一项比较认知行为疗法和瑜伽治疗晚年焦虑症的随机偏好试验：对抑郁、广泛性焦虑、疲劳、疼痛、社会参与和身体功能影响的研究。
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.
作者信息
Danhauer Suzanne C, Miller Michael E, Divers Jasmin, Anderson Andrea, Hargis Gena, Brenes Gretchen A
机构信息
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
出版信息
Glob Adv Health Med. 2022 May 16;11:2164957X221100405. doi: 10.1177/2164957X221100405. eCollection 2022.
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), = .02]. For the pain intensity score, the intervention effect also favored CBT over yoga [.7 (.2, 1.3), < .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.
背景
抑郁、广泛性焦虑、疲劳、身体功能减退、社会参与度降低和疼痛在许多老年人中很常见，并且对生活质量产生负面影响。总体试验的目的是比较认知行为疗法（CBT）和瑜伽对晚年担忧、焦虑和睡眠的影响；并研究对这些结果的偏好和选择效应。
目的
本分析比较了这两种干预措施对其他结果（抑郁症状、广泛性焦虑症状、疲劳、疼痛干扰/强度、身体功能、社会参与度）的影响；并研究这些治疗方法是否存在偏好和选择效应。
方法
对年龄≥60岁且在宾夕法尼亚州立大学忧虑问卷简版（PSWQ-A）上得分≥26的成年人进行了一项CBT和瑜伽的随机偏好试验，这些参与者通过门诊医疗诊所、邮件和广告招募。认知行为疗法包括每周10次电话咨询。瑜伽包括每两周20次团体瑜伽课程。参与者被随机分为：（1）CBT或瑜伽的随机对照试验（RCT）（n = 250）；或（2）他们选择治疗方法（CBT或瑜伽；n = 250）的偏好试验。在基线和干预后测量结果。
结果
在随机对照试验中，疼痛干扰和强度在组间存在显著差异。与瑜伽组相比，CBT组的疼痛干扰评分改善更大[干预效应（均值（95%CI）= 2.5（0.5，4.6），P = 0.02]。对于疼痛强度评分，干预效应也显示CBT优于瑜伽[0.7（0.2，1.3），P < 0.01]。两组的抑郁症状、广泛性焦虑和疲劳在组内均有临床意义的变化。两组的身体功能或社会参与度均无变化或差异。未发现偏好或选择效应。
结论
CBT和瑜伽对改善老年人的心理症状和疲劳可能都有用。认知行为疗法在减轻疼痛方面可能比瑜伽更有益。
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