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Effect of cognitive behavioural therapy and yoga for generalised anxiety disorder on sleep quality in a randomised controlled trial: the role of worry, mindfulness, and perceived stress as mediators.

Journal of sleep research
February 1, 2024
Ryan J Jacoby et al. (10 authors)
Randomized Controlled TrialJournal ArticleResearch Support, U.S. Gov't, Non-P.H.S.Research Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov'tHuman StudyClinical
Study Details

Study Goal

The researchers aimed to compare the effects of Kundalini yoga (KY) and cognitive behavioral therapy (CBT) on sleep quality in adults with generalized anxiety disorder (GAD) and examine potential mediators like mindfulness.

Results Summary

Both KY and CBT improved sleep quality, but neither outperformed the control (stress education). Changes in mindfulness, worry, and stress mediated sleep improvements, with treatment-specific effects on worry and stress.

Population

226 adults with GAD (mean age 33.37 years; 70% female; 79% White).

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (17)
InterventionDirectionEndpointPopulationDosageImpactClaim #
Kundalini yoga (KY)
decrease
generalised anxiety disorder (GAD)
individuals with generalised anxiety disorder (GAD)
-
are effective treatment options
#1
cognitive behavioural therapy (CBT)
decrease
generalised anxiety disorder (GAD)
individuals with generalised anxiety disorder (GAD)
-
are effective treatment options
#2
CBT
decrease
PSQI scores
226 adults with GAD
all d > 0.97
significantly improved
#3
CBT
decrease
ISI scores
226 adults with GAD
all d > 0.97
significantly improved
#4
KY
decrease
PSQI scores
226 adults with GAD
all d > 0.97
significantly improved
#5
KY
decrease
ISI scores
226 adults with GAD
all d > 0.97
significantly improved
#6
stress education (SEdu)
decrease
PSQI scores
226 adults with GAD
all d > 0.97
significantly improved
#7
stress education (SEdu)
decrease
ISI scores
226 adults with GAD
all d > 0.97
significantly improved
#8
CBT
no change
sleep changes
226 adults with GAD
-
were not significantly greater
#9
KY
no change
sleep changes
226 adults with GAD
-
were not significantly greater
#10
-
neutral
sleep outcomes
226 adults with GAD
-
significantly mediated
#11
CBT
neutral
Degree of change in sleep attributable to worry
226 adults with GAD
CBT > KY > SEdu
was moderated by treatment group
#12
KY
neutral
Degree of change in sleep attributable to worry
226 adults with GAD
CBT > KY > SEdu
was moderated by treatment group
#13
SEdu
neutral
Degree of change in sleep attributable to worry
226 adults with GAD
CBT > KY > SEdu
was moderated by treatment group
#14
CBT
neutral
Degree of change in sleep attributable to perceived stress
226 adults with GAD
CBT, KY > SEdu
was moderated by treatment group
#15
KY
neutral
Degree of change in sleep attributable to perceived stress
226 adults with GAD
CBT, KY > SEdu
was moderated by treatment group
#16
SEdu
neutral
Degree of change in sleep attributable to perceived stress
226 adults with GAD
CBT, KY > SEdu
was moderated by treatment group
#17
Abstract

Sleep disturbances are present in ~65% of individuals with generalised anxiety disorder (GAD). Although both Kundalini yoga (KY) and cognitive behavioural therapy (CBT) are effective treatment options for GAD, little is known about how these treatments compare in improving sleep for GAD and what drives these changes. Accordingly, we examined the effects of CBT, KY, and stress education (SEdu; an attention control condition) on subjective sleep quality (as measured by the Pittsburgh Sleep Quality Index [PSQI] and Insomnia Severity Index [ISI]) in a randomised controlled trial of 226 adults with GAD (mean age 33.37 years; 70% female; 79% White). We hypothesised that both CBT and KY would outperform SEdu in improving sleep disturbances. Three potential mediators of sleep improvement (worry, mindfulness, perceived stress) were also examined. In line with hypotheses, PSQI and ISI scores significantly improved from pre- to post-treatment for all three treatment groups (all p < 0.001, all d > 0.97). However, contrary to predictions, sleep changes were not significantly greater for CBT or KY compared to SEdu. In mediation analyses, within-person deviations in worry, mindfulness, and stress each significantly mediated the effect of time on sleep outcomes. Degree of change in sleep attributable to worry (CBT > KY > SEdu) and perceived stress (CBT, KY > SEdu) was moderated by treatment group. Personalised medicine as well as combined treatment approaches should be studied to help reduce sleep difficulties for patients with GAD who do not respond.

Medical Subject Headings (MeSH)
AdultHumansFemaleMaleMindfulnessYogaSleep QualityCognitive Behavioral TherapyAnxiety DisordersSleep Initiation and Maintenance DisordersTreatment OutcomeStress, Psychological
Study Links
Quality Scores
SafetyNot Assessed
Efficacy70/10
Quality85/10
Citation Metrics
Total Citations2
Citations/Year2.0
Research Impact Scores
APT Score0.50
Weight Score2.80
Normalized Score0.65
Related Supplements
Effect of cognitive behavioural therapy and yoga for general... | Panacea Index