Yoga is effective for treating chronic pain in veterans with Gulf War Illness at long-term follow-up.

BACKGROUND: Clinical Practice Guidelines for Gulf War Illness (GWI) recommend integrative health approaches such as yoga for relief from symptoms, yet little is known about the long-term efficacy of yoga in reducing symptoms of GWI. Here, we evaluated the long-term efficacy of yoga and cognitive-behavioral therapy (CBT) chronic pain treatment in a randomized controlled trial (RCT) of 75 Veterans (57 men, 42-71 ± 7.1 years of age) with Gulf War Illness (GWI). METHODS: Participants received either 10 weeks of yoga or 10 weeks of CBT for chronic pain. The primary outcome measures were pain severity, and pain interference (Brief Pain Inventory-Short Form). The secondary outcome measures were fatigue, as indicated by a measure of functional exercise capacity (6-Minute Walk Test), depression, autonomic symptom severity, and quality of life. Piecewise linear mixed models were used to examine study hypotheses. RESULTS: Compared to the CBT group, yoga was associated with greater reductions in pain severity during the 6-month follow-up period (group × time interaction: b = 0.036, se = 0.014, p = .011). Although we did not find between-group differences in the other primary or secondary outcome measures during follow-up (p's > 0.05), exploratory analyses revealed within-group improvements in pain interference, total pain (an experimental outcome variable which combines pain severity and interference), and fatigue in the yoga group (p's < 0.05) but not in the CBT group. CONCLUSIONS: This is the first study to report long-term follow-up results of yoga as a treatment for GWI. Our results suggest that yoga may offer long-term efficacy in reducing pain, which is a core symptom of GWI. TRIAL REGISTRATION: Secondary analyses of ClinicalTrials.gov NCT02378025.

Investigating Inter- and Intra-individual Differences in Tai Chi Practice Time, Pain, and Mood Among Participants with Chronic Nonspecific Neck Pain: Secondary Analysis of a Randomized Controlled Trial.

Background: Tai Chi is emerging as a promising treatment for a variety of pain conditions, including chronic nonspecific neck pain. Given this trend, it is important to better understand the dose-response relationship and how pain, anxiety, and depression impact this relationship. Method: This secondary analysis used data from the Tai Chi arm (age = 52.03 ± 10.92 years; 73.68% female; n = 38) of a randomized controlled trial for chronic nonspecific neck pain. The authors tested whether (1) greater home practice time or cumulative practice time during the intervention predicted greater post-treatment reductions in neck pain intensity and (2) reporting greater neck pain intensity during the current week relative to other weeks was associated with lower home practice time during the current week. Post hoc analyses were conducted to evaluate whether baseline anxiety and depression levels moderated the association between weekly pain intensity and weekly home practice time. Results: While cumulative Tai Chi practice time (i.e., home practice + class time) was associated with post-treatment reductions in neck pain intensity, home practice time alone was not associated with post-treatment reductions in neck pain. Participants with low and moderate baseline anxiety were found to practice less than usual on weeks when pain intensity was worse, while participants with high baseline anxiety were found to practice more than usual on weeks when pain intensity was worse. Baseline depression levels did not moderate the effect of weekly pain intensity on weekly home practice time. Conclusions: Combined class and at-home exposure to Tai Chi appears to be critical to reductions in chronic nonspecific neck pain. In addition, anxiety may be an important characteristic that partially governs the dose-response relationship in participants with chronic nonspecific neck pain. Clinical Trial Registration: NCT02222051.

Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial.

Importance: Cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) are thought to help patients with social anxiety disorder (SAD) via distinct emotion-regulation mechanisms. However, no study has compared the effects of CBGT and MBSR on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD. Objective: To investigate the effects of CBGT and MBSR on reappraisal and acceptance in patients with SAD and to test whether treatment-associated brain changes are associated with social anxiety symptoms 1 year posttreatment. Design, Setting, and Participants: In this randomized clinical trial, a total of 108 unmedicated adults diagnosed with generalized SAD were randomly assigned to 12 weeks of CBGT, MBSR, or waitlist. The final sample included 31 patients receiving CBGT, 32 patients receiving MBSR, and 32 waitlist patients. Data were collected at the psychology department at Stanford University from September 2012 to December 2014. Data were analyzed from February 2019 to December 2020. Interventions: CBGT and MBSR. Main Outcomes and Measures: Changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year posttreatment. Results: Of 108 participants, 60 (56%) were female. The mean (SD) age was 32.7 (8.0) years. Self-reported race and ethnicity data were collected to inform the generalizability of the study to the wider population and to satisfy the requirements of the National Institutes of Health. From the categories provided by the National Institutes of Health, 47 participants selected White (43.5%), 42 selected Asian (38.9%) 10 selected Latinx (9.3%), 1 selected Black (1%), 1 selected Native American (1%), and 7 selected more than 1 race (6.5%). CBGT and MBSR were associated with a significant decrease in negative emotion (partial η2 range, 0.38 to 0.53) with no significant between-group differences when reacting (ß, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92 = -0.37; P = .71), reappraising (ß, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92 = -1.67; P = .10), or accepting (ß, -0.05; SE, 0.08; 95% CI, -0.20 to 0.11; t92 = -0.59; P = .56). There was a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising (CBGT = 0.031; MBSR = 0.037) and accepting (CBGT = 0.012; MBSR = 0.077) negative self-beliefs. CBGT and MBSR did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses. Reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment. Conclusions and Relevance: The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks. Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies. Trial Registration: ClinicalTrials.gov Identifier: NCT02036658.

Effect of yoga on chronic non-specific neck pain: An unconditional growth model.

OBJECTIVE: Chronic neck pain is a common problem that affects approximately half of the population. Conventional treatments such as medication and exercise have shown limited analgesic effects. This analysis is based on an original study that was conducted to investigate the physical and behavioral effects of a 9-week Iyengar yoga course on chronic non-specific neck pain. This secondary analysis uses linear mixed models to investigate the individual trajectories of pain intensity in participants before, during and after the Iyengar yoga course. METHOD: Participants with chronic non-specific neck pain were selected for the study. The participants suffered from neck pain for at least 5 days per week for at least the preceding 3 months, with a mean neck pain intensity (NPI) of 40 mm or more on a Visual Analog Scale of 100 mm. The participants were randomized to either a yoga group (23) or to a self-directed exercise group (24). The mean age of the participants in the yoga group was 46, and ranged from 19 to 59. The participants in the yoga group participated in an Iyengar yoga program designed to treat chronic non-specific neck pain. Our current analysis only includes participants who were initially randomized into the yoga group. The average weekly neck pain intensity at baseline, during and post intervention, comprising 11 total time points, was used to construct the growth models. We performed a step-up linear mixed model analysis to investigate change in NPI during the yoga intervention. We fit nested models using restricted maximum-likelihood estimation (REML), tested fixed effects with Wald test p-values and random effects with the likelihood ratio test. We constructed 10 REML models. RESULTS: The model that fit the data best was an unconditional random quadratic growth model, with a first-order auto-regressive structure specified for the residual R matrix. Participants in the yoga group showed significant variation in NPI. They demonstrated variation in their intercepts, in their linear rates of change, and most tellingly, in their quadratic rates of change. CONCLUSIONS: While all participants benefitted from the yoga intervention, the degree to which they benefitted varied. Additionally, they did not experience a consistent rate of reduction in NPI - their NPI fluctuated, either increasing and then decreasing, or vice-versa. We comment on the clinical and research implications of our findings.