Yoga shown to improve anxiety

August 12, 2020

Science Daily/NYU Langone Health / NYU School of Medicine

Yoga improves symptoms of generalized anxiety disorder, a condition with chronic nervousness and worry, suggesting the popular practice may be helpful in treating anxiety in some people.

Led by researchers at NYU Grossman School of Medicine, a new study found that yoga was significantly more effective for generalized anxiety disorder than standard education on stress management, but not effective as cognitive behavioral therapy (CBT), the gold standard form of structured talk therapy that helps patients identify negative thinking for better responses to challenges.

"Generalized anxiety disorder is a very common condition, yet many are not willing or able to access evidence-based treatments," says lead study author Naomi M. Simon, MD, a professor in the Department of Psychiatry at NYU Langone Health. "Our findings demonstrate that yoga, which is safe and widely available, can improve symptoms for some people with this disorder and could be a valuable tool in an overall treatment plan."

For the study, publishing online Aug. 12 in JAMA Psychiatry, 226 men and women with generalized anxiety disorder were randomly assigned to three groups -- either CBT, Kundalini yoga, or stress-management education, a standardized control technique.

After three months, both CBT and yoga were found to be significantly more effective for anxiety than stress management. Specifically, 54 percent of those who practiced yoga met response criteria for meaningfully improved symptoms compared to 33 percent in the stress-education group. Of those treated with CBT, 71 percent met these symptom improvement criteria.

However, after six months of follow-up, the CBT response remained significantly better than stress education (the control therapy), while yoga was no longer significantly better, suggesting CBT may have more robust, longer-lasting anxiety-reducing effects.

Study Details

The study involved an evidence-based protocol for CBT treatment of generalized anxiety disorder, including psychoeducation, cognitive interventions (focused on identifying and adapting maladaptive thoughts and worrying), and muscle relaxation techniques.

Kundalini yoga included physical postures, breathing techniques, relaxation exercises, yoga theory, and meditation/mindfulness practice.

The stress-management education control group received lectures about the physiological, psychological and medical effects of stress, as well as the antianxiety effects of lifestyle behaviors, such as reducing alcohol and smoking, and the importance of exercise and a healthy diet. Homework consisted of listening to educational material about stress, nutrition, and lifestyle.

Each treatment was administered in groups of three to six participants, over weekly two-hour sessions for 12 weeks with 20 minutes of daily homework assigned.

Can Yoga Help Treat Anxiety?

According to researchers, generalized anxiety disorder is a common, impairing, and undertreated condition, currently affecting an estimated 6.8 million Americans. While most people feel anxious from time to time, it is considered a disorder when worrying becomes excessive and interferes with day-to-day life. CBT is considered the gold standard first-line treatment. Medications, including antidepressants and sometimes benzodiazepines, may also be used. Yet, not everyone is willing to take medication which can have adverse side effects and there are challenges with accessing CBT for many, including lack of access to trained therapists and long waitlists.

"Many people already seek complementary and alternative interventions, including yoga, to treat anxiety," says Dr. Simon. "This study suggests that at least short-term there is significant value for people with generalized anxiety disorder to give yoga a try to see if it works for them. Yoga is well-tolerated, easily accessible, and has a number of health benefits."

According to Dr. Simon, future research should aim to understand who is most likely to benefit from yoga for generalized anxiety disorder to help providers better personalize treatment recommendations.

"We need more options to treat anxiety because different people will respond to different interventions, and having more options can help overcome barriers to care," she says. "Having a range of effective treatments can increase the likelihood people with anxiety will be willing to engage in evidence-based care."

https://www.sciencedaily.com/releases/2020/08/200812144124.htm

People with anxiety may strategically choose worrying over relaxing

September 30, 2019

Science Daily/Penn State

Relaxing is supposed to be good for the body and soul, but people with anxiety may actively resist relaxation and continue worrying to avoid a large jump in anxiety if something bad does happen, according to Penn State research.

In a new study, the researchers found that people who were more sensitive to shifts in negative emotion -- quickly moving from a relaxed state to one of fear, for example -- were more likely to feel anxious while being led through relaxation exercises.

Michelle Newman, professor of psychology, said the results could help benefit people who experience "relaxation-induced anxiety," a phenomenon that occurs when people actually become more anxious during relaxation training.

"People may be staying anxious to prevent a large shift in anxiety, but it's actually healthier to let yourself experience those shifts," Newman said. "The more you do it, the more you realize you can do it and it's better to allow yourself to be relaxed at times. Mindfulness training and other interventions can help people let go and live in the moment."

Hanjoo Kim, a graduate student in psychology, said the study also sheds light on why relaxation treatments designed to help people feel better can potentially cause more anxiety.

"People who are more vulnerable to relaxation-induced anxiety are often the ones with anxiety disorders who may need relaxation more than others," Kim said. "And of course, these relaxation techniques were meant to help, not make someone more anxious. Our findings will hopefully serve as a cornerstone for providing better care for these populations."

Newman said that while researchers have known about relaxation-induced anxiety since the 1980s, the specific cause of this phenomenon has remained unknown. When Newman developed the contrast avoidance theory in 2011, she thought the two concepts might be connected.

"The theory revolves around the idea that people may make themselves anxious intentionally as a way to avoid the letdown they might get if something bad were to happen," Newman said. "This isn't actually helpful and just makes you more miserable. But, because most of the things we worry about don't end up happening, what's reinforced in the brain is, 'I worried and it didn't happen so I should continue worrying.'"

For this study, the researchers recruited 96 college students. Participants included 32 people with generalized anxiety disorder, 34 people with major depressive disorder and 30 controls with neither disorder.

When the participants arrived at the lab, the researchers led them through relaxation exercises before having them watch videos that may elicit fear or sadness. The participants then answered a list of questions designed to measure how sensitive they were to changes in their emotional state. For example, some people may be uncomfortable with the negative emotions incited by the videos right after relaxing, while others might find the relaxation session helpful in dealing with those emotions.

Next, the researchers led the participants through a relaxation session once more before having them fill out a second survey. These questions were designed to measure the participants' anxiety during the second relaxation session.

After analyzing the data, the researchers found that people with generalized anxiety disorder were more likely to be sensitive to sharp spikes in emotion, like going from feeling relaxed to feeling scared or stressed. Additionally, this sensitivity was linked to feeling anxious during sessions intended to induce relaxation.

The researchers found similar results in people with major depressive disorder, although the effect wasn't as strong.

Kim said he hopes the results -- recently published in the Journal of Affective Disorders -- may help clinicians provide better care for people with anxiety.

"Measuring relaxation-induced anxiety and implementing exposure techniques targeting the desensitization of negative contrast sensitivity may help patients reduce this anxiety," Kim said. "Also, it would be important to examine relaxation-induced anxiety in other disorders, such as panic disorder and persistent mild depression."

https://www.sciencedaily.com/releases/2019/09/190930114737.htm