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Hoge EA, Simon NM, Szuhany K, Feldman B, Rosenfield D, Hoeppner S, Jennings E, Khalsa SB, Hofmann SG. Comparing Kundalini Yoga, cognitive behavioral therapy, and stress education for generalized anxiety disorder: Anxiety and depression symptom outcomes. Psychiatry Res 2023; 327:115362. [PMID: 37598625 DOI: 10.1016/j.psychres.2023.115362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
Increasingly, individuals with anxiety disorders are seeking mind-body interventions (e.g., yoga), but their effectiveness is unclear. This report summarizes seven additional, secondary outcomes measuring anxiety and depression symptoms from a study of 226 adults with generalized anxiety disorder who were randomized to 12-week Kundalini Yoga, Cognitive-Behavior Therapy (CBT) or stress education (control). At post-treatment, participants receiving CBT displayed significantly lower symptom severity, compared to those in the control group, on 6 of the 7 measures. Participants who received Yoga (vs. those in the control group) displayed lower symptom severity on 3 of the 7 measures. No significant differences were detected between participants receiving CBT vs those receiving Yoga. At the 6-month follow-up, participants from the CBT continued to display lower symptoms than the control group.
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Affiliation(s)
- Elizabeth A Hoge
- Georgetown University Medical Center, Department of Psychiatry, 2115 Wisconsin Ave, NW, Suite 200, Washington, DC, 20007, USA.
| | - Naomi M Simon
- New York University Grossman School of Medicine, Department of Psychiatry, New York NY 10016, USA
| | - Kristin Szuhany
- New York University Grossman School of Medicine, Department of Psychiatry, New York NY 10016, USA
| | - Benjamin Feldman
- New York University Grossman School of Medicine, Department of Psychiatry, New York NY 10016, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Expressway Tower 1100N, Dallas, Texas, USA
| | - Susanne Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Richard B. Simches Research Center, 185 Cambridge St., Suite 2000, Boston MA, USA
| | - Emma Jennings
- New York University Grossman School of Medicine, Department of Psychiatry, New York NY 10016, USA
| | - Sat Bir Khalsa
- Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston MA, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Clinical Psychology, Philipps-University Marburg, Schulstrasse 12, 35037 Marburg, Germany
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Stein MB, Jain S, Simon NM, West JC, Marvar PJ, Bui E, He F, Benedek DM, Cassano P, Griffith JL, Howlett J, Malgaroli M, Melaragno A, Seligowski AV, Shu IW, Song S, Szuhany K, Taylor CT, Ressler KJ. Randomized, Placebo-Controlled Trial of the Angiotensin Receptor Antagonist Losartan for Posttraumatic Stress Disorder. Biol Psychiatry 2021; 90:473-481. [PMID: 34275593 DOI: 10.1016/j.biopsych.2021.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence-based pharmacological treatments for posttraumatic stress disorder (PTSD) are few and of limited efficacy. Previous work suggests that angiotensin type 1 receptor inhibition facilitates fear inhibition and extinction, important for recovery from PTSD. This study tests the efficacy of the angiotensin type 1 receptor antagonist losartan, an antihypertensive drug, repurposed for the treatment of PTSD. METHODS A randomized controlled trial was conducted for 10 weeks in 149 men and women meeting DSM-5 PTSD criteria. Losartan (vs. placebo) was flexibly titrated from 25 to 100 mg/day by week 6 and held at highest tolerated dose until week 10. Primary outcome was the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) change score at 10 weeks from baseline. A key secondary outcome was change in CAPS-5 associated with a single nucleotide polymorphism of the ACE gene. Additional secondary outcomes included changes in the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9, and proportion of responders with a Clinical Global Impressions-Improvement scale of "much improved" or "very much improved." RESULTS Both groups had robust improvement in PTSD symptoms, but there was no significant difference on the primary end point, CAPS-5 measured as week 10 change from baseline, between losartan and placebo (mean change difference, 0.9, 95% confidence interval, -3.2 to 5.0). There was no significant difference in the proportion of Clinical Global Impressions-Improvement scale responders for losartan (58.6%) versus placebo (57.9%), no significant differences in changes in PTSD Checklist for DSM-5 or Patient Health Questionnaire-9, and no association between ACE genotype and CAPS-5 improvement on losartan. CONCLUSIONS At these doses and durations, there was no significant benefit of losartan compared with placebo for the treatment of PTSD. We discuss implications for failure to determine the benefit of a repurposed drug with strong a priori expectations of success based on preclinical and epidemiological data.
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Affiliation(s)
- Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California.
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - Naomi M Simon
- NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - James C West
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Feng He
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - David M Benedek
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Paolo Cassano
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jonathan Howlett
- Department of Psychiatry, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
| | - Matteo Malgaroli
- NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Andrew Melaragno
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Antonia V Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Hospital, Belmont, Massachusetts
| | - I-Wei Shu
- Department of Psychiatry, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
| | - Suzan Song
- George Washington University, Washington, DC
| | - Kristin Szuhany
- NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Charles T Taylor
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Hospital, Belmont, Massachusetts.
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Orstad SL, Szuhany K, Tamura K, Thorpe LE, Jay M. Park Proximity and Use for Physical Activity among Urban Residents: Associations with Mental Health. Int J Environ Res Public Health 2020; 17:E4885. [PMID: 32645844 PMCID: PMC7369687 DOI: 10.3390/ijerph17134885] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 01/04/2023]
Abstract
Increasing global urbanization limits interaction between people and natural environments, which may negatively impact population health and wellbeing. Urban residents who live near parks report better mental health. Physical activity (PA) reduces depression and improves quality of life. Despite PA's protective effects on mental health, the added benefit of urban park use for PA is unclear. Thus, we examined whether park-based PA mediated associations between park proximity and mental distress among 3652 New York City residents (61.4% 45 + years, 58.9% female, 56.3% non-white) who completed the 2010-2011 Physical Activity and Transit (PAT) random-digit-dial survey. Measures included number of poor mental health days in the previous month (outcome), self-reported time to walk to the nearest park from home (exposure), and frequency of park use for sports, exercise or PA (mediator). We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation by park-based PA and moderation by gender, dog ownership, PA with others, and perceived park crime. Park proximity was indirectly associated with fewer days of poor mental health via park-based PA, but only among those not concerned about park crime (index of moderated mediation = 0.04; SE = 0.02; 95% BC CI = 0.01, 0.10). Investment in park safety and park-based PA promotion in urban neighborhoods may help to maximize the mental health benefits of nearby parks.
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Affiliation(s)
- Stephanie L. Orstad
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University (NYU) Grossman School of Medicine, New York, NY 10016, USA
| | - Kristin Szuhany
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Lorna E. Thorpe
- Department of Population Health, Division of Epidemiology, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Melanie Jay
- Departments of Medicine and Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA;
- Comprehensive Program on Obesity, NYU Langone Health, New York, NY 10016, USA
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