESSION, COMPONENTS FOCUSED ON ATTITUDES ABOUT CBT OR YOGA WERE PREDICTIVE OF ULTIMATE PREFERENCE (ODDS RATIO = 11.5, 95% C.I.6.3-21.0 PER 1SD DIFFERENCE IN COMPONENT 1 FOR CHOOSING CBT; ODDS RATIO = 7.8, 95% CI4.3-13.9 PER 1SD DIFFERENCE IN COMPONENT 2 FOR CHOOSING YOGA). THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN THE RANDOMIZED AND PREFERENCE TRIALS ON INTERVENTION ADHERENCE, COMPLETION OF ASSESSMENTS, INTERVENTION SATISFACTION, OR WORKING ALLIANCE. RECEIVING A PREFERRED TREATMENT HAD NO SIGNIFICANT EFFECTS ON INTERVENTION OUTCOMES THROUGH PARTICIPANT ENGAGEMENT OR PROCESS MEASURES. WHEN OPTIONS ARE LIMITED, PROVIDERS MAY HAVE CONFIDENCE IN OFFERING THE MOST READILY AVAILABLE NON-PHARMACOLOGICAL TREATMENTS.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
10  767  44 EFFECT OF TRADITIONAL YOGA, MINDFULNESS-BASED COGNITIVE THERAPY, AND COGNITIVE BEHAVIORAL THERAPY, ON HEALTH RELATED QUALITY OF LIFE: A RANDOMIZED CONTROLLED TRIAL ON PATIENTS ON SICK LEAVE BECAUSE OF BURNOUT. BACKGROUND: TO EXPLORE IF HEALTH RELATED QUALITY OF LIFE(HRQOL) INCREASED AFTER TRADITIONAL YOGA(TY), MINDFULNESS BASED COGNITIVE THERAPY(MBCT), OR COGNITIVE BEHAVIORAL THERAPY(CBT), IN PATIENTS ON SICK LEAVE BECAUSE OF BURNOUT. METHODS: RANDOMIZED CONTROLLED TRIAL, BLINDED, IN NINETY-FOUR PRIMARY HEALTH CARE PATIENTS, BLOCK RANDOMIZED TO TY, MBCT OR CBT (ACTIVE CONTROL) BETWEEN SEPTEMBER 2007 AND NOVEMBER 2009. PATIENTS WERE LIVING IN THE STOCKHOLM METROPOLITAN AREA, SWEDEN, WERE AGED 18-65 YEARS AND WERE ON 50%-100% SICK LEAVE. A GROUP TREATMENT FOR 20 WEEKS, THREE HOURS PER WEEK, WITH HOMEWORK FOUR HOURS PER WEEK. HRQOL WAS MEASURED BY THE SWED-QUAL QUESTIONNAIRE, COMPRISING 67 ITEMS GROUPED INTO 13 SUBSCALES, EACH WITH A SEPARATE INDEX, AND SCORES FROM 0 (WORSE) TO 100 (BEST). SWED-QUAL COVERS ASPECTS OF PHYSICAL AND EMOTIONAL WELL-BEING, COGNITIVE FUNCTION, SLEEP, GENERAL HEALTH AND SOCIAL AND SEXUAL FUNCTIONING. STATISTICS: WILCOXON'S RANK SUM AND WILCOXON'S SIGN RANK TESTS, BONETT-PRICE FOR MEDIANS AND CONFIDENCE INTERVALS, AND COHEN'S D. RESULTS: TWENTY-SIX PATIENTS IN THE TY (21 WOMEN), AND 27 PATIENTS IN BOTH THE MBCT (24 WOMEN) AND IN THE CBT (25 WOMEN), WERE ANALYZED. TEN SUBSCALES IN TY AND SEVEN SUBSCALES IN MBCT AND CBT SHOWED IMPROVEMENTS, P < 0.05, IN SEVERAL OF THE MAIN DOMAINS AFFECTED IN BURNOUT, E.G. EMOTIONAL WELL-BEING, PHYSICAL WELL-BEING, COGNITIVE FUNCTION AND SLEEP. THE MEDIAN IMPROVEMENT RANGED FROM 0 TO 27 POINTS IN TY, FROM 4 TO 25 POINTS IN CBT AND FROM 0 TO 25 POINTS IN MBCT. THE EFFECT SIZE WAS MAINLY MEDIUM OR LARGE. COMPARISON OF TREATMENTS SHOWED NO STATISTICAL DIFFERENCES, BUT BETTER EFFECT (SMALL) OF BOTH TY AND MBCT COMPARED TO CBT. WHEN COMPARING THE EFFECT OF TY AND MBCT, BOTH SHOWED A BETTER EFFECT (SMALL) IN TWO SUBSCALES EACH. CONCLUSIONS: A 20 WEEK GROUP TREATMENT WITH TY, CBT OR MBCT HAD EQUAL EFFECTS ON HRQOL, AND PARTICULARLY ON MAIN DOMAINS AFFECTED IN BURNOUT. THIS INDICATES THAT TY, MBCT AND CBT CAN BE USED AS BOTH TREATMENT AND PREVENTION, TO IMPROVE HRQOL IN PATIENTS ON SICK LEAVE BECAUSE OF BURNOUT, REDUCING THE RISK OF FUTURE MORBIDITY. TRIAL REGISTRATION: JULY 22, 2012, RETROSPECTIVELY REGISTERED. CLINICALTRAILS.GOV NCT01168661 . FUNDING: STOCKHOLM COUNTY COUNCIL, GRANT 2003-5.	2018	
                                                                                                                                                                                                                                                                        
11  345  44 ASSESSING FEASIBILITY AND ACCEPTABILITY OF YOGA AND GROUP CBT FOR ADOLESCENTS WITH DEPRESSION: A PILOT RANDOMIZED CLINICAL TRIAL. PURPOSE: GIVEN INCREASING RATES OF DEPRESSION IN ADOLESCENTS, THERE IS A CLEAR NEED FOR INNOVATIVE TREATMENTS. IN THIS PILOT RANDOMIZED CLINICAL TRIAL, WE ASSESSED ACCEPTABILITY AND FEASIBILITY OF TWO GROUP-BASED INTERVENTIONS: YOGA AND COGNITIVE-BEHAVIORAL THERAPY (CBT). THE GOAL OF THIS WORK IS TO PREPARE FOR A FUTURE FULLY POWERED RANDOMIZED TRIAL TO TEST THE HYPOTHESIS THAT YOGA IS NOT INFERIOR TO AN ESTABLISHED ADOLESCENT DEPRESSION TREATMENT, NAMELY, GROUP CBT. METHODS: WE ENROLLED 42 ADOLESCENTS WITH ELEVATED DEPRESSION SYMPTOMS. PARTICIPANTS WERE RANDOMLY ASSIGNED TO A 12-WEEK GROUP-BASED INTERVENTION, YOGA OR CBT. WE HAD A PRIORI FEASIBILITY AND ACCEPTABILITY TARGETS, INCLUDING FOR RECRUITMENT RATE, RETENTION RATE, EXPECTANCY, CREDIBILITY, PROGRAM SATISFACTION, CLASS ATTENDANCE, ENGAGEMENT IN HOME PRACTICE, AND INSTRUCTOR/LEADER MANUAL ADHERENCE. WE ASSESSED ADVERSE EVENTS, AND WITHIN-SUBJECT CHANGES IN OUTCOMES (DEPRESSION, ANXIETY, IMPAIRMENT, SLEEP DISTURBANCE) AND POSSIBLE MEDIATORS (MINDFULNESS, SELF-COMPASSION). RESULTS: BOTH INTERVENTIONS MET MOST ACCEPTABILITY AND FEASIBILITY TARGETS. THE ONLY TARGET NOT MET RELATED TO LOW ENGAGEMENT IN HOME PRACTICE. PARTICIPANTS WITHIN EACH STUDY ARM SHOWED DECREASED DEPRESSION SYMPTOMS OVER TIME AND INCREASED SELF-COMPASSION. CONCLUSIONS: A YOGA INTERVENTION APPEARS TO BE ACCEPTABLE AND FEASIBLE TO ADOLESCENTS WITH DEPRESSION. HOWEVER, IT MAY BE CHALLENGING FOR THIS GROUP TO ENGAGE IN UNSTRUCTURED HOME PRACTICE.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
12 2843  34 YOGA, COGNITIVE-BEHAVIOURAL THERAPY VERSUS EDUCATION TO IMPROVE QUALITY OF LIFE AND REDUCE HEALTHCARE COSTS IN PEOPLE WITH ENDOMETRIOSIS: A RANDOMISED CONTROLLED TRIAL. INTRODUCTION: ENDOMETRIOSIS IS A DEBILITATING CHRONIC INFLAMMATORY CONDITION HIGHLY BURDENSOME TO THE HEALTHCARE SYSTEM. THE PRESENT TRIAL WILL ESTABLISH THE EFFICACY OF (1) YOGA AND (2) COGNITIVE-BEHAVIOURAL THERAPY (CBT), ABOVE (3) EDUCATION, ON QUALITY OF LIFE, BIOPSYCHOSOCIAL OUTCOMES AND COST-EFFECTIVENESS. METHODS AND ANALYSIS: THIS STUDY IS A PARALLEL RANDOMISED CONTROLLED TRIAL. PARTICIPANTS WILL BE RANDOMLY ALLOCATED TO YOGA, CBT OR EDUCATION. PARTICIPANTS WILL BE ENGLISH-SPEAKING ADULTS, HAVE A DIAGNOSIS OF ENDOMETRIOSIS BY A QUALIFIED PHYSICIAN, WITH PAIN FOR AT LEAST 6 MONTHS, AND ACCESS TO INTERNET. PARTICIPANTS WILL ATTEND 8 WEEKLY GROUP CBT SESSIONS OF 120 MIN; OR 8 WEEKLY GROUP YOGA SESSIONS OF 60 MIN; OR RECEIVE WEEKLY EDUCATIONAL HANDOUTS ON ENDOMETRIOSIS. THE PRIMARY OUTCOME MEASURE IS QUALITY OF LIFE. THE ANALYSIS WILL INCLUDE MIXED-EFFECTS ANALYSIS OF VARIANCE AND LINEAR MODELS, COST-UTILITY ANALYSIS FROM A SOCIETAL AND HEALTH SYSTEM PERSPECTIVE AND QUALITATIVE THEMATIC ANALYSIS. ETHICS AND DISSEMINATION: ENROLMENT IN THE STUDY IS VOLUNTARY AND PARTICIPANTS CAN WITHDRAW AT ANY TIME. PARTICIPANTS WILL BE GIVEN THE OPTION TO DISCUSS THE STUDY WITH THEIR NEXT OF KIN/TREATING PHYSICIAN. FINDINGS WILL BE DISSEMINATED VIA PUBLICATIONS, CONFERENCES AND BRIEFS TO PROFESSIONAL ORGANISATIONS. THE UNIVERSITY'S MEDIA TEAM WILL ALSO BE USED TO FURTHER DISSEMINATE VIA LAY PERSON ARTICLES AND MEDIA RELEASES. TRIAL REGISTRATION NUMBER: ACTRN12620000756921P; PRE-RESULTS.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
13 1156  56 ENSURING YOGA INTERVENTION FIDELITY IN A RANDOMIZED PREFERENCE TRIAL FOR THE TREATMENT OF WORRY IN OLDER ADULTS. INTRODUCTION: YOGA FOR TREATMENT OF WORRY IN OLDER ADULTS IS AN INTERVENTION THAT IS ESPECIALLY LIKELY TO TRANSLATE INTO REAL-WORLD PRACTICE. ASSESSING TREATMENT FIDELITY IMPROVES CONFIDENCE THAT EFFECTIVE INTERVENTIONS CAN BE CONSISTENTLY APPLIED AND ALLOWS RESEARCHERS TO EXPLORE IF ANY NULL RESULTS FOR EFFECTIVENESS ARE INDEED THE RESULT OF A LACK OF INTERVENTION EFFICACY OR LACK OF PROPER INTERVENTION IMPLEMENTATION. METHODS: THIS STUDY DESCRIBES TREATMENT FIDELITY OF A YOGA INTERVENTION IN A RANDOMIZED PREFERENCE TRIAL THAT COMPARED COGNITIVE-BEHAVIORAL THERAPY (CBT) AND YOGA FOR THE TREATMENT OF WORRY, ANXIETY, AND SLEEP IN WORRIED OLDER (>/=60 YEARS) ADULTS. ESTABLISHED METHODS FOR ASSESSING TREATMENT FIDELITY OF CBT GUIDED THE PROCEDURE FOR ENSURING THAT THE YOGA INTERVENTION WAS DELIVERED AS INTENDED. THE YOGA INTERVENTION CONSISTED OF 20, 75-MIN, IN-PERSON, GROUP, GENTLE YOGA CLASSES HELD TWICE WEEKLY. RESULTS: SIX FEMALE INSTRUCTORS (MEAN AGE = 64 YEARS) TAUGHT 660 YOGA CLASSES THAT WERE VIDEOTAPED. TEN PERCENT OF THESE CLASSES, STRATIFIED BY INSTRUCTOR, WERE RANDOMLY SELECTED FOR REVIEW. THE AVERAGE ADHERENCE SCORE FOR YOGA INSTRUCTORS WAS 6.84 (RANGE 4-8). THE AVERAGE COMPETENCY SCORES WERE CONSISTENTLY HIGH, WITH AN AVERAGE SCORE OF 7.24 (RANGE 6-8). TEACHING CONTENT NOT INCLUDED IN THE PROTOCOL OCCURRED IN 26 (38.1%) SESSIONS AND DECREASED OVER TIME. OBSERVED RATINGS OF INSTRUCTOR ADHERENCE WERE SIGNIFICANTLY RELATED TO RATINGS OF COMPETENCY. INSTRUCTOR ADHERENCE WAS ALSO SIGNIFICANTLY ASSOCIATED WITH LOWER PARTICIPANT ATTENDANCE, BUT NOT WITH ANY OF THE OTHER PROCESS OR OUTCOME MEASURES. CONCLUSIONS: THE LARGER RANGE FOUND IN ADHERENCE RELATIVE TO COMPETENCE SCORES DEMONSTRATED THAT TEACHING A YOGA CLASS ACCORDING TO A PROTOCOL REQUIRES DIFFERENT SKILLS THAN COMPETENTLY TEACHING A YOGA CLASS IN THE COMMUNITY, AND THESE SKILLS IMPROVED WITH FEEDBACK. THESE RESULTS MAY FOSTER DIALOG BETWEEN THE YOGA RESEARCH AND PRACTICE COMMUNITIES. CLINICAL TRIAL REGISTRATION NO.: NCT02968238.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
14   44  33 A CASE SERIES ON THE EFFECTS OF KRIPALU YOGA FOR GENERALIZED ANXIETY DISORDER. GENERALIZED ANXIETY DISORDER (GAD) IS A PREVALENT PSYCHIATRIC DISORDER ASSOCIATED WITH SUBSTANTIAL IMPAIRMENT AND POOR TREATMENT RESPONSE. YOGA INFLUENCES PROCESSES THAT ARE LINKED TO THE MAINTENANCE OF GAD INCLUDING MINDFULNESS, ANXIETY, AND HEART RATE VARIABILITY, BUT HAS YET TO BE EVALUATED AMONG PEOPLE WITH THE DISORDER. THE PRESENT STUDY IS A FIRST STEP TOWARD DOCUMENTING THE EFFICACY OF YOGA FOR REDUCING WORRY AMONG PEOPLE WITH GAD USING A SINGLE-SUBJECT AB DESIGN CASE SERIES AND DAILY RATINGS OF WORRY. STANDARDIZED SELF-REPORT MEASURES OF WORRY, TRAIT ANXIETY, EXPERIENTIAL AVOIDANCE, MINDFULNESS, AND HEART RATE VARIABILITY WERE ASSESSED PRE- AND POST-INTERVENTION. THREE PARTICIPANTS WITH PRIMARY GAD RECEIVED EIGHT TWICE-WEEKLY KRIPALU YOGA SESSIONS FOLLOWING A BASELINE DATA COLLECTION PERIOD. ALL PARTICIPANTS SHOWED SYSTEMATIC IMPROVEMENT IN DAILY WORRY RATINGS ON AT LEAST ONE INDEX AND ALL SCORES ON SELF-REPORTED MEASURES OF WORRY, ANXIETY, EXPERIENTIAL AVOIDANCE, AND MINDFULNESS CHANGED IN THE EXPECTED DIRECTION FOLLOWING YOGA (WITH ONE OR TWO EXCEPTIONS). PARTICIPANTS ALSO SHOWED IMPROVED HEART RATE VARIABILITY DURING A WORRY PERIOD FROM PRE- TO POST-INTERVENTION. YOGA HAS THE POTENTIAL TO IMPROVE THE PROCESSES LINKED TO GAD AND SHOULD STIMULATE FURTHER RESEARCH IN THIS AREA.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
15 2520  37 YOGA COMPLEMENTS COGNITIVE BEHAVIOUR THERAPY AS AN ADJUNCT TREATMENT FOR ANXIETY AND DEPRESSION: QUALITATIVE FINDINGS FROM A MIXED-METHODS STUDY. OBJECTIVES: COGNITIVE BEHAVIOUR THERAPY (CBT) IS RECOMMENDED FOR TREATING ANXIETY AND DEPRESSION, DEMONSTRATING GOOD EFFICACY AND MODERATE RATES OF ENGAGEMENT. TO FURTHER IMPROVE OUTCOMES AND ACCESS TO EVIDENCE-BASED TREATMENTS, RESEARCHERS HAVE SOUGHT TO ENHANCE CBT PROTOCOLS WITH MINDFULNESS-BASED APPROACHES, SUCH AS YOGA. THIS STUDY AIMED TO EXAMINE WHETHER YOGA IS AN ACCEPTABLE AND COMPLEMENTARY ADJUNCT TO CBT THROUGH EXPLORING THE LIVED EXPERIENCES OF ADULTS WITH ANXIETY AND DEPRESSION WHO ENGAGED IN AN ADJUNCT THERAPEUTIC YOGA PROGRAMME ALONGSIDE GROUP CBT. DESIGN: SINGLE-GROUP QUALITATIVE DESIGN WITH POST-INTERVENTION AND FOLLOW-UP TIMEPOINTS. METHODS: THIRTY-SIX ADULTS WITH ANXIETY AND DEPRESSION SELF-SELECTED INTO A THERAPEUTIC YOGA PROGRAMME AS AN ADJUNCT TO GROUP CBT. QUALITATIVE INTERVIEWS WERE CONDUCTED WITH 27 PARTICIPANTS IMMEDIATELY AFTER THE EIGHT-WEEK PROGRAMME AND AGAIN THREE MONTHS LATER. THEMATIC ANALYSIS WAS USED TO IDENTIFY COMMON THEMES FROM THE LIVED EXPERIENCES. RESULTS: THREE PRIMARY THEMES, WITH NINE SUBTHEMES, WERE IDENTIFIED WHICH REFLECT THE EXPERIENCES OF THE COMBINED THERAPIES, THE COMPLEMENTARY ELEMENTS, AND PROCESS OF ENGAGEMENT OVER TIME. THE ADJUNCT YOGA PROGRAMME WAS HIGHLY ACCEPTABLE TO ADULTS WITH ANXIETY AND DEPRESSION, ENHANCING ENGAGEMENT AND PERCEIVED OUTCOMES. YOGA WAS IDENTIFIED AS PROVIDING A UNIQUE COMBINATION OF ELEMENTS THAT COMPLEMENTED PROCESSES OF CBT, SUCH AS BEHAVIOURAL ACTIVATION AND THOUGHT DISPUTATION. YOGA PRACTICES REPRESENTED MENTAL HEALTH SELF-MANAGEMENT TOOLS THAT ARE ACCESSIBLE AND AVAILABLE AS RELAPSE PREVENTION STRATEGIES. CONCLUSIONS: THERAPEUTIC YOGA WARRANTS CONSIDERATION AS AN ADJUNCT TREATMENT FOR ANXIETY AND DEPRESSION AS IT OFFERS UNIQUE AND COMPLEMENTARY ELEMENTS TO CBT AND CAN ENHANCE ENGAGEMENT AND PERCEIVED CLINICAL OUTCOMES. PRACTITIONER POINTS: ADULTS WITH ANXIETY AND DEPRESSION EXPERIENCED A THERAPEUTIC YOGA PROGRAMME AS A SUITABLE AND APPEALING ADJUNCT THAT ENHANCED ENGAGEMENT WITH PSYCHOLOGICAL TREATMENT. YOGA OFFERS A UNIQUE COMBINATION OF ELEMENTS, INCLUDING A VALUES SYSTEM, BODY-BASED MINDFULNESS PRACTICES, AND BREATHING TECHNIQUES, THAT COMPLEMENT CBT PROCESSES, SUCH AS BEHAVIOURAL ACTIVATION, AWARENESS OF MALADAPTIVE PATTERNS, AND THOUGHT DISPUTATION. A THERAPEUTIC YOGA PROGRAMME PROVIDES ADULTS WITH ANXIETY AND DEPRESSION WITH AN ACCESSIBLE AND SUSTAINABLE MENTAL HEALTH SELF-MANAGEMENT TOOL. THERAPEUTIC YOGA CAN BE CONSIDERED FOR INTEGRATION TO MODELS OF MENTAL HEALTH SERVICE PROVISION TO ENHANCE ENGAGEMENT AND CLINICAL OUTCOMES FOR ADULTS WITH ANXIETY AND DEPRESSION.	2021	

16 2852  49 YOGA, PHYSICAL THERAPY, OR EDUCATION FOR CHRONIC LOW BACK PAIN: A RANDOMIZED NONINFERIORITY TRIAL. BACKGROUND: YOGA IS EFFECTIVE FOR MILD TO MODERATE CHRONIC LOW BACK PAIN (CLBP), BUT ITS COMPARATIVE EFFECTIVENESS WITH PHYSICAL THERAPY (PT) IS UNKNOWN. MOREOVER, LITTLE IS KNOWN ABOUT YOGA'S EFFECTIVENESS IN UNDERSERVED PATIENTS WITH MORE SEVERE FUNCTIONAL DISABILITY AND PAIN. OBJECTIVE: TO DETERMINE WHETHER YOGA IS NONINFERIOR TO PT FOR CLBP. DESIGN: 12-WEEK, SINGLE-BLIND, 3-GROUP RANDOMIZED NONINFERIORITY TRIAL AND SUBSEQUENT 40-WEEK MAINTENANCE PHASE. (CLINICALTRIALS.GOV: NCT01343927). SETTING: ACADEMIC SAFETY-NET HOSPITAL AND 7 AFFILIATED COMMUNITY HEALTH CENTERS. PARTICIPANTS: 320 PREDOMINANTLY LOW-INCOME, RACIALLY DIVERSE ADULTS WITH NONSPECIFIC CLBP. INTERVENTION: PARTICIPANTS RECEIVED 12 WEEKLY YOGA CLASSES, 15 PT VISITS, OR AN EDUCATIONAL BOOK AND NEWSLETTERS. THE MAINTENANCE PHASE COMPARED YOGA DROP-IN CLASSES VERSUS HOME PRACTICE AND PT BOOSTER SESSIONS VERSUS HOME PRACTICE. MEASUREMENTS: PRIMARY OUTCOMES WERE BACK-RELATED FUNCTION, MEASURED BY THE ROLAND MORRIS DISABILITY QUESTIONNAIRE (RMDQ), AND PAIN, MEASURED BY AN 11-POINT SCALE, AT 12 WEEKS. PRESPECIFIED NONINFERIORITY MARGINS WERE 1.5 (RMDQ) AND 1.0 (PAIN). SECONDARY OUTCOMES INCLUDED PAIN MEDICATION USE, GLOBAL IMPROVEMENT, SATISFACTION WITH INTERVENTION, AND HEALTH-RELATED QUALITY OF LIFE. RESULTS: ONE-SIDED 95% LOWER CONFIDENCE LIMITS WERE 0.83 (RMDQ) AND 0.97 (PAIN), DEMONSTRATING NONINFERIORITY OF YOGA TO PT. HOWEVER, YOGA WAS NOT SUPERIOR TO EDUCATION FOR EITHER OUTCOME. YOGA AND PT WERE SIMILAR FOR MOST SECONDARY OUTCOMES. YOGA AND PT PARTICIPANTS WERE 21 AND 22 PERCENTAGE POINTS LESS LIKELY, RESPECTIVELY, THAN EDUCATION PARTICIPANTS TO USE PAIN MEDICATION AT 12 WEEKS. IMPROVEMENTS IN YOGA AND PT GROUPS WERE MAINTAINED AT 1 YEAR WITH NO DIFFERENCES BETWEEN MAINTENANCE STRATEGIES. FREQUENCY OF ADVERSE EVENTS, MOSTLY MILD SELF-LIMITED JOINT AND BACK PAIN, DID NOT DIFFER BETWEEN THE YOGA AND PT GROUPS. LIMITATIONS: PARTICIPANTS WERE NOT BLINDED TO TREATMENT ASSIGNMENT. THE PT GROUP HAD DISPROPORTIONATE LOSS TO FOLLOW-UP. CONCLUSION: A MANUALIZED YOGA PROGRAM FOR NONSPECIFIC CLBP WAS NONINFERIOR TO PT FOR FUNCTION AND PAIN. PRIMARY FUNDING SOURCE: NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH OF THE NATIONAL INSTITUTES OF HEALTH.	2017	
                                                                                                                                                                                                                                                                                                                                                                                                           
17 1543  29 KUNDALINI YOGA FOR GENERALIZED ANXIETY DISORDER: AN EXPLORATION OF TREATMENT EFFICACY AND POSSIBLE MECHANISMS. THE AIM OF THIS STUDY WAS TO EXAMINE THE EFFICACY OF KUNDALINI YOGA IN REDUCING SYMPTOMS OF GENERALIZED ANXIETY DISORDER (GAD) COMPARED TO A COMMON TREATMENT-AS-USUAL CONDITION USING COGNITIVE TECHNIQUES. A SECONDARY OBJECTIVE WAS TO EXPLORE POTENTIAL TREATMENT MECHANISMS. FEMALES AGED 24 TO 75 YEARS WITH GAD ( N = 49) RECEIVED EITHER AN 8-WEEK KUNDALINI YOGA INTERVENTION ( N = 34) OR AN 8-WEEK TREATMENT-AS-USUAL CONDITION ( N = 15). THE YOGA CONDITION RESULTED IN LOWER LEVELS OF ANXIETY RELATIVE TO THE TREATMENT-AS-USUAL CONDITION. FURTHERMORE, CHANGES IN SOMATIC SYMPTOMS MEDIATED TREATMENT OUTCOME FOR KUNDALINI YOGA. KUNDALINI YOGA MAY SHOW PROMISE AS A TREATMENT FOR GAD, AND THIS TREATMENT MIGHT CONVEY ITS EFFECT ON SYMPTOM SEVERITY BY REDUCING SOMATIC SYMPTOMS.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
18 2457  35 YOGA AS A COMPLEMENTARY TREATMENT FOR SMOKING CESSATION: RATIONALE, STUDY DESIGN AND PARTICIPANT CHARACTERISTICS OF THE QUITTING-IN-BALANCE STUDY. BACKGROUND: TOBACCO SMOKING REMAINS THE LEADING PREVENTABLE CAUSE OF DEATH AMONG AMERICAN WOMEN. EXERCISE HAS SHOWN PROMISE AS AN AID TO SMOKING CESSATION BECAUSE IT REDUCES WEIGHT GAIN AND WEIGHT CONCERNS, IMPROVES AFFECT, AND REDUCES NICOTINE WITHDRAWAL SYMPTOMS AND CIGARETTE CRAVING. STUDIES HAVE SHOWN THAT THE PRACTICE OF YOGA IMPROVES WEIGHT CONTROL, AND REDUCES PERCEIVED STRESS AND NEGATIVE AFFECT. YOGA PRACTICE ALSO INCLUDES REGULATION OF BREATHING AND FOCUSED ATTENTION, BOTH OF WHICH MAY ENHANCE STRESS REDUCTION AND IMPROVE MOOD AND WELL-BEING AND MAY IMPROVE CESSATION OUTCOMES. METHODS/DESIGN: THIS PILOT EFFICACY STUDY IS DESIGNED TO EXAMINE THE RATES OF CESSATION AMONG WOMEN RANDOMIZED TO EITHER A NOVEL, 8-WEEK YOGA PLUS COGNITIVE BEHAVIORAL THERAPY (CBT) SMOKING CESSATION INTERVENTION VERSUS A WELLNESS PROGRAM PLUS THE SAME CBT SMOKING CESSATION INTERVENTION. OUTCOME MEASURES INCLUDE 7-DAY POINT PREVALENCE ABSTINENCE AT END OF TREATMENT, 3 AND 6 MONTHS FOLLOW UP AND POTENTIAL MEDIATING VARIABLES (E.G., CONFIDENCE IN QUITTING SMOKING, SELF-EFFICACY). OTHER ASSESSMENTS INCLUDE MEASURES OF MINDFULNESS, SPIRITUALITY, DEPRESSIVE SYMPTOMS, ANXIETY AND PERCEIVED HEALTH (SF-36). DISCUSSION: INNOVATIVE TREATMENTS ARE NEEDED THAT ADDRESS BARRIERS TO SUCCESSFUL SMOKING CESSATION AMONG MEN AND WOMEN. THE DESIGN CHOSEN FOR THIS STUDY WILL ALLOW US TO EXPLORE POTENTIAL MEDIATORS OF INTERVENTION EFFICACY SO THAT WE MAY BETTER UNDERSTAND THE MECHANISM(S) BY WHICH YOGA MAY ACT AS AN EFFECTIVE COMPLEMENTARY TREATMENT FOR SMOKING CESSATION. IF SHOWN TO BE EFFECTIVE, YOGA CAN OFFER AN ALTERNATIVE TO TRADITIONAL EXERCISE FOR REDUCING NEGATIVE SYMPTOMS THAT OFTEN ACCOMPANY SMOKING CESSATION AND PREDICT RELAPSE TO SMOKING AMONG RECENT QUITTERS. TRIAL REGISTRATION: CLINICALTRIALS NCT00492310.	2010	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
19 2638  46 YOGA FOR VETERANS WITH CHRONIC LOW BACK PAIN: DESIGN AND METHODS OF A RANDOMIZED CLINICAL TRIAL. CHRONIC LOW BACK PAIN (CLBP) AFFLICTS MILLIONS OF PEOPLE WORLDWIDE, WITH PARTICULARLY HIGH PREVALENCE IN MILITARY VETERANS. MANY TREATMENT OPTIONS EXIST FOR CLBP, BUT MOST HAVE LIMITED EFFECTIVENESS AND SOME HAVE SIGNIFICANT SIDE EFFECTS. IN GENERAL POPULATIONS WITH CLBP, YOGA HAS BEEN SHOWN TO IMPROVE HEALTH OUTCOMES WITH FEW SIDE EFFECTS. HOWEVER, YOGA HAS NOT BEEN ADEQUATELY STUDIED IN MILITARY VETERAN POPULATIONS. IN THE CURRENT PAPER WE WILL DESCRIBE THE DESIGN AND METHODS OF A RANDOMIZED CLINICAL TRIAL AIMED AT EXAMINING WHETHER YOGA CAN EFFECTIVELY REDUCE DISABILITY AND PAIN IN US MILITARY VETERANS WITH CLBP. A TOTAL OF 144 US MILITARY VETERANS WITH CLBP WILL BE RANDOMIZED TO EITHER YOGA OR A DELAYED TREATMENT COMPARISON GROUP. THE YOGA INTERVENTION WILL CONSIST OF 2X WEEKLY YOGA CLASSES FOR 12WEEKS, COMPLEMENTED BY REGULAR HOME PRACTICE GUIDED BY A MANUAL. THE DELAYED TREATMENT GROUP WILL RECEIVE THE SAME INTERVENTION AFTER SIX MONTHS. THE PRIMARY OUTCOME IS THE CHANGE IN BACK PAIN-RELATED DISABILITY MEASURED WITH THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE AT BASELINE AND 12-WEEKS. SECONDARY OUTCOMES INCLUDE PAIN INTENSITY, PAIN INTERFERENCE, DEPRESSION, ANXIETY, FATIGUE/ENERGY, QUALITY OF LIFE, SELF-EFFICACY, SLEEP QUALITY, AND MEDICATION USAGE. ADDITIONAL PROCESS AND/OR MEDIATIONAL FACTORS WILL BE MEASURED TO EXAMINE DOSE RESPONSE AND EFFECT MECHANISMS. ASSESSMENTS WILL BE CONDUCTED AT BASELINE, 6-WEEKS, 12-WEEKS, AND 6-MONTHS. ALL RANDOMIZED PARTICIPANTS WILL BE INCLUDED IN INTENTION-TO-TREAT ANALYSES. STUDY RESULTS WILL PROVIDE MUCH NEEDED EVIDENCE ON THE FEASIBILITY AND EFFECTIVENESS OF YOGA AS A THERAPEUTIC MODALITY FOR THE TREATMENT OF CLBP IN US MILITARY VETERANS.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
20 2320  44 TREATMENT CREDIBILITY, EXPECTANCY, AND PREFERENCE: PREDICTION OF TREATMENT ENGAGEMENT AND OUTCOME IN A RANDOMIZED CLINICAL TRIAL OF HATHA YOGA VS. HEALTH EDUCATION AS ADJUNCT TREATMENTS FOR DEPRESSION. BACKGROUND: HATHA YOGA MAY BE HELPFUL FOR ALLEVIATING DEPRESSION SYMPTOMS. THE PURPOSE OF THIS ANALYSIS IS TO DETERMINE WHETHER TREATMENT PROGRAM PREFERENCE, CREDIBILITY, OR EXPECTANCY PREDICT ENGAGEMENT IN DEPRESSION INTERVENTIONS (YOGA OR A CONTROL CLASS) OR DEPRESSION SYMPTOM SEVERITY OVER TIME. METHODS: THIS IS A SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL (RCT) OF HATHA YOGA VS. A HEALTH EDUCATION CONTROL GROUP FOR TREATMENT OF DEPRESSION. DEPRESSED PARTICIPANTS (N=122) ATTENDED UP TO 20 CLASSES OVER A PERIOD OF 10 WEEKS, AND THEN COMPLETED ADDITIONAL ASSESSMENTS AFTER 3 AND 6 MONTHS. WE ASSESSED TREATMENT PREFERENCE PRIOR TO RANDOMIZATION, AND TREATMENT CREDIBILITY AND EXPECTANCY AFTER PARTICIPANTS ATTENDED THEIR FIRST CLASS. TREATMENT "CONCORDANCE" INDICATED THAT TREATMENT PREFERENCE MATCHED ASSIGNED TREATMENT. RESULTS: TREATMENT CREDIBILITY, EXPECTANCY, AND CONCORDANCE WERE NOT ASSOCIATED WITH TREATMENT ENGAGEMENT. TREATMENT EXPECTANCY MODERATED THE ASSOCIATION BETWEEN TREATMENT GROUP AND DEPRESSION. DEPRESSION SEVERITY OVER TIME DIFFERED BY EXPECTANCY LEVEL FOR THE YOGA GROUP BUT NOT FOR THE HEALTH EDUCATION GROUP. CONTROLLING FOR BASELINE DEPRESSION, PARTICIPANTS IN THE YOGA GROUP WITH AN AVERAGE OR HIGH EXPECTANCY FOR IMPROVEMENT SHOWED LOWER DEPRESSION SYMPTOMS ACROSS THE ACUTE INTERVENTION AND FOLLOW-UP PERIOD THAN THOSE WITH A LOW EXPECTANCY FOR IMPROVEMENT. THERE WAS A TREND FOR A SIMILAR PATTERN FOR CREDIBILITY. CONCORDANCE WAS NOT ASSOCIATED WITH TREATMENT OUTCOME. LIMITATIONS: THIS IS A SECONDARY, POST-HOC ANALYSIS AND SHOULD BE CONSIDERED HYPOTHESIS-GENERATING. CONCLUSIONS: RESULTS SUGGEST THAT EXPECTANCY IMPROVES THE LIKELIHOOD OF SUCCESS ONLY FOR A INTERVENTION THOUGHT TO ACTIVELY TARGET DEPRESSION (YOGA) AND NOT A CONTROL INTERVENTION.	2018