A randomized preference trial of cognitive-behavioral therapy and yoga for the treatment of worry in anxious older adults

Yoga studio websites: are they an accurate first glance at the studio's mission, values, and resources?

BACKGROUND

Yoga, as an ancient and modern practice, increases physical, mental, emotional, spiritual, and social health. Yoga studio websites serve as a dissemination channel for studios to express their offerings, whom they employ, and whom they seek as clientele. Public health workers, physicians, researchers, and clinicians, can refer to existing studios to increase health among their patients or clients. The degree to which these websites can provide relevant information to these various stakeholder groups has yet to be defined.

METHODS

A pragmatic, sequential mixed-methods study was employed with quantitative data extraction, summarized as means and proportions, to score the studio websites (N = 28), and semi-structured interviews (n = 6) analyzed using the rigorous and accelerated data reduction (RADaR) technique, to confirm website content and staff intention. To explore urban and rural characteristics, yoga studios in southwest Virginia and Los Angeles were selected for inclusion.

RESULTS

Overall, community-based yoga studios websites included information on the type, duration, cost, and COVID mitigation strategies. The most common class duration was 60 min. Rural Southwest Virginia studios offered 8.5 classes per week whereas those in urban Los Angeles offered 24.2 classes per week. All studios used iconography and images to invite racial, ethnic, age, and body type and ability diversity. While studios in both areas specified that there were 200- and 500-hour registered yoga teachers, many of the instructor biographies did not include information on their training. Although only preliminary, the interviews (n = 6) confirmed that the websites generally represented the feel, intention, and offerings of the studio and that the primary purpose of the studio was to build relationships and ensure people felt comfortable in the space.

CONCLUSION

Website information was related to studio offerings and values; however, discussion with management or visiting the studio may provide a richer picture of the yoga practices offered in the space. Further suggestions for website content are provided.

Systematic review to explore the effect of yoga on anxiety in adults

Introduction: The National Health Service cannot chronically sustain the overwhelming demands being placed on it due to financial cuts, staff numbers and recent presence of Covid-19. As a result, anxiety levels are on the rise thus increasing the need for effective first-line treatment. Purpose: The purpose of this systematic review was to examine the efficacy of yoga as a first-line treatment for anxiety. Previous systematic reviews have produced mixed results. Methodology: The inclusion criteria followed the PICO research statement. The population (P) were either healthy or diagnosed with anxiety and the intervention (I) was yoga. The comparison (C) was a control group, or CBT, or used a pre-and post-intervention design. The outcome (O) was the change in the level of anxiety post-intervention. Results and Discussion: After the review of 64 studies, 7 studies fit the inclusion criteria: four randomized controlled studies, one longitudinal study, and two pre- and post-intervention comparisons. All the studies included provided statistically significant results for the beneficial effect of yoga on anxiety. Conclusion: This study adds to preceding literature on the current anxiety levels of adults and the potential utility of yoga as a first-line treatment for self-management of anxiety levels. This review stresses the issue of heterogeneity, mode of yoga and calls for more robust randomised controlled trials to pioneer the subject matter to help, if not prevent, to slow down the rising cases of anxiety and ill mental health worldwide.

Effects of Temperature and Tempo: Evaluating How Much Time in a Typical Community-Based Yoga Class Is Moderate-Intensity Aerobic Activity

The 2nd edition of the Physical Activity Guidelines for Americans (PAG) recommends, in part, 150 min of moderate-intensity aerobic physical activity. The PAG states that yoga may be able to help meet the guidelines for moderate-intensity aerobic exercise for adults and older adults. Our study aims to objectively measure the proportion of time participants' activity that is categorized as moderate-intensity aerobic activity based on heart rate data and to subjectively measure rate of perceived exertion (RPE). Participants completed the Stanford Leisure-Time Activity Categorical item to establish baseline PAG aerobic activity compliance. Participants then completed four separate 1-h yoga sessions at different tempos (cadence) and temperatures while wearing heart rate monitors. During and directly after the session they also marked their RPE on a modified 10-point scale. All participants reached moderate-intensity aerobic activity for at least some portion of a yoga session based on heart rate monitor data and RPE. The average duration of moderate intensity was 32.75% of the class across all four class types, with no significant differences by condition. Age was a significant factor in time spent in moderate-to-vigorous physical activity for only the thermo-neutral Hatha classes (p = 0.010). Tempo, temperature, and baseline activity levels were not significant factors in time spent in moderate-to-vigorous intensity physical activity based on Pearson Correlation and the Kruskal-Wallis test. Hatha and Vinyasa yoga classes, at room or hot temperatures, can be used to meet a portion of the PAG moderate-intensity activity recommendations.

Effectiveness of cognitive behavioral therapy with yoga in reducing job stress among university lecturers

Introduction

Job stress is highly prevalent in the workforce worldwide, and tends to threaten employees' physical and mental wellbeing, reducing organizational outcomes. The negative impacts of workplace stress on academics have been found to disproportionately interfere with both institutional research productivity and students' learning outcomes. This study analyzed data from a randomized control trial, to validate the effectiveness of cognitive behavioral therapy combined with yoga in treating job-related stress among lecturers from two Universities in South-East, Nigeria.

Methods

Participants included 93 academic staff members from two Federal Universities in Enugu and Ebonyi States in Nigeria. We assigned participants to Y-CBT (N = 46) and waitlist control (N = 47) groups using random sampling techniques. A 2-h Y-CBT program was delivered weekly for a period of 12 weeks. Two instruments were used to collect data for the study. Single Item Stress Questionnaire (SISQ) was employed to identify the potential participants, while the teachers' Stress Inventory (TSI) was served for data collection at baseline, post-intervention, and follow-up tests. Mean, standard deviations, t-test, statistics, and repeated measures Analysis of Variance, were used to analyze data for the study.

Results

Results revealed that the perception of stressors and stress symptoms reduced significantly at post-test and follow-up assessments following Y-CBT intervention.

Discussion and conclusion

The outcomes of this study support the prior that Y-CBT is valuable for harmonizing mind and body for a stable psychological state. The conclusion was that Y-CBT can minimize the perception of stressors and stress manifestation among university lecturers.

Shared decision-making interventions for people with mental health conditions

BACKGROUND

One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society.  International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision.  This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010.

OBJECTIVES

To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes.

SEARCH METHODS

We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies.  We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification.

SELECTION CRITERIA

Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria).

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents.  Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported.

AUTHORS' CONCLUSIONS

This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations.  Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.

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);^1,2 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.

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

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.

Role of Yoga practices on cognitive functions

Yoga is the science of conditioning one's mind and body via the practise of shatkarma, asana, pranayama, mudra, and meditation. The aim of this review of literature is to give theoretical rationale for identifying (a) the specific attributes of yoga poses that have been used in yoga protocols of various studies but have not been explicitly explored, & (b) the minimum time necessary to keep a posture to bring about a corresponding change in performance among the aforementioned cognitive functions (s) In humans, The most prevalent and under-treated problems are cognitive decline & psychological health problems. Different studies have been carried out to determine the influence of Yoga on human cognitive and psychological health indices. However, no comprehensive examination of the effects of yoga-based therapy on human cognitive and mental health has been undertaken to far. Yoga is an ancient science that places a premium on disease prevention and treatment, as well as the percentage of health. Yoga is recognized to delay the effects of aging and has been found to be effective in the therapy of aging-related disorders. Yoga is a centuries-old discipline that is said to improve both physical and emotional well-being.

Managing job stress among teachers of children with autism spectrum disorders: A randomized controlled trial of cognitive behavioral therapy with yoga

BACKGROUND

Job-related stress undermines occupational, personal, and organizational outcomes. Stress symptoms are common among teachers of children with autism spectrum disorders and affect the academic progress of the children. This study investigated the effectiveness of yoga-based cognitive behavioral therapy in reducing occupational stress among teachers of children with autism in Lagos states, Nigeria.

METHODS

The current study adopted a group-randomized waitlist control (WLC) trial design with pre-test, posttest, and follow-up assessments. Participants included 58 teachers of children with autism in public and private special schools in Lagos state. Participants were randomly assigned to combined cognitive behavioral therapy and yoga (Y-CBT) (N = 29) and WLC (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments - Demographic Questionnaire, Single-Item Stress Questionnaire, and Teachers' Stress Inventory (TSI) were used to collect data. Data were collected at baseline; posttest and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts.

RESULTS

Results revealed that all dimensions of job stress (perception of stress sources, stress manifestation, and total TSI scores) reduced significantly at posttest and follow up assessments among the Y-CBT group, compared to the WLC.

CONCLUSION

It was concluded that Y-CBT modalities could help to minimize the perception of stress sources and stress manifestation as well as total TSI scores among teachers of children with autism spectrum disorders.

Yoga as an Integrative Therapy for Mental Health Concerns: An Overview of Current Research Evidence

Background: Because the prevalence of mental health concerns is high and access or full responsiveness to pharmacological or psychotherapeutic treatment for many individuals is low, there has been increased interest in yoga as a potential therapy for many mental health concerns. Approach: We synthesize and critique current research on the efficacy of yoga relative to pharmacological approaches for anxiety disorders, mood disorders, posttraumatic stress disorder, obsessive-compulsive disorder, and eating disorders. Results: Yoga has been tested mostly as a complementary treatment to standard psychiatric and psychotherapeutic approaches. Findings from efficacy trials largely support the notion that yoga can help reduce symptoms of many psychiatric conditions, including anxiety, depression, and PTSD symptoms, above and beyond the effects achieved by standard pharmacological treatments alone; however, most evidence is of poor to moderate quality. Plausible transdiagnostic bottom-up and top-down mechanisms of yoga’s therapeutic effects have been advanced but remain untested. Conclusions: While results should be considered preliminary until more rigorous evidence is available, yoga appears to have the potential to provide many people suffering with psychiatric symptoms additional relief at relatively little cost. Yoga may be a viable complementary therapy to psychiatric and psychotherapeutic approaches for people with mental health challenges.

Yoga complemented cognitive behavioral therapy on job burnout among teachers of children with autism spectrum disorders

BACKGROUND/OBJECTIVE

Job burnout is a syndrome of reaction to chronic job-related stress which affects overall health, limits occupational efficacy, and personal accomplishments of employees thereby thwarting organizational outcomes. Burnout symptoms are common among teachers of children with autism spectrum disorders (ASD) and affect the academic progress of the children. This study investigated the effectiveness of Yoga-based cognitive behavioral therapy (Y-CBT) in reducing occupational burnout among teachers of children with autism in Lagos States, Nigeria.

METHODS

A group-randomized control-trial with immediate intervention and waitlist control groups was design was adopted. Participants included 58 teachers of children with autism in public and private special schools in the area. Participants were randomly assigned to Y-CBT (N = 29) and waitlist control (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments Demographic variable, Single Item Stress Questionnaire (SISQ), and Maslach Burnout Inventory-Educators' Survey (MBI-ES) were used to collect data. Data were collected at baseline; post-test and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts.

RESULTS

Results revealed that job-burnout reduced significantly at post-test assessment among the Y-CBT group compared to the waitlisted group. The reduction in the participant was sustained across 3months follow-up evaluation.

CONCLUSION

It was concluded that Y-CBT modalities could help to reduce the burnout symptoms among teachers of children with ASD.

Predictors of preference for cognitive-behavioral therapy (CBT) and yoga interventions among older adults

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.

Ensuring Yoga Intervention Fidelity in a Randomized Preference Trial for the Treatment of Worry in Older Adults

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.

Worry about COVID-19 in relation to cognitive-affective smoking processes among daily adult combustible cigarette smokers

Cigarette smoking is a known risk factor for severe disease and death from respiratory infection. Initial data suggest that smoking is a risk factor for COVID-19 symptom severity. Exposure to increased pandemic-related stress and subsequent worry about COVID-19 may amplify the desire to smoke to down-regulate distress. The present investigation sought to test this conceptual model by evaluating worry about COVID-19 in relation to COVID-19 coping motives for smoking, perceived barriers for smoking cessation, and smoking abstinence expectancies. Participants were 219 daily combustible cigarette smokers (55.70% female, M_age = 41.43 years, SD = 11.06). Six separate, two-step hierarchical linear regression models were conducted for each of the criterion variables. As expected, worry about COVID-19 was significantly and positively related to COVID-19 coping motives for smoking and perceived barriers for smoking cessation. Worry about COVID-19 also was a positively significant predictor of smoking abstinence expectancies of negative mood, somatic symptoms, and harmful consequences, but not positive consequences. The present study provides novel empirical evidence that worry about COVID-19 is related to key cognitive-affective smoking processes beyond the effects of age, sex, race, ethnicity, COVID-19 exposure, smoking rate, e-cigarette use status, and anxiety symptoms. These results highlight the potential utility in assessing level of worry about COVID-19, a transdiagnostic construct, among combustible cigarette smokers to better understand cognitive-affective factors that may maintain smoking behavior in the context of the COVID-19 pandemic.

Comparison of cognitive-behavioral therapy and yoga for the treatment of late-life worry: A randomized preference trial

BACKGROUND

The purpose of this study 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.

METHODS

A randomized preference trial of CBT and yoga was conducted in community-dwelling adults 60 years or older, who scored 26 or above on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A). CBT consisted of 10 weekly telephone sessions. Yoga consisted of 20 biweekly group yoga classes. The primary outcome was worry (PSWQ-A); the secondary outcomes were anxiety (PROMIS-Anxiety) and sleep (Insomnia Severity Index [ISI]). We examined both preference effects (average effect for those who received their preferred intervention [regardless of whether it was CBT or yoga] minus the average for those who did not receive their preferred intervention [regardless of the intervention]) and selection effect (which addresses the question of whether there is a benefit to getting to select one intervention over the other, and measures the effect on outcomes of self-selection to a specific intervention).

RESULTS

Five hundred older adults were randomized to the randomized trial (125 each in CBT and yoga) or the preference trial (120 chose CBT; 130 chose yoga). In the randomized trial, the intervention effect of yoga compared with CBT adjusted for baseline psychotropic medication use, gender, and race was 1.6 (-0.2, 3.3), p = .08 for the PSWQ-A. Similar results were observed with PROMIS-Anxiety (adjusted intervention effect: 0.3 [-1.5, 2.2], p = .71). Participants randomized to CBT experienced a greater reduction in the ISI compared with yoga (adjusted intervention effect: 2.4 [1.2, 3.7], p < .01]). Estimated in the combined data set (N = 500), the preference and selection effects were not significant for the PSWQ-A, PROMIS-Anxiety, and ISI. Of the 52 adverse events, only two were possibly related to the intervention. None of the 26 serious adverse events were related to the study interventions.

CONCLUSIONS

CBT and yoga were both effective at reducing late-life worry and anxiety. However, a greater impact was seen for CBT compared with yoga for improving sleep. Neither preference nor selection effects was found.

mHealth Assessment and Intervention of Depression and Anxiety in Older Adults

Mobile technology is increasingly being used to enhance health and wellness, including in the assessment and treatment of psychiatric disorders. Such applications have been referred to collectively as mHealth, and this article provides a comprehensive review and clinical perspective of research regarding mHealth in late-life mood and anxiety disorders. The novel data collection offered by mHealth has contributed to a broader understanding of psychopathology, to an increased diversity of psychological interventions, and to novel methods of assessment that may ultimately provide individually adaptive mental health care for this population. Older adults face challenges (e.g., transportation, mobility) that limit their ability to receive medical and mental health care services, and mHealth may improve the capacity to reach this population. Although several mobile interventions exist for health-related issues in older adults (e.g., balance, diabetes, medication management), mHealth targeting psychiatric disorders is limited and most often focuses on problems related to dementia, cognitive dysfunction, and memory loss. Given that depression and anxiety are two of the most common mental health concerns among this population, mHealth has strong potential for broad public health interventions that may improve effectiveness of mental health care via individualized assessments and treatments.

Leisure Motivation and Satisfaction: A Text Mining of Yoga Centres, Yoga Consumers, and Their Interactions

Understanding the motivation and satisfaction of yoga consumers is of critical importance for both leisure service providers and leisure researchers to enhance the sustainability of personal lives in terms of physical wellness and mental happiness. For this purpose, this study investigated 25,120 pairs of online ratings and reviews from 100 yoga centres in Shanghai, China using latent Dirichlet allocation (LDA)-based text mining, and successfully established the relationship between rating and review. Findings suggest that Chinese yogis are motivated by improving physical condition, improving psychological condition, gracing appearance, establishing social connection, and creating social isolation. In addition to teaching mainstream yoga, yoga centres also provide additional courses. From a consumer perspective, yogis are relatively satisfied with teachers, courses, and the environment, but complain about the supporting staff, membership price, and reservation service. Managerially, yoga centres are encouraged to continue attending to the motivations of yogis, specialising their guidance, and fostering strengths and circumventing weaknesses in their service. This study also contributes by verifying, elaborating on, and tentatively extending the framework of the Physical Activity and Leisure Motivation Scale (PALMS).