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 Hopko DR Stanley MA Reas DL et al. Assessing worry in older adults: confirmatory factor analysis of the penn state worry questionnaire and psychometric properties of an abbreviated model. Psychol Assess. 2003; 15: 173-183 Crossref PubMed Scopus (188) Google Scholar ,2 Meyer TJ Miller ML Metzger RL et al. Development and validation of the penn state worry questionnaire. Behav Res Ther. 1990; 28: 487-495 Crossref PubMed Scopus (3464) Google Scholar Insomnia Severity Index (sleep); 3 Bastien CH Vallieres A Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001; 2: 297-307 Crossref PubMed Scopus (3952) Google Scholar PROMIS Anxiety Short Form v1.0 (anxiety); 4 Pilkonis PA choi SW Reise SP et al. Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS(R)): depression, anxiety, and anger. Assessment. 2011; 18: 263-283 Crossref PubMed Scopus (1040) Google Scholar ,5 Pilkonis PA Yu L Colditz J et al. Item banks for alcohol use from the patient-reported outcomes measurement information system (PROMIS): use, consequences, and expectancies. Drug Alcohol Depend. 2013; 130: 167-177 Crossref PubMed Scopus (48) Google Scholar Generalized Anxiety Disorder Screener (generalized anxiety); 6 Spitzer RL Kroenke K Williams JB et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. ArchIntern Med. 2006; 166: 1092-1097 Google Scholar ,7 Löwe B Decker O Müller S et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care. 2008; 46: 266-274 Crossref PubMed Scopus (1992) Google Scholar and PROMIS-29 (depression, fatigue, physical function, social participation, pain). 8 Kroenke K Stump TE Kean J et al. PROMIS 4-item measures and numeric rating scales efficiently assess SPADE symptoms compared with legacy measures. J Clin Epidemiol. 2019; 115: 116-124 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar ,9 Deyo RA Ramsey K Buckley DI et al. Performance of a patient reported outcomes measurement information system (PROMIS) short form in older adults with chronic musculoskeletal pain. Pain Med. 2015; 17: 314-324 Google Scholar 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 NCT 02968238.