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.
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
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
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 |
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.