Impact of preference for yoga or cognitive behavioral therapy in patients with generalized anxiety disorder on treatment outcomes and engagement. (September 2022)

• Record Type: Journal Article
• Authors: Szuhany, Kristin L.; Adhikari, Samrachana; Chen, Alan; Lubin, Rebecca E.; Jennings, Emma; Rassaby, Madeleine; Eakley, Rachel; Brown, Mackenzie L.; Suzuki, Rebecca; Barthel, Abigail L.; Rosenfield, David; Hoeppner, Susanne S.; Khalsa, Sat Bir; Bui, Eric; Hofmann, Stefan G.; Simon, Naomi M.
• Is Part Of: Journal of psychiatric research. Volume 153(2022)
• Page Start: 109
• Page End: 115
• Publication Date: 2022-09
• Subjects: Generalized anxiety disorder -- Cognitive-behavioral therapy -- Yoga -- Preference -- Match -- Engagement; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2022.07.008
• Languages: English
• ISSNs: 0022-3956

Abstract

Abstract: There is some, but inconsistent, evidence to suggest that matching patient treatment preference enhances treatment engagement and outcome. The current study examined differential preferences and factors associated with treatment preference for 12-week group cognitive behavioral therapy (CBT), yoga, or stress education in 226 adults with generalized anxiety disorder (GAD; 70% female, Mean age = 33 ± 13.5). In a subsample of 165 patients who reported an intervention preference and were randomized to yoga or CBT, we further examined whether match to preferred intervention improved the primary treatment outcome (responder status on Clinical Global Impressions Scale) and engagement (dropout, homework compliance). Preferences for CBT (44%) and yoga (40%) were similar among patients. Women tended to prefer yoga (OR = 2.75, p = .01) and CBT preference was associated with higher baseline perceived stress (OR = 0.92, p = .04) and self-consciousness meta-cognitions (OR = 0.90, p = .02). Among those not matched to their preference, treatment response was higher for those receiving CBT than yoga (OR = 11.73, p = .013); there were no group differences for those matched to their treatment preference. In yoga, those who received their preference were more likely to drop than those who did not (OR = 3.02, 95% CI = [1.20, 7.58], p = .037). This was not the case for CBT (OR = 0.37, 95% CI = [0.13, 1.03], p = .076). Preference match did not predict homework compliance. Overall, results suggest that treatment preference may be important to consider to optimize outcome and engagement; however, it may vary by treatment modality. Future research incorporating preference, especially with yoga for anxiety, is aligned with personalized medicine. Trial registration: clinicaltrials.gov: NCT01912287 ; https://clinicaltrials.gov/ct2/show/NCT01912287 . Highlights: Proportion of patients with GAD who preferred CBT or yoga was similar. Receiving the preferred treatment vs. not did not alter outcomes. For those who did not receive their preference, CBT had better outcomes than yoga. For yoga, preference match had higher dropout than non-match.