1
|
Ando M, Kao YC, Lee YC, Tai SA, Mendez SR, Sasaki K, Tang W, Papatheodorou S. Remote cognitive behavioral therapy for older adults with anxiety symptoms: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:1376-1385. [PMID: 36794548 DOI: 10.1177/1357633x231151788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults. METHODS We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire - Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively. RESULTS Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: -0.63; 95% CI: -0.99 to -0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: -0.74; 95% CI: -1.24 to -0.25). DISCUSSION Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults.
Collapse
Affiliation(s)
- Mariko Ando
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ying-Chia Kao
- Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Chien Lee
- Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Sung-An Tai
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Samuel R Mendez
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kosuke Sasaki
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Wenze Tang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | |
Collapse
|
2
|
Schmidt A, Grey N, Strauss C, Gaysina D. Predictors of treatment outcome of psychological therapies for common mental health problems (CMHP) in older adults: A systematic literature review. Clin Psychol Rev 2024; 112:102463. [PMID: 38968690 DOI: 10.1016/j.cpr.2024.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
Identifying factors that impact psychological treatment outcomes in older people with common mental health problems (CMHP) has important implications for supporting healthier and longer lives. The aim of the present study was to synthesise the evidence on predictors of psychological treatment outcomes in older people (aged 65+). PubMed, Scopus, Web of Science and PsycINFO were searched and 3929 articles were identified and screened, with 42 studies (N = 7978, M age = 68.9, SD age = 2.85) included: depression: k = 21, anxiety: k = 11, panic disorder: k = 3, mixed anxiety & depression: k = 3, PTSD: k = 2, various CMHP: k = 2, with CBT being the most common treatment (71%). The review identified 28 factors reported as significant predictors of treatment outcome in at least one study, across different domains: psychosocial (n = 9), clinical (n = 6), treatment-related (n = 6), socio-demographic (n = 4), neurobiological (n = 3). Homework completion was the most consistent predictor of positive treatment outcome. Baseline symptom severity was the most frequently studied significant predictor and across all conditions, with higher baseline symptom severity largely linked to worse treatment outcomes. No significant effects on treatment outcome were reported for gender, income and physical comorbidities. For a large majority of factors evidence was mixed or inconclusive. Further studies are required to identify factors affecting psychological treatment outcomes, which will be important for the development of personalised treatment approaches.
Collapse
Affiliation(s)
| | - Nick Grey
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
| |
Collapse
|
3
|
Hendriks GJ, Janssen N, Robertson L, van Balkom AJ, van Zelst WH, Wolfe S, Oude Voshaar RC, Uphoff E. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev 2024; 7:CD007674. [PMID: 38973756 PMCID: PMC11229394 DOI: 10.1002/14651858.cd007674.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This systematic review aims to provide a comprehensive and up-to-date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders. OBJECTIVES To assess the effects of Cognitive Behavioural Therapy (CT, BT, CBT and third-wave CBT interventions) on severity of anxiety symptoms compared with minimal management (not providing therapy) for anxiety and related disorders in older adults, aged 55 years or over. To assess the effects of CBT and related therapies on severity of anxiety symptoms compared with other psychological therapies for anxiety and related disorders in older adults, aged 55 years or over. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled studies Register (CCMDCTR), CENTRAL, Ovid MEDLINE, Ovid Embase and Ovid PsycINFO to 21 July 2022. These searches were updated on 2 February 2024. We also searched the international studies registries, including Clinicalstudies.gov and the WHO International Clinical Trials Registry Platform (ICTRP), to identify additional ongoing and unpublished studies. These sources were manually searched for studies up to 12 February 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) in older adults (≥ 55 years) with an anxiety disorder, or a related disorder, including obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD), that compared CBT to either minimal management or an active (non-CBT) psychological therapy. Eligible studies had to have an anxiety-related outcome. DATA COLLECTION AND ANALYSIS Several authors independently screened all titles identified by the searches. All full texts were screened for eligibility according to our prespecified selection criteria. Data were extracted and the risk of bias was assessed using the Cochrane tool for RCTs. The certainty of evidence was evaluated using GRADE. Meta-analyses were performed for outcomes with quantitative data from more than one study. MAIN RESULTS We included 21 RCTs on 1234 older people allocated to either CBT or control conditions. Ten studies focused on generalised anxiety disorder; others mostly included a mix of clinical diagnoses. Nineteen studies focused on the comparison between CBT and minimal management. Key issues relating to risk of bias were lack of blinding of participants and personnel, and participants dropping out of studies, potentially due to treatment preference and allocation. CBT may result in a small-to-moderate reduction of anxiety post-treatment (SMD -0.51, 95% CI -0.66 to -0.36, low-certainty evidence). However, compared to this benefit with CBT immediately after treatment, at three to six months post-treatment, there was little to no difference between CBT and minimal management (SMD -0.29, 95% CI -0.59 to 0.01, low-certainty evidence). CBT may have little or no effect on clinical recovery/ improvement post-treatment compared to minimal management, but the evidence is very uncertain (RR 1.56, 95% CI 1.20 to 2.03, very low-certainty evidence). Results indicate that five people would need to receive treatment for one additional person to benefit (NNTB = 5). Compared to minimal management, CBT may result in a reduction of comorbid depression symptoms post-treatment (SMD -0.57, 95% CI -0.74 to -0.40, low-certainty evidence). There was no difference in dropout rates post-treatment, although the certainty of the evidence was low (RR 1.19, 95% CI 0.80 to 1.78). Two studies reported adverse events, both of which related to medication in the control groups (very low-certainty evidence, no quantitative estimate). Only two studies compared CBT to other psychological therapies, both of which only included participants with post-traumatic stress disorder. Low-certainty evidence showed no difference in anxiety severity post-treatment and at four to six months post-treatment, symptoms of depression post-treatment, and dropout rates post-treatment. Other outcomes and time points are reported in the results section of the manuscript. AUTHORS' CONCLUSIONS CBT may be more effective than minimal management in reducing anxiety and symptoms of worry and depression post-treatment in older adults with anxiety disorders. The evidence is less certain longer-term and for other outcomes including clinical recovery/improvement. There is not enough evidence to determine whether CBT is more effective than alternative psychological therapies for anxiety in older adults.
Collapse
Affiliation(s)
- Gert-Jan Hendriks
- "Overwaal" Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institute for Integrated Mental Health Care "Pro Persona, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Noortje Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Anton J van Balkom
- Department of Psychiatry, Amsterdam University Medical Centre Vrije Universiteit, Amsterdam Public Health Institute and GGZ inGeest, Amsterdam, Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
| | - Samantha Wolfe
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | | | - Eleonora Uphoff
- Centre for Reviews and Dissemination, University of York, York, UK
| |
Collapse
|
4
|
McPhillips MV, Petrovsky DV, Lorenz R, Lee J, George T, Smyth A, Bubu OM, Brewster GS. Treatment Modalities for Insomnia in Adults Aged 55 and Older: A Systematic Review of Literature from 2018 to 2023. CURRENT SLEEP MEDICINE REPORTS 2024; 10:232-256. [PMID: 39156226 PMCID: PMC11328977 DOI: 10.1007/s40675-024-00285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 08/20/2024]
Abstract
Purpose of Review Insomnia is the most common sleep disorder experienced by older adults. There is a wide range of pharmacological and non-pharmacological treatment options in existing literature. The purpose of this systematic review was to synthesize randomized controlled trials of insomnia treatment modalities for adults aged 55 and older over the last 5 years. We searched four databases, and after screening, there were 34 full-text manuscripts that met the inclusion/exclusion criteria. Recent Findings We found non-pharmacological interventions, including exercise and behavioral/psychoeducational therapies, remain effective and favorable. Complementary and alternative therapies ranged across studies and warrant further testing in larger, more diverse samples. Dual orexin receptor antagonist medications were tested in a few studies with positive benefits for sleep and minimal side effects. Finally, measures of insomnia/sleep disturbance outcomes varied among the studies, with the Pittsburgh Sleep Quality Index being used most frequently. Summary Non-pharmacological interventions for insomnia in older adults are effective, and some newer medications may be safer, with less side effects, at managing insomnia in this population.
Collapse
Affiliation(s)
| | - Darina V. Petrovsky
- Health Care Policy, and Aging Research, School of Nursing, Institute for Health, Rutgers University, New Brunswick, USA
| | | | - Jiwon Lee
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Tessy George
- Georgia Baptist College of Nursing, Mercer University, Macon, USA
| | - Aisling Smyth
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, USA
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Australia
| | - Omonigho Michael Bubu
- Departments of Psychiatry, NYU Grossman School of Medicine, Population Health & Neurology, New York, NY, USA
| | - Glenna S. Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Room 256, Atlanta, GA 30322, USA
| |
Collapse
|
5
|
Eigenhuis E, van Buuren VEM, Boeschoten RE, Muntingh ADT, Batelaan NM, van Oppen P. The Effects of Patient Preference on Clinical Outcome, Satisfaction and Adherence Within the Treatment of Anxiety and Depression: A Meta-Analysis. Clin Psychol Psychother 2024; 31:e2985. [PMID: 38706162 DOI: 10.1002/cpp.2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/01/2024] [Accepted: 03/26/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Taking patient preference into consideration has received increased attention in the last decades. We conducted a meta-analysis to estimate the effects of patient preference on clinical outcome, satisfaction and adherence regarding treatment of depression and anxiety. METHODS Pubmed, Embase, PsycINFO and Scopus were searched for (cluster) randomized controlled trials. Twenty-six randomized controlled clinical trials were included, comprising 3670 participants, examining the effect of patient preference regarding treatment of anxiety and depression on clinical outcome, satisfaction and/or adherence. RESULTS No effect of patient preference was found on clinical outcome [d = 0.06, 95% CI = (-0.03, 0.15), p = 0.16, n = 23 studies]. A small effect of patient preference was found on treatment satisfaction [d = 0.33, 95% CI = (0.08, 0.59), p = 0.01, n = 6 studies] and on treatment adherence [OR = 1.55, 95% CI = (1.28, 1.87), p < 0.001, n = 22 studies]. LIMITATIONS Patient preference is a heterogeneous concept, future studies should strive to equalize operationalization of preference. Subgroup analyses within this study should be interpreted with caution because the amount of studies per analysed subgroup was generally low. Most studies included in this meta-analysis focused on patients with depression. The small number of studies (n = 6) on satisfaction, prevents us from drawing firm conclusions. CONCLUSIONS While this meta-analysis did not find a positive effect of considering patient preference on clinical outcome, it was associated with slightly better treatment satisfaction and adherence. Accommodating preference of patients with anxiety and depression can improve treatment. TRIAL REGISTRATION PROSPERO: CRD42020172556.
Collapse
Affiliation(s)
- Eline Eigenhuis
- Department for Anxiety and Depression, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Vanessa E M van Buuren
- Department for Anxiety and Depression, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Rosa E Boeschoten
- Department for Anxiety and Depression, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Anna D T Muntingh
- Department for Anxiety and Depression, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Neeltje M Batelaan
- Department for Anxiety and Depression, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department for Anxiety and Depression, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Jacoby RJ, Brown ML, Wieman ST, Rosenfield D, Hoeppner SS, Bui E, Hoge EA, Khalsa SBS, Hofmann SG, Simon NM. 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. J Sleep Res 2024; 33:e13992. [PMID: 37577773 PMCID: PMC10840983 DOI: 10.1111/jsr.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023]
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.
Collapse
Affiliation(s)
- Ryan J. Jacoby
- Massachusetts General Hospital / Harvard Medical School, Department of Psychiatry, 185 Cambridge St, Suite 2000, Boston, MA 02114, USA
| | - Mackenzie L. Brown
- University of Louisville, Department of Psychology, 2301 S 3rd St, Louisville, KY 40292, USA
| | - Sarah T. Wieman
- Suffolk University, Department of Psychology, 73 Tremont St., Boston, MA 02108, USA
| | - David Rosenfield
- Southern Methodist University, Department of Psychology, P.O. Box 750442, Dallas, TX 75275, USA
| | - Susanne S. Hoeppner
- Massachusetts General Hospital / Harvard Medical School, Department of Psychiatry, 185 Cambridge St, Suite 2000, Boston, MA 02114, USA
| | - Eric Bui
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France & Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Elizabeth A. Hoge
- Georgetown University Medical Center, Department of Psychiatry, 2115 Wisconsin Ave, NW, Suite 200, Washington, DC, 20007, USA
| | - Sat Bir S. Khalsa
- Brigham and Women’s Hospital / Harvard Medical School, Division of Sleep and Circadian Disorders, Department of Medicine, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Stefan G. Hofmann
- Philipps-University Marburg, Department of Clinical Psychology, Schulstrasse 12, 35037 Marburg/Lahn, Germany
| | - Naomi M. Simon
- New York University Grossman School of Medicine, Department of Psychiatry, One Park Avenue, 8th Floor, New York NY 10016, USA
| |
Collapse
|
7
|
Chen S, Wang W. A scoping review on two-stage randomized preference trial in the field of mental health and addiction. BMC Psychiatry 2023; 23:192. [PMID: 36959551 PMCID: PMC10037890 DOI: 10.1186/s12888-023-04676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Randomized Controlled Trial is the most rigorous study design to test the efficacy and effectiveness of an intervention. Patient preference may negatively affect patient performance and decrease the generalizability of a trial to clinical population. Patient preference trial have particular implications in the field of mental health and addiction since mental health interventions are generally complex, blinding of intervention is often difficult or impossible, patients may have strong preference, and outcome measures are often subjective patient self-report which may be greatly influenced if patient's preference did not match with the intervention received. METHODS In this review, we have surveyed the application of two-stage randomized preference trial with focus on studies in the field of mental health and addiction. The study selection followed the guideline provided by Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. RESULTS Six two-stage randomized preference trials (ten publications) have been identified in the field of mental health field and addiction. In these trials, the pooled dropout rates were 18.3% for the preference arm, and 28.7% for the random arm, with a pooled RR of 0.70 (95% CI, 0.56-0.88; P = 0.010) indicating lower risk of dropout in the preference arm. The standardized preference effects varied widely from 0.07 to 0.57, and could be as large as the treatment effect in some of the trials. CONCLUSION This scoping review has shown that two-stage randomized preference trials are not as popular as expected in mental health research. The results indicated that two-stage randomized preference trials in mental health would be beneficial in retaining patients to expand the generalizability of the trial.
Collapse
Affiliation(s)
- Sheng Chen
- Biostatistics Core, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Biostatistics Core, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada.
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, USA.
| |
Collapse
|
8
|
Szuhany KL, Adhikari S, Chen A, Lubin RE, Jennings E, Rassaby M, Eakley R, Brown ML, Suzuki R, Barthel AL, Rosenfield D, Hoeppner SS, Khalsa SB, Bui E, Hofmann SG, Simon NM. Impact of preference for yoga or cognitive behavioral therapy in patients with generalized anxiety disorder on treatment outcomes and engagement. J Psychiatr Res 2022; 153:109-115. [PMID: 35810600 PMCID: PMC9969964 DOI: 10.1016/j.jpsychires.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/11/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
There is some, but inconsistent, evidence to suggest that matching patient treatment preference enhances treatment engagement and outcome. The current study examined differential preferences and factors associated with treatment preference for 12-week group cognitive behavioral therapy (CBT), yoga, or stress education in 226 adults with generalized anxiety disorder (GAD; 70% female, Mean age = 33 ± 13.5). In a subsample of 165 patients who reported an intervention preference and were randomized to yoga or CBT, we further examined whether match to preferred intervention improved the primary treatment outcome (responder status on Clinical Global Impressions Scale) and engagement (dropout, homework compliance). Preferences for CBT (44%) and yoga (40%) were similar among patients. Women tended to prefer yoga (OR = 2.75, p = .01) and CBT preference was associated with higher baseline perceived stress (OR = 0.92, p = .04) and self-consciousness meta-cognitions (OR = 0.90, p = .02). Among those not matched to their preference, treatment response was higher for those receiving CBT than yoga (OR = 11.73, p = .013); there were no group differences for those matched to their treatment preference. In yoga, those who received their preference were more likely to drop than those who did not (OR = 3.02, 95% CI = [1.20, 7.58], p = .037). This was not the case for CBT (OR = 0.37, 95% CI = [0.13, 1.03], p = .076). Preference match did not predict homework compliance. Overall, results suggest that treatment preference may be important to consider to optimize outcome and engagement; however, it may vary by treatment modality. Future research incorporating preference, especially with yoga for anxiety, is aligned with personalized medicine. TRIAL REGISTRATION: clinicaltrials.gov: NCT01912287; https://clinicaltrials.gov/ct2/show/NCT01912287.
Collapse
Affiliation(s)
- Kristin L Szuhany
- Anxiety, Stress and Prolonged Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, 1 Park Avenue, 8th Floor, New York, NY, 10016, USA.
| | - Samrachana Adhikari
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, New York, NY, 10016, USA.
| | - Alan Chen
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, New York, NY, 10016, USA.
| | - Rebecca E Lubin
- Department of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA.
| | - Emma Jennings
- Anxiety, Stress and Prolonged Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, 1 Park Avenue, 8th Floor, New York, NY, 10016, USA.
| | - Madeleine Rassaby
- Anxiety, Stress and Prolonged Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, 1 Park Avenue, 8th Floor, New York, NY, 10016, USA.
| | - Rachel Eakley
- Anxiety, Stress and Prolonged Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, 1 Park Avenue, 8th Floor, New York, NY, 10016, USA.
| | - Mackenzie L Brown
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA.
| | - Rebecca Suzuki
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO, 80210, USA.
| | - Abigail L Barthel
- Department of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA.
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Expressway Tower 1100N, Dallas, TX, USA.
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Richard B. Simches Research Center, 185 Cambridge St., Suite, 2000, Boston, MA, USA.
| | - Sat Bir Khalsa
- Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, USA.
| | - Eric Bui
- Department of Psychiatry, University of Caen Normandy & Caen University Hospital, Avenue de la Cote de Nacre, Caen, France.
| | - Stefan G Hofmann
- Department of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA; Department of Clinical Psychology, Philipps-University Marburg, Germany, Schulstrasse 12, 35037, Marburg, Germany.
| | - Naomi M Simon
- Anxiety, Stress and Prolonged Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, 1 Park Avenue, 8th Floor, New York, NY, 10016, USA.
| |
Collapse
|
9
|
Danhauer SC, Miller ME, Divers J, Anderson A, Hargis G, Brenes GA. Long-Term Effects of Cognitive-Behavioral Therapy and Yoga for Worried Older Adults. Am J Geriatr Psychiatry 2022; 30:979-990. [PMID: 35260292 DOI: 10.1016/j.jagp.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
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);1,2 Insomnia Severity Index (sleep);3 PROMIS Anxiety Short Form v1.0 (anxiety);4,5 Generalized Anxiety Disorder Screener (generalized anxiety);6,7 and PROMIS-29 (depression, fatigue, physical function, social participation, pain).8,9 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 NCT02968238.
Collapse
Affiliation(s)
- Suzanne C Danhauer
- Department of Social Sciences and Health Policy (SCD), Wake Forest School of Medicine, Winston Salem, NC.
| | - Michael E Miller
- Department of Biostatistics and Data Science (MEM), Wake Forest School of Medicine, Winston Salem, NC
| | - Jasmin Divers
- Division of Health Services Research (JD), NYU Long Island School of Medicine, New York, NY
| | - Andrea Anderson
- Department of Biostatistics and Data Science (AA), Wake Forest School of Medicine, Winston Salem, NC
| | - Gena Hargis
- Department of Internal Medicine (GH), Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Gretchen A Brenes
- Department of Internal Medicine (GAB), Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC
| |
Collapse
|
10
|
Bentham C, Eaves L. The Impact of Cognitive-Behavioral Interventions on Sleep Disturbance in Depressed and Anxious Community-dwelling Older Adults: A Systematic Review. Behav Sleep Med 2022; 20:477-499. [PMID: 34120539 DOI: 10.1080/15402002.2021.1933488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Depression and anxiety are prevalent mental health conditions in older adulthood. Despite sleep disturbance being a common comorbidity in late-life depression and anxiety, it is often discounted as a target for treatment. The current review aims to establish whether cognitive-behavioral therapy (CBT) is effective in treating concomitant sleep disturbance in depressed and anxious older adults and to review evidence supporting whether CBT interventions targeting anxiety and depression, or concurrent sleep disturbance, have the greatest effectiveness in this client group. METHOD A systematic database search was conducted to identify primary research papers evaluating the effectiveness of CBT interventions, recruiting older adults with symptoms of depression and/or anxiety, and employing a validated measure of sleep disturbance. The identified papers were included in a narrative synthesis of the literature. RESULTS Eleven identified studies consistently support reductions in sleep disturbance in elderly participants with depression and anxiety in response to CBT. Most CBT interventions in the review included techniques specifically targeting sleep, and only one study directly compared CBT for insomnia (CBT-I) with a CBT-I intervention also targeting depressive symptoms, limiting the ability of the review to comment on whether interventions targeting sleep disturbance or mental health symptoms have superior effectiveness. CONCLUSION The extant research indicates that CBT interventions are effective in ameliorating sleep disturbance in late-life depression and anxiety. Future high-quality research is required to substantiate this finding and to compare the effectiveness of CBT-I and CBT for depression and anxiety in this group to inform clinical practice.
Collapse
Affiliation(s)
| | - Lucy Eaves
- Department of Psychological Services, Sheffield Teaching Hospitals, UK
| |
Collapse
|
11
|
Danhauer SC, Miller ME, Divers J, Anderson A, Hargis G, Brenes GA. A Randomized Preference Trial Comparing Cognitive-Behavioral Therapy and Yoga for the Treatment of Late-Life Worry: Examination of Impact on Depression, Generalized Anxiety, Fatigue, Pain, Social Participation, and Physical Function. Glob Adv Health Med 2022; 11:2164957X221100405. [PMID: 35601466 PMCID: PMC9118438 DOI: 10.1177/2164957x221100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/14/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Depression, generalized anxiety, fatigue, diminished physical function, reduced social participation, and pain are common for many older adults and negatively impact quality of life. The purpose of the overall trial was to compare the effects of cognitive-behavioral therapy (CBT) and yoga on late-life worry, anxiety, and sleep; and examine preference and selection effects on these outcomes. Objective The present analyses compared effects of the 2 interventions on additional outcomes (depressive symptoms, generalized anxiety symptoms, fatigue, pain interference/intensity, physical function, social participation); and examined whether there are preference and selection effects for these treatments. Methods A randomized preference trial of CBT and yoga was conducted in adults ≥60 years who scored ≥26 on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), recruited from outpatient medical clinics, mailings, and advertisements. Cognitive-behavioral therapy consisted of 10 weekly telephone sessions. Yoga consisted of 20 bi-weekly group yoga classes. Participants were randomized to(1): a randomized controlled trial (RCT) of CBT or yoga (n = 250); or (2) a preference trial in which they selected their treatment (CBT or yoga; n = 250). Outcomes were measured at baseline and post-intervention. Results Within the RCT, there were significant between-group differences for both pain interference and intensity. The pain interference score improved more for the CBT group compared with the yoga group [intervention effect of (mean (95% CI) = 2.5 (.5, 4.6), P = .02]. For the pain intensity score, the intervention effect also favored CBT over yoga [.7 (.2, 1.3), P < .01]. Depressive symptoms, generalized anxiety, and fatigue showed clinically meaningful within-group changes in both groups. There were no changes in or difference between physical function or social participation for either group. No preference or selection effects were found. Conclusion Both CBT and yoga may be useful for older adults for improving psychological symptoms and fatigue. Cognitive-behavioral therapy may offer even greater benefit than yoga for decreasing pain.
Collapse
Affiliation(s)
- Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael E Miller
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jasmin Divers
- Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Andrea Anderson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gena Hargis
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
12
|
Dutta A, Aruchunan M, Mukherjee A, Metri KG, Ghosh K, Basu-Ray I. A Comprehensive Review of Yoga Research in 2020. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:114-123. [PMID: 35099279 DOI: 10.1089/jicm.2021.0420] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objectives: Accumulated evidence garnered in the last few decades has highlighted the role of yoga in health and disease. The overwhelming mortality and morbidity mediated by noncommunicable epidemics such as heart disease and cancer have fostered a search for mechanisms to attenuate them. Despite overwhelming success in acute care, the efficacy of modern medicines has been limited on this front. Yoga is one of the integrative therapies that has come to light as having a substantial role in preventing and mitigating such disorders. It thus seems trite to analyze and discuss the research advancements in yoga for 2020. The present review attempts to distill recent research highlights from voluminous literature generated in 2020. Methods: This review was conducted on the articles published or assigned to an issue in 2020. The authors searched the PubMed database for clinical studies published in the English language, using yoga (including meditation) as the intervention, and having an adequate description of the intervention. Then, they extracted data from each study into a standardized Google sheet. Results: A total of 1149 citations were retrieved in the initial search. Of these, 46 studies met eligibility criteria and were finally included. The studies were predominantly on mental health and neuropsychology, addressing various issues such as anxiety, postural balance, migraine, academic performance, and childhood neglect. Anxiety, stress, and depression were other common denominators. Eight studies were on cardiorespiratory systems, including exercise capacity, cardiac rehabilitation, myocardial infarction, and hypertension. Three studies were on diabetes, evaluating the effect of yoga. Five studies focused on cognition, health status, and autonomic regulation and few others included cancers, infertility, ulcerative colitis, urinary incontinence, restless leg syndrome, rheumatoid arthritis, chronic pain, and metabolic syndrome. Finally, most studies were on noncommunicable diseases with one exception, human immunodeficiency virus; two randomized controlled trials were dedicated to it. Conclusions: Yoga has been studied under a wide variety of clinicopathological conditions in the year 2020. This landscape review intends to provide an idea of the role of yoga in various clinical conditions and its future therapeutic implications.
Collapse
Affiliation(s)
- Abhijit Dutta
- Advanced Yoga Research Council, AAYM, Germantown, TN, USA
| | - Mooventhan Aruchunan
- Department of Research, Government Yoga and Naturopathy Medical College, Chennai, India
| | | | | | - Kuntal Ghosh
- Department of Yoga, Manipur University, Imphal, India
| | - Indranill Basu-Ray
- Department of Cardiology, Memphis VA Medical Center, Memphis, TN, USA
- School of Public Health, The University of Memphis, Memphis, TN, USA
- Integrative Cardiology, All India Institute of Medical Sciences, Rishikesh, India
| |
Collapse
|
13
|
Carlisle S, Ayling K, Jia R, Buchanan H, Vedhara K. The effect of choice interventions on retention-related, behavioural and mood outcomes: a systematic review with meta-analysis. Health Psychol Rev 2021; 16:220-256. [PMID: 34423744 DOI: 10.1080/17437199.2021.1962386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The provision of choice within interventions has been associated with increased motivation, engagement and interest, as well as improved clinical outcomes. Existing reviews are limited by their wide inclusion criteria or by not assessing behaviour change and mood outcomes. This review examines whether participant-driven choice-based interventions specifically are more likely to be enjoyed and accepted by participants compared to no-choice interventions, and whether this impacts on intervention outcomes in terms of behaviour change or mood. Forty-four randomised controlled trials were identified for inclusion. Random effects meta-analyses were performed for retention-related outcomes (drop-out, adherence and satisfaction), and aggregate behaviour change and mood outcomes. Choice-based interventions resulted in significantly less participant drop-out and increased adherence compared to interventions not offering choice. Results for the behaviour change and mood analyses were mixed. This meta-analytic review demonstrates that choice-based interventions may enhance participant retention and adherence, thus researchers and clinicians alike should consider the provision of choice when designing research and interventions. The evidence for the role of choice in behaviour change and mood is less convincing, and there is a need for more, higher quality research in this area.
Collapse
Affiliation(s)
- Sophie Carlisle
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kieran Ayling
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ru Jia
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Kavita Vedhara
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
14
|
Brenes GA, Munger Clary HM, Miller ME, Divers J, Anderson A, Hargis G, Danhauer SC. Predictors of preference for cognitive-behavioral therapy (CBT) and yoga interventions among older adults. J Psychiatr Res 2021; 138:311-318. [PMID: 33892269 DOI: 10.1016/j.jpsychires.2021.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to examine factors that influence a person's choice of cognitive-behavioral therapy (CBT) or yoga, the stability of these preferences, and the impact of preference on engagement and process measures. We conducted a randomized preference trial of CBT and yoga in 500 adults ≥60 years with symptoms of worry. Participants reported their intervention preference, strength of preference, and factors impacting preference. Engagement in the intervention (session completion and dropout rates) was assessed. Process measures included satisfaction with the intervention, therapeutic alliance, and intervention expectancy. Neither intervention preference (48% and 52% chose CBT and yoga, respectively) nor strength of preference differed significantly between the two preference trial groups. Intervention expectancies at baseline among those in the preference trial were approximately 4.5 units (40-point scale) higher for their preferred intervention (p < .0001 within each group). A principal component analysis of factors influencing preference identified three constructs. Using logistic regression, components focused on attitudes about CBT or yoga were predictive of ultimate preference (odds ratio = 11.5, 95% C.I.6.3-21.0 per 1SD difference in component 1 for choosing CBT; odds ratio = 7.8, 95% CI4.3-13.9 per 1SD difference in component 2 for choosing yoga). There were no significant differences between the randomized and preference trials on intervention adherence, completion of assessments, intervention satisfaction, or working alliance. Receiving a preferred treatment had no significant effects on intervention outcomes through participant engagement or process measures. When options are limited, providers may have confidence in offering the most readily available non-pharmacological treatments.
Collapse
Affiliation(s)
- Gretchen A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, United States.
| | | | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, United States.
| | - Jasmin Divers
- Division of Health Services Research and Winthrop Research Institute, Department of Foundations of Medicine, NYU Long Island School of Medicine, United States.
| | - Andrea Anderson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, United States.
| | - Gena Hargis
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, United States.
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, United States.
| |
Collapse
|
15
|
Sohl SJ, Brenes GA, Krucoff C, Hargis G, Anderson A, Miller ME, Danhauer SC. Ensuring Yoga Intervention Fidelity in a Randomized Preference Trial for the Treatment of Worry in Older Adults. J Altern Complement Med 2021; 27:489-495. [PMID: 33684325 DOI: 10.1089/acm.2020.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction: Yoga for treatment of worry in older adults is an intervention that is especially likely to translate into real-world practice. Assessing treatment fidelity improves confidence that effective interventions can be consistently applied and allows researchers to explore if any null results for effectiveness are indeed the result of a lack of intervention efficacy or lack of proper intervention implementation. Methods: This study describes treatment fidelity of a yoga intervention in a randomized preference trial that compared cognitive-behavioral therapy (CBT) and yoga for the treatment of worry, anxiety, and sleep in worried older (≥60 years) adults. Established methods for assessing treatment fidelity of CBT guided the procedure for ensuring that the yoga intervention was delivered as intended. The yoga intervention consisted of 20, 75-min, in-person, group, gentle yoga classes held twice weekly. Results: Six female instructors (mean age = 64 years) taught 660 yoga classes that were videotaped. Ten percent of these classes, stratified by instructor, were randomly selected for review. The average adherence score for yoga instructors was 6.84 (range 4-8). The average competency scores were consistently high, with an average score of 7.24 (range 6-8). Teaching content not included in the protocol occurred in 26 (38.1%) sessions and decreased over time. Observed ratings of instructor adherence were significantly related to ratings of competency. Instructor adherence was also significantly associated with lower participant attendance, but not with any of the other process or outcome measures. Conclusions: The larger range found in adherence relative to competence scores demonstrated that teaching a yoga class according to a protocol requires different skills than competently teaching a yoga class in the community, and these skills improved with feedback. These results may foster dialog between the yoga research and practice communities. Clinical Trial Registration No.: NCT02968238.
Collapse
Affiliation(s)
- Stephanie J Sohl
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carol Krucoff
- Duke Integrative Medicine, Duke Health, Durham, NC, USA
| | - Gena Hargis
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrea Anderson
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael E Miller
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|