Trial Review

The ANZCTR website is back online for trial registration and updates. We apologise for any inconvenience caused while the site was inactive.


With activity expected to increase on the ANZCTR again, there may be extended wait times while we process pending studies, with priority being given to those trials submitted in February. Thank you for your patience.


Reset your password and enable multi-factor authentication (MFA)


For ANZCTR account holders: to help ensure the cyber safety of your account, you’ll need to reset your password and set-up multi-factor authentication (MFA) as per the instructions below.


  1. Go to the Login page, click ‘reset password’ and follow the instructions.
  2. Check your email for the link to set a new password.
  3. Create a new password that meets requirements.
  4. Return to the Login page and enter your new password. A verification code will be sent to your email.
  5. Check your email for the code and enter it on the Login page. If the code is entered incorrectly, you can re-enter the correct one or request a new one.

Learn more about MFA and its importance on the Australian Signals Directorate website.

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been endorsed by the ANZCTR. Before participating in a study, talk to your health care provider and refer to this information for consumers
Trial registered on ANZCTR


Registration number
ACTRN12622000544774
Ethics application status
Approved
Date submitted
31/03/2022
Date registered
7/04/2022
Date last updated
21/07/2024
Date data sharing statement initially provided
7/04/2022
Type of registration
Prospectively registered

Titles & IDs
Public title
Yoga or cognitive behavioural therapy for mental health: Can our neurophysiology predict treatment efficacy?
Scientific title
Transdiagnostic treatments for comorbid mental health disorders: Efficacy and mechanisms of yoga versus cognitive behavioural therapy
Secondary ID [1] 306814 0
None
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Comorbid mental health 325897 0
Condition category
Condition code
Mental Health 323204 323204 0 0
Anxiety
Mental Health 323205 323205 0 0
Depression
Mental Health 323206 323206 0 0
Addiction
Mental Health 323207 323207 0 0
Other mental health disorders

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
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 deliver the group yoga on this project to complete their training hours (trained and supervised by co-proprietor Dr Byrne, Yoga Teacher Level 2, Senior Member YA, ERYT-500, Yoga Alliance RPYT).

Most yoga or CBT interventions with mental health efficacy average 8-12 sessions in total. In a 2021 Perth-based pilot randomised controlled trial (RCT) of yoga versus CBT for transdiagnostic mental health (N=12; 100% retention), we found that aligning schedules with school terms (i.e., 10 weekly sessions) was most feasible in Perth.

Yoga sessions will be audio recorded to assess protocol adherence. Group interventions will be conducted either in-person or via telehealth (pragmatic design) to increase scope and reach across Australia and to comply with general health recommendations and/or government mandates during the global pandemic, as necessary.
Intervention code [1] 323281 0
Treatment: Other
Intervention code [2] 323282 0
Rehabilitation
Intervention code [3] 323283 0
Behaviour
Comparator / control treatment
COGNITIVE BEHAVIOURAL THERAPY (CBT)

CBT is the first-line, gold standard, evidence-based treatment for mental health and therefore is an ideal active control comparison. The CBT for this trial is the Unified Protocol, a well-established, manualised, transdiagnostic CBT developed for emotional disorders and/or emotion regulation. It is effective for anxiety, MDD, PTSD, alcohol use, comorbidity, group delivery, and is equivalent to disorder-specific CBT.

CBT will consist of one, 90-min group session per week for 10-weeks plus 10-15-min daily home practice (recorded via diary) to match the Yoga intervention. It will be delivered by Murdoch postgraduate clinical psychology students (supervised by Dr Mathersul, registered psychologist with clinical psychology endorsement, board-approved clinical psychology supervisor).

As per the Yoga intervention, CBT sessions will be audio recorded to assess protocol adherence. Group interventions will be conducted either in-person or via telehealth (pragmatic design) to increase scope and reach across Australia and to comply with general health recommendations and/or government mandates during the global pandemic, as necessary.
Control group
Active

Outcomes
Primary outcome [1] 330962 0
Kessler Psychological Distress Scale (K10)
Timepoint [1] 330962 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Primary outcome [2] 330963 0
Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) clinical severity ratings for primary and comorbid mental health disorders.
Timepoint [2] 330963 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [1] 408271 0
Depression Anxiety Stress Scale (DASS-21)
Timepoint [1] 408271 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [2] 408272 0
PTSD Checklist for DSM-5 (PCL-5)
Timepoint [2] 408272 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [3] 408273 0
Alcohol Use Disorders Identification Test (AUDIT)
Timepoint [3] 408273 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [4] 408274 0
Suicidal Ideation Attributes Scale (SIDAS)
Timepoint [4] 408274 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [5] 408275 0
World Health Organisation Well-being Index (WHO5)
Timepoint [5] 408275 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [6] 408276 0
World Health Organisation Disability Assessment Schedule (WHODAS)
Timepoint [6] 408276 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [7] 408277 0
Mental Health Continuum (MHC-SF)
Timepoint [7] 408277 0
Baseline, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [8] 408278 0
Pittsburgh Sleep Quality Index (PSQI)
Timepoint [8] 408278 0
Baseline, mid-treatment, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [9] 408279 0
Perth Emotion Regulation Competency Inventory (PERCI)
Timepoint [9] 408279 0
Baseline, mid-treatment, post-intervention/end-of-treatment, 3-month follow-up, 6-month follow-up
Secondary outcome [10] 408280 0
Ecological Momentary Assessment (EMA) across 1-week, assessing sleep and emotion regulation in daily life via smartphone app
Timepoint [10] 408280 0
Baseline, post-intervention/end-of-treatment
Secondary outcome [11] 408281 0
Actigraphy (sleep biomarker) via wristwatches worn for 1-week concurrently with EMA/HRV
Timepoint [11] 408281 0
Baseline, post-intervention/end-of-treatment
Secondary outcome [12] 408282 0
Heart Rate Variability (HRV; emotion regulation biomarker) via ambulatory (chest monitors) worn for 1-week concurrently with EMA/actigraphy AND 5-min resting-state
Timepoint [12] 408282 0
Baseline, post-intervention/end-of-treatment (5-min resting-state also at mid-treatment)

Eligibility
Key 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.
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
1. active psychosis or mania
or
2. severe neurological or substance use disorder preventing engagement.

Temporary exclusion criteria (i.e., may participate when stabilised):
1. recent hospitalisation or suicide attempt (in the last 2mths);
2. recent CBT/yoga (>2 sessions in last 2mths); or
3. medication change (in the last 6wks).

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Yes. Allocation will occur via either sealed opaque envelopes (e.g., for in-person interventions) or names and group allocation drawn out of two hats concurrently (e.g., for telehealth interventions). Allocation will occur after eligibility decisions are made.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation. Each cohort will have an equal number of Yoga and CBT sealed envelopes or names/interventions in hats, with the total number set according to the number of participants enrolled in the cohort.
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?


The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Phase
Not Applicable
Type of endpoint/s
Efficacy
Statistical methods / analysis
This study is a single-blind non-inferiority RCT design to evaluate the efficacy of yoga versus CBT (active control) for comorbid mental health.

Power Analyses (80% power; a=.05): Based on meta-analysis effect sizes for Yoga (.61-.90) and CBT (.62-1.06) and non-inferiority margins and standard deviations of the K10 (4.6, 9.4) and ADIS-5 (0.75, 1.62) primary outcome measures, a non-inferiority RCT requires N=104-120 treatment completers (up to n=60/group completers). Medium-large to large-large mediation requires N=34-74. Thus, taking a conservative approach (largest sample size) and assuming 70% retention, we will randomise N=172 participants to ensure N=120 completers.

Data Analyses:
Aim 1/Hypothesis 1 (Yoga non-inferiority to CBT): Noninferiority margins for K10 and ADIS-5 set at 4.6 and 0.75, respectively, based on previous RCTs and clinically meaningful change in scales. All analyses will be both intent-to-treat and per protocol, as recommended for non-inferiority RCTs. Mixed modelling analyses with repeated measures (K10/ADIS-5 severity over time) by group (Yoga vs. CBT) and confirmatory sensitivity analyses on self-report (DASS-21, PCL-5, AUDIT, SIDAS) and functional (WHO5, WHODAS, MHC-SF) outcome measures.

Aim 2/Hypothesis 2 (sleep and/or emotion regulation will moderate mental health outcome with Yoga vs. CBT): Mixed modelling analyses of baseline PSQI, PERCI, EMA, sleep actigraphy, HRV, predicting K10/ADIS-5 by group over time.

Aim 3/Hypothesis 3 (sleep and/or emotion regulation will mediate mental health): Mixed modelling analyses of change from baseline-to-mid-treatment of PSQI, PERCI, HRV, predicting K10/ADIS-5 severity by group.

Recruitment
Recruitment status
Recruiting
Date of first participant enrolment
Anticipated
25/04/2022
Actual
12/04/2022
Date of last participant enrolment
Anticipated
31/12/2025
Actual
Date of last data collection
Anticipated
1/07/2026
Actual
Sample size
Target
172
Accrual to date
120
Final
Recruitment in Australia
Recruitment state(s)
ACT,NSW,NT,QLD,SA,TAS,WA,VIC
Recruitment postcode(s) [1] 37224 0
6150 - Murdoch

Funding & Sponsors
Funding source category [1] 311150 0
University
Name [1] 311150 0
Murdoch University
Country [1] 311150 0
Australia
Primary sponsor type
University
Name
Murdoch University
Address
90 South Street
Murdoch WA 6150
Country
Australia
Secondary sponsor category [1] 312499 0
Individual
Name [1] 312499 0
Danielle C. Mathersul
Address [1] 312499 0
Murdoch University 90 South Street Building 440 Murdoch WA 6150
Country [1] 312499 0
Australia
Other collaborator category [1] 282234 0
Individual
Name [1] 282234 0
Peter J. Bayley
Address [1] 282234 0
VA Palo Alto Health Care System Stanford University 3801 Miranda Ave Palo Alto, CA 94304
Country [1] 282234 0
United States of America
Other collaborator category [2] 282235 0
Individual
Name [2] 282235 0
Peter M. McEvoy
Address [2] 282235 0
Curtin University Centre for Clinical Interventions Kent Street Bentley WA 6102
Country [2] 282235 0
Australia
Other collaborator category [3] 282236 0
Individual
Name [3] 282236 0
Kristin Gainey
Address [3] 282236 0
University of Western Australia 35 Stirling Hwy Crawley WA 6009
Country [3] 282236 0
Australia
Other collaborator category [4] 282237 0
Individual
Name [4] 282237 0
Jean Byrne
Address [4] 282237 0
The Yoga Space 6/79 Colin St West Perth WA 6005
Country [4] 282237 0
Australia
Other collaborator category [5] 282241 0
Individual
Name [5] 282241 0
Rob Schütze
Address [5] 282241 0
Curtin University The Yoga Space Kent Street Bentley WA 6102
Country [5] 282241 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 310678 0
Murdoch University Human Research Ethics Committee
Ethics committee address [1] 310678 0
Ethics committee country [1] 310678 0
Australia
Date submitted for ethics approval [1] 310678 0
18/12/2020
Approval date [1] 310678 0
02/02/2021
Ethics approval number [1] 310678 0
2020/511

Summary
Brief summary
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 118486 0
Dr Danielle C. Mathersul
Address 118486 0
Murdoch University 90 South Street Building 440 Murdoch WA 6150
Country 118486 0
Australia
Phone 118486 0
+61 8 9360 6542
Fax 118486 0
Email 118486 0
[email protected]
Contact person for public queries
Name 118487 0
Danielle C. Mathersul
Address 118487 0
Murdoch University 90 South Street Building 440 Murdoch WA 6150
Country 118487 0
Australia
Phone 118487 0
+61 8 9360 6542
Fax 118487 0
Email 118487 0
[email protected]
Contact person for scientific queries
Name 118488 0
Danielle C. Mathersul
Address 118488 0
Murdoch University 90 South Street Building 440 Murdoch WA 6150
Country 118488 0
Australia
Phone 118488 0
+61 8 9360 6542
Fax 118488 0
Email 118488 0
[email protected]

Data sharing statement
Will the study consider sharing individual participant data?
Yes
Will there be any conditions when requesting access to individual participant data?
Persons/groups eligible to request access:
• On a case-by-case basis at the discretion of Primary Sponsor/Principle Investigator (Dr Mathersul) upon written request by researchers who provide a methodologically sound proposal.

Conditions for requesting access:
• -

What individual participant data might be shared?
• De-identified IPD

What types of analyses could be done with individual participant data?
• IPD meta-analyses

When can requests for individual participant data be made (start and end dates)?
From:
Start date: Only once all data collection is completed (including follow-up) and the primary outcomes manuscript is published.

End date: No end date.

To:
-

Where can requests to access individual participant data be made, or data be obtained directly?
• Subject to approvals by Principal Investigator ([email protected])

Are there extra considerations when requesting access to individual participant data?
No


What supporting documents are/will be available?

Doc. No.TypeCitationLinkEmailOther DetailsAttachment
15641Study protocol    To be published
15642Ethical approval    Study-related document.pdf
15643Informed consent form    Available upon written request to the Primary Spon... [More Details]



Results publications and other study-related documents

Documents added manually
No documents have been uploaded by study researchers.

Documents added automatically
No additional documents have been identified.