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Long-Term Effects of Cognitive-Behavioral Therapy and Yoga for Worried Older Adults

Published:February 06, 2022DOI:https://doi.org/10.1016/j.jagp.2022.02.002

      HIGHLIGHTS

      • What is the primary question addressed by this study?
        These secondary data analyses examined long-term effects of CBT delivered by telephone and yoga on worry, anxiety, sleep, depressive symptoms, fatigue, physical function, social participation, and pain.
      • What is the main finding of this study?
        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.
      • What is the meaning of the finding?
        These findings offer two solid evidence-based approaches (CBT and yoga) with long-term impact for treating worry in older adults.

      ABSTRACT

      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);
      • 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.
      ,
      • Meyer TJ
      • Miller ML
      • Metzger RL
      • et al.
      Development and validation of the penn state worry questionnaire.
      Insomnia Severity Index (sleep);
      • Bastien CH
      • Vallieres A
      • Morin CM.
      Validation of the insomnia severity index as an outcome measure for insomnia research.
      PROMIS Anxiety Short Form v1.0 (anxiety);
      • 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.
      ,
      • 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.
      Generalized Anxiety Disorder Screener (generalized anxiety);
      • Spitzer RL
      • Kroenke K
      • Williams JB
      • et al.
      A brief measure for assessing generalized anxiety disorder: the GAD-7.
      ,
      • Löwe B
      • Decker O
      • Müller S
      • et al.
      Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population.
      and PROMIS-29 (depression, fatigue, physical function, social participation, pain).
      • Kroenke K
      • Stump TE
      • Kean J
      • et al.
      PROMIS 4-item measures and numeric rating scales efficiently assess SPADE symptoms compared with legacy measures.
      ,
      • 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.

      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.

      Key Words

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      Linked Article

      • The Humble Worrier - The Long-Term Impact of Using Yoga to Treat Severe Worry and Anxiety in Older Adults
        The American Journal of Geriatric PsychiatryVol. 30Issue 9
        • Preview
          Over the last decade, multiple reports have signaled the association of late-life anxiety and its phenotypes with increased morbidity and mortality. A 2014 study of 6,019 participants showed that higher anxiety symptoms were prospectively associated with increased risk of incident stroke independent of all other risk factors, including depression.1 The independent effect of anxiety on increasing the risk of cognitive decline has been documented in several recent studies,2 including longitudinal studies indicating an increased association between amyloid burden, and anxiety symptoms in cognitively normal older adults.
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