What was the research about?
Some older adults have high levels of worry that cause them to feel restless, tired, or tense. Two ways to treat worry are yoga and cognitive behavioral therapy, or CBT. Yoga combines movement, breathing techniques, and meditation to help people reduce stress. CBT is a type of talk therapy. In CBT, patients learn to change patterns in their thinking to improve how they feel.
In this study, the research team compared how well yoga versus CBT helped older adults with high levels of worry to reduce worry, anxiety, and sleeping problems. The team assigned half of the older adults to CBT or yoga by chance. The other half chose between CBT and yoga.
What were the results?
After 11 weeks, older adults who received CBT and those who took yoga classes had less worry, anxiety, and sleeping problems. Compared with those taking yoga, adults receiving CBT reported fewer sleeping problems. Both groups had similar decreases in worry and anxiety.
These changes were the same whether older adults chose their treatment or the research team assigned it. Choosing treatment didn’t affect whether older adults followed their treatment plan or stayed in the study.
Who was in the study?
The study included 500 older adults with high levels of worry. Of these, 79 percent were white, 15 percent were black, and 6 percent were other races. Average age was 67, and 86 percent were women.
What did the research team do?
The research team assigned adults to one of the two treatment groups, or to choose between the groups. Of the 250 older adults who chose between CBT and yoga, 120 chose CBT and 130 chose yoga.
The group receiving CBT had 10 weekly phone sessions with a therapist. Sessions were 45–50 minutes. This group also received a workbook that described techniques and included a homework exercise so adults could practice.
The second group took two yoga classes each week for 10 weeks at local community sites. Classes focused on breathing, posture, and relaxation. The research team also asked adults to practice yoga for 15–20 minutes at least five times a week.
The adults completed surveys about worry, anxiety, and sleep at the start of the study and after 6 and 11 weeks. After 11 weeks, the research team looked at whether older adults who chose their treatment followed their treatment plan and stayed in the study.
Patients, doctors, and community organizations gave input throughout the study.
What were the limits of the study?
Most adults in the study were white women. Results may differ for other racial and gender groups. Because the research team didn’t compare the older adults doing CBT and yoga with a group that didn’t get help with their worry, the team doesn’t know if the changes were due to CBT and yoga, or something else.
Future research could compare CBT versus yoga with people from other race and gender backgrounds.
How can people use the results?
Older adults and their doctors can use these results when considering ways to reduce high levels of worry.
To compare the effectiveness of cognitive behavioral therapy (CBT) versus yoga in improving worry, anxiety, and sleep quality among older adults
|Study Design||Randomized controlled trial plus a preference trial|
|Population||500 adults ages 60 and older with moderate to severe levels of worry|
Secondary: anxiety; sleep quality; and preference effects on worry, anxiety, sleep, treatment adherence, and attrition
|Timeframe||11-week follow-up for primary outcome|
This two-stage, randomized trial compared the effectiveness of CBT versus yoga in treating worry among older adults. Researchers randomly assigned older adults to either a randomized trial or a preference trial. Each trial had 250 older adults.
In the randomized trial, researchers randomly assigned older adults to one of two groups. The first group had 10 weekly CBT phone sessions with a therapist. The sessions were 45–50 minutes and covered techniques for anxiety management. Older adults in the CBT group also received a workbook that described the techniques and included a homework exercise so that adults could practice. The second group took two yoga classes per week for 10 weeks at local community sites. The classes emphasized breathing, relaxation, and postures. Researchers asked adults in the yoga groups to practice yoga for 15–20 minutes at least five times a week on their own.
In the preference trial, older adults chose whether they wanted to receive CBT or yoga; 120 chose CBT and 130 chose yoga.
Overall, the study included 500 older adults with moderate to severe levels of worry. Of these adults, 79% were white, 15% were black, and 6% were other races. The average age was 67, and 86% were female.
Older adults in both trials completed assessments of worry, anxiety, and sleep at baseline and after 6 and 11 weeks. Researchers assessed preference effects on treatment adherence and attrition after 11 weeks.
Patients, clinicians, and community organizations provided input throughout the study.
After 11 weeks, older adults who received CBT and those who took yoga classes had improvements in worry, anxiety, and sleep quality (all p<0.05). The two groups did not differ significantly in improvements in worry and anxiety. Older adults who received CBT had more improvement in sleep quality than those who took yoga classes (an average of 5.4 fewer sleep problems for the CBT group versus 3.0 fewer sleep problems for the yoga group; p<0.05).
Researchers did not find significant preference effects for any study outcomes.
Most study participants were white women. Results may not be generalizable to other populations. Without a usual care comparison, this study could not establish with certainty that the improvements seen before and after CBT and yoga were the result of the interventions.
Conclusions and Relevance
In this study, CBT and yoga were effective in decreasing worry and anxiety, and CBT was associated with more improvement in sleep quality than yoga. Older adults who were randomly assigned to a treatment for worry did just as well as those who were given a choice of treatments.
Future Research Needs
Future research could test the interventions with other demographic groups.
Final Research Report
View this project's final research report.
Article Highlight: As reported in Depression and Anxiety, this study found that cognitive behavioral therapy (CBT) and yoga were both effective at reducing worry and anxiety in older adults, while CBT improved sleep more than yoga. In the study, the research team at Wake Forest University assigned half of the older adults to CBT or yoga by chance; the other half chose between CBT and yoga. These results held regardless of whether the participants chose their treatment or were assigned treatment at random.
Results of This Project
Related Journal Citations
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers asked for a clearer explanation for why the researchers chose worry, rather than anxiety as the primary outcome, noting that the report frequently used the terms worry and anxiety interchangeably. The researchers edited the report to consistently use the term moderate to severe worry instead. They explained that they chose to focus on worry rather than generalized anxiety disorder because worry, in and of itself, is linked to a number of negative outcomes for older adults, and because the researchers expected that more older adults in their community would have worry that disrupted their quality of life than would have formally diagnosed anxiety disorder. By focusing on worry, their results would be more widely applicable. Also, practically speaking, worry could be assessed more quickly and easily, and anyone with anxiety disorder would also meet the study’s inclusion criteria.
- The reviewers pointed out that the goal of the study was to compare the two interventions, cognitive behavioral therapy and yoga, to see which might be better at reducing worry. The reviewers asked the researchers to focus on this comparison rather than focusing on how much each intervention reduced worry in the participants. The researchers revised their report to focus on the comparative question and did not report significance testing results for within-group changes in worry to downplay discussion of these changes over time. The researchers did report on how much change in worry scores would indicate a minimal clinically important difference so that readers could evaluate for themselves whether the changes in worry scores within each intervention were clinically relevant.
Conflict of Interest Disclosures
Patient / Caregiver Partners
- Barbara Harmon
- Vickie Webb
Other Stakeholder Partners
- Claudia Campos, MD, Wake Forest School of Medicine
- Andrea Fernandez, MD, Wake Forest School of Medicine
- Mark Knudson, MD, Wake Forest School of Medicine
- Mary F. Lyles, MD, Wake Forest School of Medicine
Study Registration Information
- Has Results