Yoga or cognitive behavioural therapy for mental health: Can our neurophysiology predict treatment efficacy?

INTERVENTION: YOGA Yoga – a holistic practice combining mindfulness meditation, breathwork, and physical postures – is proposed to exert positive effects via improved sleep and emotion regulation, including better autonomic regulation, higher heart rate variability (HRV), and healthier sleep electroencephalography (EEG). Holistic yoga has enhanced effects over mindfulness‐only interventions. Thus, yoga is a compelling, novel transdiagnostic solution for improving comorbid mental health, likely via improved sleep and emotion regulation. Meta‐analyses demonstrate that yoga is efficacious for non‐comorbid anxiety, major depressive (MDD), posttraumatic stress (PTSD), and alcohol use disorders. However, no study has yet assessed the efficacy of yoga for comorbid mental health. Yoga improves wellbeing and is popular, acceptable, and tolerable across a range of demographics. It has several advantages over gold standard mental health interventions like cognitive behavioural therapy (CBT), such as lower associated stigma, reduced healthcare wait times, and increased cost‐effectiveness. Further, CBT response rates vary from 33‐87% (average 50%) and efficacy is lower and drop‐out higher for disorders with high comorbidity (cooccurrence) rates. The Yoga intervention is a trauma‐informed protocol we designed to enhance the holistic effects of yoga on mental wellbeing, sleep, and emotion regulation. It will consist of one, 90‐min group session per week for 10‐weeks plus 10‐15‐min daily home practice (recorded via diary) and will be delivered by student yoga teachers/yoga therapists from The Yoga Space/Wisdom Yoga Institute, Perth. Student yoga teachers/yoga therapists undergoing training must deliver classes (hours) to complete their qualifications and become registered and will d CONDITION: Comorbid mental health; ; Comorbid mental health Mental Health ‐ Addiction Mental Health ‐ Anxiety Mental Health ‐ Depression Mental Health ‐ Other mental health disorders PRIMARY OUTCOME: Anxiety and Related Disorders Interview Schedule for DSM‐5 (ADIS‐5) clinical severity ratings for primary and comorbid mental health disorders. [Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] Kessler Psychological Distress Scale (K10)[Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] INCLUSION CRITERIA: 1. primary diagnosis of anxiety, major depressive (MDD), posttraumatic stress (PTSD), or alcohol use disorders and 2. at least one comorbid mental health disorder as assessed by the ADIS‐5. SECONDARY OUTCOME: Actigraphy (sleep biomarker) via wristwatches worn for 1‐week concurrently with EMA/HRV[Baseline, post‐intervention/end‐of‐treatment] Alcohol Use Disorders Identification Test (AUDIT)[Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] Depression Anxiety Stress Scale (DASS‐21)[Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] Ecological Momentary Assessment (EMA) across 1‐week, assessing sleep and emotion regulation in daily life via smartphone app [Baseline, post‐intervention/end‐of‐treatment] Heart Rate Variability (HRV; emotion regulation biomarker) via ambulatory (chest monitors) worn for 1‐week concurrently with EMA/actigraphy AND 5‐min resting‐state [Baseline, post‐intervention/end‐of‐treatment (5‐min resting‐state also at mid‐treatment) ; ] Mental Health Continuum (MHC‐SF)[Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] Perth Emotion Regulation Competency Inventory (PERCI)[Baseline, mid‐treatment, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] Pittsburgh Sleep Quality Index (PSQI) [Baseline, mid‐treatment, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] PTSD Checklist for DSM‐5 (PCL‐5)[Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] Suicidal Ideation Attributes Scale (SIDAS)[Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] World Health Organisation Disability Assessment Schedule (WHODAS)[Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ] World Health Organisation Well‐being Index (WHO5)[Baseline, post‐intervention/end‐of‐treatment, 3‐month follow‐up, 6‐month follow‐up ]