Yoga-Cognitive Behavioral Therapy (Y-CBT) May Benefit Older Adults

Anxiety is a difficult and prevalent problem in the population as a whole [1] as well as among doctors, nurses, and allied healthcare professionals [2]. Anxiety is characterized by worry, apprehension and a sense of impeding threat or catastrophe. Somatic symptoms often accompany these feelings as the body mobilizes to face the perceived danger – breath may be held or become faster [3], muscles may tense, and the heart may beat faster [4].

To treat anxiety, behavioral health professionals often use Cognitive Behavioral Therapy (CBT), which is considered highly effective [5]. CBT highlights the impact dysfunctional beliefs and thought processes (Beck, 1995); it is a goal-oriented approach that teaches people to perceive internal and external cues and use strategies that will lead to better control of the triggers of anxiety [6]. CBT has grown into a family of treatments that integrate CBT protocols with other techniques. Often considered the “third wave of CBT,” techniques include Mindfulness-Based CBT (MBCT) which combines CBT with Mindfulness [7]. Mindfulness educates people to focus their attention on the present moment and suspend judgment in difficult situations [3]. MBCT has demonstrated significant reductions in bodily distress, anxiety, and depression [8].

Similar to mindfulness, yoga & meditation have shown a beneficial effect on the physiologic and psychological processes of stress across several studies [9]. Yoga is a series of physical and mental exercises that have demonstrated significant improvements for depression [10], anxiety and stress [11]. Yoga may also reduce cortisol [12] and inflammatory cytokines [13]. helping to protect practitioners from the biochemical effects of stress. This may be particularly helpful for older adults, who may experience significant stress from loss, financial issues, and other factors of aging; this stress may lead to a process called inflame-aging. Inflame-aging explains that when older people have continuous stress, they may experience a persistent inflammatory process which leaves them more vulnerable to several diseases [13,14].

Enriching CBT with yoga may result in a broader approach to reducing anxiety because while CBT primarily targets thought (and subsequent behavior), yoga and meditation primarily target physical states. Towards this goal, Yoga Cognitive Behavioral Therapy (Y-CBT) was created to address both the cognitive and somatic symptoms of anxiety [3].

The goal of Y-CBT is to restructure the destructive physical, emotional, and cognitive patterns associated with the symptoms of anxiety. In two published studies, Y-CBT has shown promise for reducing anxiety and depression [15,16]. In the 2015 study, 22 clients at a community mental health clinic, who were diagnosed with Generalized Anxiety Disorder (GAD) completed the Y-CBT intervention; statistically significant improvements were found in depression, anxiety, panic, quality of life, and sleep. This pilot study indicated that Y-CBT may have potential as a promising treatment for GAD.

This current article reviews the results of a 2023 study conducted with older adults who attended Senior Centers, titled Yoga-Cognitive Behavioral Therapy (Y-CBT) Benefits Older Adults [16]. Older adults often experience significant stress, anxiety, and depression from the loss of loved ones, declining health, and financial problems. As there is a connection between these variables and the diseases of aging [17] via inflame-aging [13], these factors represent a significant public health concern. Senior centers provide important support for older adults and the goal of this study was to explore the effectiveness of Y-CBT in Senior center settings.

Participants: 37 older adults (age 62+) enrolled in the study through three senior centers. The average age was 73.31 and most participants were women (n = 31, 84%).

Study Design

Quasi-experimental, pre-post design. All questionnaires were administered prior to, and after the 6-sessions. Pre-post differences were calculated using paired t-tests; effect sizes were also calculated using hedges’ g and power was analyzed using G*Power calculations. Participant engagement was assessed based on attendance.

Treatment

Y-CBT was administered as a six week, 1.5-hour group session program consisting of 8-10 participants and 2 leaders. Each session consisted of yoga/meditation, instruction & experience with CBT, and group discussion/process. Participants practiced chair yoga and breathing techniques to alter physical patterns, while also often focusing on cognitive constructs to help alter thought patterns. The group treatment model is both didactic and process oriented. Learning new strategies and techniques, practicing them, and discussing them in a therapeutic setting with peers demonstrated positive results among participants. The treatment is fully described in the book The Yoga-CBT Workbook for anxiety [3].

Measures

Two well-established self-report tests were chosen to measure anxiety and depression, respectively: The State Trait Anxiety Inventory State subscale (STAI-S) [18] and the Patient Health Questionnaire (PHQ-9) [19]. Self-compassion was also measured in the Self-Compassion Scale – Short form (SCS-SF) [20].

After Y-CBT, anxiety significantly improved (p < .0056) with a large effect size (g = 0.88), as did self-compassion (p≤.0438) with a moderate effect size (g = .384). Though not significant, depression also improved (g = 0.418).

These results indicate that Y-CBT may be a promising approach for the symptoms of anxiety and co-occurring depression which older adults experience.

None.

No conflict of interest.

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