Source/Disclosures
Disclosures: Simon reports receiving several grants, having numerous pharmaceutical ties and other relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
August 17, 2020
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Kundalini yoga effective for reducing anxiety

Source/Disclosures
Disclosures: Simon reports receiving several grants, having numerous pharmaceutical ties and other relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Kundalini yoga appeared effective for reducing anxiety, but cognitive behavioral therapy should remain first-line treatment, according to results of a randomized clinical trial published in JAMA Psychiatry.

“Generalized anxiety disorder is common, impairing and often undertreated,” Naomi M. Simon, MD, MSc, of the department of psychiatry at New York University Grossman School of Medicine, told Healio Psychiatry. “Although evidence-based treatments, such as CBT and medication, are available, not all people with this disorder are willing or able to access them. Yoga is a popular stress reduction strategy, but little was known about how effective it is in treating a clinical anxiety disorder.

“This study filled a gap by examining Kundalini yoga, a multicomponent form of yoga, under rigorous conditions compared with a control condition and compared with the first-line psychosocial treatment CBT.”

Naomi M. Simon
Naomi M. Simon

Results of prior studies suggest that mindfulness-based approaches were efficacious for anxiety disorders, yet the efficacy of yoga remains less clear. Yoga for anxiety produced inconclusive meta-analytic results. Further, a pilot study showed Kundalini yoga, which is considered a safe, popular and accessible style of yoga involving all its traditional components, might improve outcomes of generalized anxiety disorder. However, research is sparse regarding its efficacy compared with CBT, as well as about its active mechanisms.

Simon and colleagues evaluated data of 538 participants, of whom 226 had a primary generalized anxiety disorder diagnosis, who were recruited from two specialty academic centers between December 2013 and October 25, 2019. They included superiority testing of Kundalini yoga and CBT vs. stress education, as well as noninferiority testing of Kundalini yoga vs. CBT, in primary analyses. A total of 93 participants were randomly assigned to Kundalini yoga, 90 to CBT for generalized anxiety disorder and 43 to stress education, each of which were delivered to groups of four to six participants by two instructors in twelve 2-hour sessions with 20 minutes of homework each day. Acute generalized anxiety disorder response according to Clinical Global Impression-Improvement Scale score of much or very much improved after 12 weeks as assessed by trained independent raters served as the primary intention-to-treat outcome.

Posttreatment assessment data were available for 155 (68.6%) participants, and the completion rates did not differ between form of intervention. Results showed higher response rates among the Kundalini yoga group (54.2%) vs. the stress education group (OR = 2.46; 95% CI, 1.12-5.42), as well as in the CBT group (70.8%) vs. the stress education group (33%) (OR = 5; 95% CI, 2.12-11.82). Results of the noninferiority test found Kundalini yoga was not as effective as CBT, with a difference of 16.6% (P = .42 for noninferiority).

“These findings suggest that people with generalized anxiety disorder and clinicians treating these can consider yoga as one evidence-supported option in an overall treatment plan, but some people may need additional intervention if they do not respond sufficiently, as yoga’s effects may be less robust or long-lasting than CBT,” Simon told Healio Psychiatry. “More research is needed to better understand what patient characteristics predict who responds best to yoga over time.”